Donegan Gemma, Noonan Maria, Bradshaw Carmel
University of Limerick and University Maternity Hospital, Limerick, Ireland.
Department of Nursing and Midwifery, Health Research Institute (HRI) Affiliated, University of Limerick, Limerick, Ireland.
Midwifery. 2023 Jun;121:103673. doi: 10.1016/j.midw.2023.103673. Epub 2023 Mar 30.
Pregnancy following perinatal loss has a profound effect on parents and may contribute to intense psychological distress including grief, post-traumatic stress disorder, anxiety and depression. The subsequent pregnancy may also be perceived as more stressful due to the fear of recurrent loss. Midwives and other health care professionals need to be sensitive and empathetic to the needs of these parents when providing care in a pregnancy subsequent to a loss.
The aim of this integrated literature review was to explore parents' experiences of pregnancy following a previous perinatal loss using a systematic approach. This is presented in a five-stage process that includes problem identification, literature search, data extraction and evaluation, data analysis and presentation of results. A systematic search of seven electronic databases was conducted (Jan 2009 -Jan 2023) to identify relevant primary research which addressed parents' experiences of pregnancy following a previous perinatal loss. Seven papers met the eligibility criteria and were assessed for quality using Crowe's Critical Appraisal Tool (CCAT). Thematic analysis identified two themes.
The key themes identified from the literature were; the psychosocial needs and challenges faced by previously bereaved parents in subsequent pregnancies; and the need for specialist care and support in a subsequent pregnancy. Psychological needs and challenges included continued grief, depression, anxiety, and disparities in the grief process between men and women. The importance of specialist care with an increased level of support from competent, confident and compassionate health care providers was highlighted.
The experience of pregnancy following a perinatal loss can be a complex emotional experience for parents. The review identifies the need for post pregnancy loss debriefing and counselling and care pathways specific to caring for women and their partners in a pregnancy subsequent to a perinatal loss. Care in pregnancy subsequent to loss should be provided by empathetic, competent health care providers and include additional antenatal clinic appointments, pregnancy monitoring and psychological support in order to meet the needs of these expectant parents.
围产期丧子后再次怀孕会对父母产生深远影响，可能导致强烈的心理困扰，包括悲伤、创伤后应激障碍、焦虑和抑郁。由于担心再次失去，后续的怀孕也可能被视为压力更大。助产士和其他医疗保健专业人员在为丧子后再次怀孕的父母提供护理时，需要对他们的需求保持敏感和同理心。
本综合文献综述的目的是采用系统方法探索父母在先前围产期丧子后再次怀孕的经历。这一过程分为五个阶段，包括问题识别、文献检索、数据提取与评估、数据分析和结果呈现。对七个电子数据库进行了系统检索（2009年1月至2023年1月），以确定涉及父母在先前围产期丧子后再次怀孕经历的相关原始研究。七篇论文符合纳入标准，并使用克劳批判性评估工具（CCAT）进行质量评估。主题分析确定了两个主题。
从文献中确定的关键主题是：先前经历丧子之痛的父母在后续怀孕中面临的心理社会需求和挑战；以及后续怀孕中对专科护理和支持的需求。心理需求和挑战包括持续的悲伤、抑郁、焦虑，以及男性和女性在悲伤过程中的差异。强调了专科护理的重要性，以及来自有能力、自信和富有同情心的医疗保健提供者更多支持的重要性。
围产期丧子后再次怀孕的经历对父母来说可能是一段复杂的情感经历。该综述确定了在围产期丧子后的后续怀孕中，需要进行产后丧子情况汇报、咨询以及针对照顾女性及其伴侣的特定护理途径。丧子后的孕期护理应由富有同理心、有能力的医疗保健提供者提供，包括额外的产前门诊预约、孕期监测和心理支持，以满足这些准父母的需求。
