Ch 37 Perinatal Loss

Question 1

Define miscarriage

Answer 1

Death of fetus before 20 weeks and weighing less than 350-500 grams

Question 2

Define stillbirth

Answer 2

Death of fetus after 20 weeks, over 350-500 grams before birth

Question 3

Define neonatal death

Answer 3

Death of any live-born infant within the first 28 days after birth

Question 4

What is more important, weight or age, when determining miscarriage versus stillborn?

Answer 4

Weight

Question 5

When do most miscarriages occur?

Answer 5

Usually before 12 weeks

Question 6

What is the rate for stillbirths?

Answer 6

1 in 150

Question 7

About __% of live births end in neonatal death

Answer 7

1%

Question 8

Still birth rates are 2.3 times higher for __ than white women

Answer 8

non-hispanic black women

Question 9

Stillbirth rates for asian and hispanic women are…

Answer 9

Asian 29%

Hispanic 14%

Question 10

Fetal mortality is higher among which demographics of women

Answer 10

Teenagers
Women >35 years
Unmarried women
Multiple gestations

Question 11

Most lethal fetal diagnoses are made at which gestational age?

Answer 11

18-20 weeks

Question 12

How a fetal loss is perceived to parents will highly depend on …

Answer 12

How well-known the fetus is to the parent

Question 13

Define grief

Answer 13

A process which bereaved persons go through to make meaning of their loss

Question 14

What are the attribute of grief?

Answer 14

No time limit
Dynamic and involves complex emotions
Highly individualized
Pervasive, involving every aspect of a bereaved person’s life

Question 15

How is still birth prevented?

Answer 15

Monitor of fetal movement after 24 weeks gestation (50% reduction)

Question 16

What is ACOG recommendation for fetal kick counts?

Answer 16

Determine how long it takes to feel 10 kicks. Ideally want to feel 10 kicks within 2 hrs

Question 17

What are the risk factors of stillbirth?

Answer 17

Primiparity
AMA
Multiple gestation
Hypertensive disorders of pregnancy
Prematurity
UIGR
Obesity 
Smoking

Question 18

What are mental health associated with perinatal loss?

Answer 18

4x risk of depression
2x risk of anxiety
7x risk for PTSD

Question 19

What are mental health issues associated with perinatal loss?

Answer 19

Suicidal ideation
Divorce
Loss can last 10 years

Question 20

Perinatal loss is associated with the development of major physical health problems such as…

Answer 20

Hypertension, weight gain, DM, heart disease, substance abuse, suicide, and premature death

Question 21

What are risk factors for highly intense grief after perinatal loss?

Answer 21

Low social support
Previous psychiatric history
Termination for pregnancy for fetal anomalies
Perceive baby as a person

Question 22

What is the nurse’s role after perinatal loss?

Answer 22

Determine attachment, meaning, and related losses they are experiencing
History of prenatal loss
Mirror their language to discuss loss
Assess time to adjust and immediate responses
Determine social support

Question 23

When discussing perinatal loss use simple __ language

Answer 23

unambiguous

Question 24

What type of language should the nurse avoid when discussing perinatal loss?

Answer 24

euphemisms

Question 25

For early perinatal losses, what term should the nurse use?

Answer 25

miscarriage

Question 26

What should the nurse make sure to do before bringing the deceased baby to the parents?

Answer 26

Make sure the parents want to see and hold the baby

Question 27

Before the parents see the baby, the nurse should make sure to explain...

Answer 27

Any abnormalities they may see before showing the baby to them

Question 28

How should the nurse present the baby after a perinatal loss?

Answer 28

Bring the baby to them in a clean blanket, wrapped carefully

Question 29

It is important that the nurse treats the deceased baby like she would...

Answer 29

a baby who is alive

Question 30

What are the most distressing behaviors a nurse can exhibit to a patient dealing with perinatal loss?

Answer 30

Avoidance Insensitivity Poor communication

Question 31

How can nurses support parents dealing with perinatal loss

Answer 31

Give parents choice in their care whenever possible Encourage them to discuss feelings Obtain mementos

Question 32

Nurses should make parents aware that discussing their feelings with loved ones can result in...

Answer 32

Inadequate or inappropriate responses

Question 33

The nurse should discuss trigger events with parents such as...

Answer 33

Anniversary of baby's death Holidays seeing pregnant women, baby isle etc

Question 34

If care does not mold to what the parent is feeling, they will feel

Answer 34

angry and victimized

Question 35

Most women experiencing perinatal loss cannot be assertive in their need and...

Answer 35

need their nurse to advocate for them

Question 36

If mother is not grieving, focus on comfort measures such as...

Answer 36

``` Bleeding Pain or cramping Fear Ask what they need Preserve their dignity ```

Question 37

What are 4 things the nurse should do before caring for a patient after perinatal loss?

Answer 37

1. Assess grief 2. Shape experience to match what patient wants 3. Assist them in the pass through unfamiliar events/decisions 4. Determine preferences for the loss

Question 38

What scale is used to assess perinatal bereavement?

Answer 38

Perinatal Greif Intensity Scale

Question 39

What score on the perinatal grief intensity scale determines a woman is at risk for mental health issues and needs a referral for intervention?

Answer 39

Greater than or equal to 3.53

Question 40

What are the three sub scales of the perinatal grief intensity scale?

Answer 40

Reality (6 items) Congruence (4 items) Confront others (4 items)

Question 41

What type of scale does the perinatal grief intensity scale use?

Answer 41

4-point Likert scale ranging from strongly agree to strongly disagree