Ch 37 Perinatal Loss Flashcards
Define miscarriage
Death of fetus before 20 weeks and weighing less than 350-500 grams
Define stillbirth
Death of fetus after 20 weeks, over 350-500 grams before birth
Define neonatal death
Death of any live-born infant within the first 28 days after birth
What is more important, weight or age, when determining miscarriage versus stillborn?
Weight
When do most miscarriages occur?
Usually before 12 weeks
What is the rate for stillbirths?
1 in 150
About __% of live births end in neonatal death
1%
Still birth rates are 2.3 times higher for __ than white women
non-hispanic black women
Stillbirth rates for asian and hispanic women are…
Asian 29%
Hispanic 14%
Fetal mortality is higher among which demographics of women
Teenagers
Women >35 years
Unmarried women
Multiple gestations
Most lethal fetal diagnoses are made at which gestational age?
18-20 weeks
How a fetal loss is perceived to parents will highly depend on …
How well-known the fetus is to the parent
Define grief
A process which bereaved persons go through to make meaning of their loss
What are the attribute of grief?
No time limit
Dynamic and involves complex emotions
Highly individualized
Pervasive, involving every aspect of a bereaved person’s life
How is still birth prevented?
Monitor of fetal movement after 24 weeks gestation (50% reduction)
What is ACOG recommendation for fetal kick counts?
Determine how long it takes to feel 10 kicks. Ideally want to feel 10 kicks within 2 hrs
What are the risk factors of stillbirth?
Primiparity AMA Multiple gestation Hypertensive disorders of pregnancy Prematurity UIGR Obesity Smoking
What are mental health associated with perinatal loss?
4x risk of depression
2x risk of anxiety
7x risk for PTSD
What are mental health issues associated with perinatal loss?
Suicidal ideation
Divorce
Loss can last 10 years
Perinatal loss is associated with the development of major physical health problems such as…
Hypertension, weight gain, DM, heart disease, substance abuse, suicide, and premature death
What are risk factors for highly intense grief after perinatal loss?
Low social support
Previous psychiatric history
Termination for pregnancy for fetal anomalies
Perceive baby as a person
What is the nurse’s role after perinatal loss?
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
When discussing perinatal loss use simple __ language
unambiguous
What type of language should the nurse avoid when discussing perinatal loss?
euphemisms
For early perinatal losses, what term should the nurse use?
miscarriage
What should the nurse make sure to do before bringing the deceased baby to the parents?
Make sure the parents want to see and hold the baby
Before the parents see the baby, the nurse should make sure to explain…
Any abnormalities they may see before showing the baby to them
How should the nurse present the baby after a perinatal loss?
Bring the baby to them in a clean blanket, wrapped carefully
It is important that the nurse treats the deceased baby like she would…
a baby who is alive
What are the most distressing behaviors a nurse can exhibit to a patient dealing with perinatal loss?
Avoidance
Insensitivity
Poor communication
How can nurses support parents dealing with perinatal loss
Give parents choice in their care whenever possible
Encourage them to discuss feelings
Obtain mementos
Nurses should make parents aware that discussing their feelings with loved ones can result in…
Inadequate or inappropriate responses
The nurse should discuss trigger events with parents such as…
Anniversary of baby’s death
Holidays
seeing pregnant women, baby isle etc
If care does not mold to what the parent is feeling, they will feel
angry and victimized
Most women experiencing perinatal loss cannot be assertive in their need and…
need their nurse to advocate for them
If mother is not grieving, focus on comfort measures such as…
Bleeding Pain or cramping Fear Ask what they need Preserve their dignity
What are 4 things the nurse should do before caring for a patient after perinatal loss?
- Assess grief
- Shape experience to match what patient wants
- Assist them in the pass through unfamiliar events/decisions
- Determine preferences for the loss
What scale is used to assess perinatal bereavement?
Perinatal Greif Intensity Scale
What score on the perinatal grief intensity scale determines a woman is at risk for mental health issues and needs a referral for intervention?
Greater than or equal to 3.53
What are the three sub scales of the perinatal grief intensity scale?
Reality (6 items)
Congruence (4 items)
Confront others (4 items)
What type of scale does the perinatal grief intensity scale use?
4-point Likert scale ranging from strongly agree to strongly disagree
