Department of Women & Children's Health, School of Life Course & Population Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK.
Gynaecology Services, Royal London Hospital, Barts Health NHS Trust, London, UK.
BMC Pregnancy Childbirth. 2024 Aug 9;24(1):522. doi: 10.1186/s12884-024-06721-7.
Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic's impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported.
In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women's access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic.
All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal.
These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss.
经历早期妊娠丢失的女性需要特定的临床护理、后续护理和持续支持。在英国，包括流产在内的早期妊娠并发症的临床管理主要通过专科早期妊娠评估单位提供。COVID-19 大流行从根本上改变了产妇和妇科护理的提供方式，因为卫生系统迅速重新配置和组织服务，旨在降低 SARS-CoV-2 感染的风险和传播。PUDDLES 是一个国际合作项目，旨在调查大流行对遭受围产期丧亲之痛的人的护理的影响。这里介绍的是对英国在大流行期间经历早期妊娠丢失的女性进行的初步定性研究结果，这些女性讲述了她们如何在医疗保健系统及其限制下进行导航，以及她们是如何得到支持的。
根据定性研究设计，对在 COVID-19 大流行期间经历任何早期妊娠丢失的机会样本女性（N=32）进行了深入的半结构式访谈。使用模板分析对数据进行分析，以了解女性在大流行后经历妊娠丢失时对服务、护理和支持网络的获取情况。主题模板基于在英国经历晚期流产、死胎或新生儿死亡的父母的发现。
所有女性都经历了重新配置的产科和早期妊娠服务。数据支持以下主题：1）COVID-19 限制不切实际且不人性化；2）独自面对，只有工作人员支持她们；3）服务提供减少导致护理贬值的感知；4）寻求自己的支持。结果表明，早期妊娠丢失服务的获取减少，与大流行相关的限制往往不切实际（即，限制增加了获取或接受护理的负担）。女性经常报告感到孤立无援，令人担忧的是，早期妊娠丢失服务的某些方面被报告为不理想。
这些发现为大流行后恢复和重建卫生服务提供了重要的见解，并帮助我们为未来提供更高标准的护理做好准备，并为任何其他卫生系统冲击做好准备。得出的结论可以为未来的政策和规划提供信息，以确保为经历早期妊娠丢失的女性提供尽可能好的支持。
