Quality of care provided to women requesting a late termination of pregnancy in a tertiary hospital

Quality of care provided to women requesting a late termination of pregnancy in a tertiary hospital

Estela Moreno BSN (1), Anna Peguero MD (1), Amparo Martínez BSN (1), Montse Palacio MD, PhD (1,2,3), Ángela Arranz MSN,PhD (1,2), Olga Gómez MD, PhD (1,2,3).

(1)BCNatal – Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu, University of Barcelona), Spain. (2)Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain. (3)Center for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.

Introduction
Termination of pregnancy (TOP) is a complex process not only for the parents but also for health providers. The perinatal grief is an emotional and painful process which the families go through, in which feelings and doubts that are very difficult to manage arise. It is crucial to a) identify the aspects which most concern these families and b) adapt our resources to their needs.

Methods and patients
The perinatal grief care group in our Center designed a questionnaire including 16 questions (valued from 1 to 10) to specifically retrieve information on aspects related to the quality of care provided. 20 families undergoing a late TOP (> 22 weeks of gestation) were invited to answer anonymously the survey at the end of the process. The standard approach for families undergoing a TOP is by far focused on guaranteeing information on all aspects of induction and delivery, pain relief, time with the baby after birth, memory of their footprints and an individual room.

Results
The overall score of the care provided was 9.45 (0-10). However, 60% (12/20) of the families would have liked to receive other memories such as a birth certificate (15/20, 75%) or a photograph (10/20, 50%). Moreover, 65% (13/20) of the families said they would have spent more time with their baby. Environmental noise in different hospital facilities and delivery-to-discharge time scored 5.98 (0-10) and 6.22 (0-10), respectively. Finally, 55% (11/20) of the families reported the need for more emotional and/or psychological support, both during hospital admission and the postpartum period.

Conclusions
The overall assessment of the care provided was very good although some aspects might be improved. Conducting a survey to families undergoing a late TOP is a useful method to evaluate the quality of care provided and to design future actions.

Details of ethics approval
Patient selection was performed in accordance with the Declaration of Helsinki and applicable local regulatory requirements after approval from the Ethics Committee of the Hospital Clinic on 26 January 2019 (Reg. HCB/2019/0121). All data were acquired and analysed anonymously, after the patients understood and accepted to participate in our study.

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