Exploring parents' experiences and holistic needs following late miscarriage: a narrative systematic review.

BACKGROUND: Up to 2% of all pregnancies result in pregnancy loss between 14 + 0 and 23 + 6 weeks' gestation, which is defined as 'late miscarriage'. Lack of consensus about definition of viability paired with existing multiple definitions of perinatal loss make it difficult to define the term 'late miscarriage'. Parents who experience late miscarriage often have had reassuring scan-milestones, which established their confidence in healthy pregnancy progression and identity formation, which socially integrates their baby into their family. The clinical lexicon alongside the lack of support offered to parents experiencing late miscarriage may disclaim their needs, which has potential to cause adverse psychological responses. AIM: To review what primary research reports about parents' experiences and their perceived holistic needs following late miscarriage. METHODS: A narrative systematic review was carried out. Papers were screened based on gestational age at time of loss (i.e. between 14 + 0 and 23 + 6 weeks' gestation). The focus was set on experience and holistic needs arising from the loss rather than its clinical care and pathophysiology. Studies were selected using PRISMA-S checklist, and quality assessed using the Critical Appraisal Skills Program (CASP) tool. Thematic analysis was used to guide the narrative synthesis of findings. RESULTS: Six studies met the inclusion criteria. Three main themes emerged: communication and information-giving; feelings post-event; and impact of support provision. CONCLUSION: Literature about the experience of late miscarriage is scarce, with what was found reporting a lack of compassionate and individually tailored psychological follow-up care for parents following late miscarriage. Hence, more research in this arena is required to inform and develop this area of maternity care provision.

ICD-11 complex Post Traumatic Stress Disorder (CPTSD) in parents with perinatal bereavement: Implications for treatment and care.

INTRODUCTION: The 11th revision of the WHO International Classification of Diseases (ICD-11) has identified Complex PTSD (CPTSD) as a new condition. AIM: To explore whether the new diagnosis of CPTSD (ICD11) is relevant to women who have experienced perinatal bereavement and to advance knowledge about the acceptability, feasibility and perceived impact of delivering an innovative flexible Compassionate Focused Therapy (CFT) informed treatment package to alleviate symptoms of this condition. METHODS: A mixed methods study using survey and interviews was conducted. Participants first completed the International Trauma Questionnaire (ITQ) to assess if they met the criteria for PTSD or CPTSD (n=72), and subsequent semi-structured interviews (n=12) identified participants' views about different treatment approaches. PARTICIPANTS: A convenience sample of women who had experienced perinatal bereavement were recruited from one geographical region in Scotland. DATA COLLECTION: Information was gathered about trauma experiences related to perinatal bereavement; participants' levels of PTSD or CPTSD using the ITQ; and views regarding the features of treatment options. In-depth interviews with women (n=12) and a focus group with staff (n=5) were also conducted. FINDINGS: Of 74 participants (n=74) who fully completed the ITQ, 10.8% (n=8) met the criteria for PTSD and 29.7% (n=22) for CPTSD, equating to a total of 40.5% of participants experiencing traumatic stress. Results suggest that CPTSD is a more common condition than PTSD in people with perinatal bereavement, with qualitative data suggesting that CFT and EMDR can be useful and acceptable interventions for this population group. CONCLUSION: A feasibility study is recommended next to evaluate acceptability of trial processes in preparation for a definitive randomised controlled trial of a new flexible CFT informed treatment package to address PTSD and CPTSD in people with perinatal bereavement. RECOMMENDATIONS FOR PRACTICE: Routine assessment of ICD-11 CPTSD is recommended in this population group.

Analysis of the time course for organ culture-induced endothelin ET B receptor upregulation in rat mesenteric arteries.

In contrast to the constitutively expressed endothelin ET(A) receptor, the distribution of endothelin ET(B) receptors is more variable. The aim of the present study was to investigate the kinetics of organ culture-induced upregulation of contractile endothelin ET(B) receptors in rat mesenteric arteries at both mRNA and functional levels. Assessment of mRNA expression revealed low levels of endothelin ET(B) receptor mRNA relative to endothelin ET(A) receptor mRNA after 3 h of culture, which gradually increased to reach a plateau level after 24 h. Correspondingly, vessels cultured for 3 h showed a negligible contractile response the selective endothelin ET(B) receptor agonist sarafotoxin 6c. Subsequently, the contractile response to sarafotoxin 6c was successively increased during organ culture until 24 h and, thereafter, a further increase in potency was seen after 48 h. These results demonstrate a rapid induction of transcription within less than 7 h followed by an increase in the response to receptor stimulation.