背景:遭受早期妊娠损失的妇女需要特定的临床护理,善后,和持续的支持。在英国,早期妊娠并发症的临床处理,包括损失主要通过专业早孕评估单位提供。COVID-19大流行从根本上改变了产妇和妇科护理的提供方式,随着卫生系统转向快速重新配置和重组服务,旨在降低SARS-CoV-2感染的风险和传播。PUDDLES是一项国际合作,调查大流行对围产期丧亲患者护理的影响。这里介绍了在大流行期间遭受早孕损失的英国妇女的初步定性发现,关于他们如何导航医疗保健系统及其限制,以及他们是如何得到支持的。
方法:与定性研究设计保持一致,我们对在COVID-19大流行期间出现早期妊娠丢失的女性(N=32)进行了深入的半结构化访谈.使用模板分析对数据进行分析,以了解女性获得服务的情况,care,和支持网络,在怀孕后的大流行期间。主题模板是基于患有晚期流产的父母的发现,死产,或者英国的新生儿死亡,在大流行期间。
结果:所有妇女都经历过重新配置的孕产和早孕服务。数据支持的主题为:1)COVID-19限制不切实际和不个人化;2)单独,只有工作人员来支持他们;3)服务提供的减少导致医疗服务的贬值;4)寻求他们自己的支持。结果表明,获得早期妊娠损失服务的机会减少了,与大流行相关的限制往往不切实际(即,限制增加了获得或接受护理的负担)。妇女经常报告被孤立,令人担忧的是,早期妊娠丢失服务的各个方面被报告为次优.
结论:这些发现为大流行后时期卫生服务的恢复和重建提供了重要的见解,并帮助我们准备在未来以及任何其他卫生系统冲击中提供更高标准的护理。得出的结论可以为未来的政策和计划提供信息,以确保为经历早孕流产的妇女提供最佳支持。
BACKGROUND: 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.
METHODS: 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.
RESULTS: 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.
CONCLUSIONS: 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.