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  • Title: Termination of pregnancy following diagnosis of fetal malformation: the need for improved follow-up services.
    Author: Kenyon SL, Hackett GA, Campbell S.
    Journal: Clin Obstet Gynecol; 1988 Mar; 31(1):97-100. PubMed ID: 3282742.
    Abstract:
    Eighty parents were offered an emotional support and counseling service following termination of pregnancy for fetal abnormality detected by second trimester ultrasound examination. Twenty couples took up the invitation to talk about their experiences. It was found that these women and their partners were profoundly affected by their decision to terminate the pregnancy. The lack of organized follow-up by existing agencies and the availability of professional support for these parents is a serious deficiency in our prenatal diagnostic services. Parents who decide to terminate a pregnancy after an ultrasound diagnosis of structural abnormality in the fetus experience the same feelings of grief and loss as parents feel after a stillbirth or neonatal death, but it is compounded by a feeling of guilt because they themselves decided to terminate the pregnancy. 80 women referred to the Kings College School of Medicine and Dentistry for ultrasound scan between 1984 and 1985 were found to have fetuses with severe structural abnormalities. 20 of them accepted invitations to return for counseling. 18 would have liked more information, and 2 were disturbed by discussion during the scan. After returning to their own hospitals for pregnancy termination, the parents were reinterviewed. All had found the pregnancy termination more traumatic than anticipated. 5 felt that professional support was inadequate. 9 saw the baby and felt that it was important to do so because it confirmed the correctness of their decision, and it gave them a tangible memory of the baby. 16 felt that some burial ceremony should have been observed. 8 of the parents received postabortion follow-up from their general practitioner, and 5 were offered genetic counseling. This study indicated that: 1) There should be rapid referral of patients to a level 3 center; 2) Sympathetic personnel are essential; 3) Adequate pain relief should be available during the procedure; 4) Medical and genetic follow-up should be a matter of course; 5) Medical professionals should be educated about the psychological trauma to be expected in these patients; and 6) A self-help group of couples with similar experiences is helpful.
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