Termination of pregnancy due to fetal anomaly: A qualitative study from Turkey on women's experiences.

BACKGROUND: Termination of pregnancy due to fetal anomaly is an unexpected traumatic event for women. It can cause serious complications that can negatively affect both the physical and psychological health of women. AIM: This study aims to examine the experiences of women who underwent medical termination for fetal anomaly in the second trimester. METHODS: The study included 12 women whose pregnancies were terminated due to fetal anomaly. Data were collected through in-depth interviews until data sufficiency was reached. Thematic analysis method was used to analyze the data. This study was conducted using an inductive qualitative design. The women's statements were examined and double-coded. By examining the codes, main themes were created after sub-themes. RESULTS: Women's experiences were analyzed in five themes: difficulty in decision-making (1), emotional impact (2), stigmatization (3), dilemma between hope and anxiety (4), and post-termination care and support needs (5). Participants stated that they experienced many emotions such as indecision, sadness, helplessness, guilt, and remorse during the medical termination process. Hope, anxiety, fear, social pressure and support needs were also frequently experienced in this process. CONCLUSION: Termination of pregnancy in the second trimester due to fetal anomaly caused significant psychological symptoms. In order to prevent long-term health complications, it will be important for health professionals to provide interventions designed to meet the demands of women diagnosed with fetal anomaly.

First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers.

BACKGROUND: The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. METHODS: We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. FINDINGS: From 7076 hits, we included 80 papers (1994-2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. CONCLUSION: Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.

Associations of physical activity, sedentary time, and physical fitness with mental health during pregnancy: The GESTAFIT project.

PURPOSE: This study was aimed to analyze the associations of objectively measured physical activity (PA), sedentary time, and physical fitness with mental health in the early second trimester (16 ± 2 gestational weeks) of pregnancy. METHODS: From 229 women initially contacted, 124 pregnant women participated in the present cross-sectional study. Data were collected between November 2015 and March 2017. The participants wore Actigraph GT3X+ Triaxial accelerometers for 9 consecutive days to objectively measure their PA levels and sedentary time. A performance-based test battery was used to measure physical fitness. Self-report questionnaires assessed psychological ill-being (i.e., negative affect, anxiety, and depression), and psychological well-being (i.e., emotional intelligence, resilience, and positive affect). Linear regression analyses were adjusted for age, educational level, accelerometer wear time, miscarriages, and low back pain. RESULTS: Moderate-to-vigorous PA was negatively associated with depression (ß = -0.222, adjusted R2 = 0.050, p = 0.041). Higher levels of sedentary time were negatively associated with positive affect (ß = -0.260, adjusted R2 = 0.085, p = 0.017). Greater upper-body flexibility was positively associated with better emotional regulation (ß = 0.195, adjusted R2= 0.030, p = 0.047). The remaining associations were not significant (all p > 0.05). CONCLUSION: An active lifestyle characterized by higher levels of moderate-to-vigorous PA and lower levels of sedentary time during pregnancy might modestly improve the mental health of pregnant women. Although previous research has focused on the benefits of cardiorespiratory exercise, the present study shows that only upper-body flexibility is related to emotional regulation in early pregnant women. If the present findings are corroborated in further experimental research, physical exercise programs should focus on enhancing flexibility to promote improvements in emotional regulation during early second-trimester of pregnancy.

Prenatal distress levels of pregnant women in Turkey and affecting factors: a multicentre study.

This study was conducted to determine prenatal distress levels of pregnant women from seven provinces of Turkey and factors affecting prenatal distress levels. The multicentre descriptive study included 2365 pregnant women who were in the twentieth gestational week and above. The data were collected using the pregnancy information form, prenatal distress questionnaire and spousal support scale. Descriptive statistics, Student's t-test, ANOVA and logistic regression were used to evaluate the data. The results of this study demonstrated that pregnant women's prenatal distress levels are affected by such factors as the region lived in, lack of spousal support and being a primary school graduate. Nurses should develop intervention strategies that involve the pregnant woman's spouse to reduce prenatal distress and the factors affecting prenatal distress.Impact statementWhat is already known on this subject? Prenatal distress can have significant effects on pregnancy, maternal health and human development across the lifespan.What the results of this study add? Spousal support could also have an effect on the psychological health of mothers.What the implications are of these findings for clinical practice and/or further research? Nurses and midwives monitor the pregnant women, and therefore, they should evaluate the prenatal distress levels in the prenatal period, plan intervention strategies for pregnant women with high stress levels and include the pregnant women's spouses in these intervention strategies.

Psychological predictors of gestational outcomes in second trimester pregnant women: associations with daily uplifts.

PURPOSE: We investigated whether pregnancy/birth anxiety is associated with shorter gestation while maternal chronic stress and depressive symptoms are associated with lower birth weight; we also examined whether experiencing daily uplifts prenatally may contribute to a more favorable birth outcome. METHODS: Thirty-four healthy second trimester pregnant women responded to questions regarding their experience of pregnancy/birth anxiety, chronic stress, depressive symptoms, and daily uplifts. Information on birth outcome was obtained from medical records. RESULTS: Maternal pregnancy/birth anxiety, depression, and stress were unrelated to birth outcomes. Daily uplifts were associated with gestational age at birth (B = 2.0, p = 0.01), neonatal weight (B = 46.9, p = 0.00), and size (B = 10.6, p = 0.01). Our results suggest that pregnancy/birth anxiety is not associated with shorter gestation as well as depression and stress seem to not predict lower birth weight. CONCLUSION: We expand the literature by showing that experiencing daily uplifts during mid-gestation may further fetal development.

Sedentary behavior relates to mental distress of pregnant women differently across trimesters: An observational study in China.

BACKGROUND: The independent effect of sedentary behavior (SB) on maternal mental health is still unclear. The purpose of this study was to examine the different relationships of SB with maternal distress in pregnant women across the three trimesters, controlling for the confounding factors including physical activity (PA), diet and gestational weight gain. METHODS: Survey data were collected from 1272 participants in different trimesters of pregnancy. The data were divided into three data sets based on trimester, and regression analysis was conducted on each data set. Both the linear and quadratic relationships between SB and mental distress were estimated. RESULTS: There was no significant association between SB and any mental distress symptoms in the first trimester. In the second trimester, SB was positively associated with higher mental overall distress symptoms (ß=0.34, P < 0.001), including depress and anxiety. There is an inverted-U shaped curvilinear relationship between SB and mental distress in the third trimester, as SB-squared is significantly associated with mental overall distress (GSI: ß=-0.65, P = 0.002, depression: ß=-0.53, P = 0.014, anxiety: ß=-0.46, P = 0.031). LIMITATIONS: The data were collected from only one city in China, which may limit the generalizability of the findings for all Chinese women. This was an observational study and causality cannot be established. CONCLUSION: This study found that the relationship between SB and maternal mental distress depends on trimesters. The stage of pregnancy should be considered when designing interventions for pregnant women to change SB to reduce mental distress.

Maternal night-eating pattern and glucose tolerance during pregnancy: study protocol for a longitudinal study.

INTRODUCTION: Coordinating eating schedules with day-night cycles has been shown to improve glucose regulation in adults, but its association with gestational glycaemia is less clear. A better understanding on how eating time can influence glucose levels in pregnancy may improve strategies for gestational glycaemic control. This study aims to examine the association of maternal night-eating pattern with glucose tolerance in the second trimester of pregnancy, and to investigate how lifestyle factors may be related to night-eating pattern. METHODS AND ANALYSIS: This is an observational longitudinal study that targets to recruit 200 pregnant women at 18-24 weeks' gestation from the KK Women's and Children's Hospital in Singapore. Data collection includes sociodemographics, lifestyle habits and obstetric information. Maternal dietary intake is collected using the 4-day food diary and food frequency questionnaire; while 24-hour physical activity, sedentary behaviour, sleep and light exposure are captured using the accelerometer at 18-24 weeks' gestation. Continuous glucose monitoring at 18-24 weeks' gestation, oral glucose tolerance test and insulin test at 24-28 weeks' gestation are performed to assess glycaemic outcomes. Multivariable generalised linear models will be used to analyse the association of maternal night-eating pattern (consumption of meal and snack during 1900-0659 hours) with glycaemic measures, and the associated factors of night-eating pattern, controlling for potential confounders. Recruitment began in March 2019 and is estimated to end in November 2020. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Centralised Institutional Review Board of SingHealth, Singapore (reference 2018/2529). The results will be presented at conferences and disseminated in journal articles. TRIAL REGISTRATION NUMBER: NCT03803345.

Screening of depression in overweight and obese pregnant women and its predictors.

AIM: The aim of this study was to investigate the screening result of depression and its predictors in overweight and obese pregnant women in second and third trimester of pregnancy. METHODS: The present cross-sectional study was carried out on 232 overweight or obese pregnant women older than 18 years in the second and third trimesters of pregnancy. Edinburgh Postnatal Depression Scale questionnaire, the International Physical Activity Questionnaire and the Food Record were used. Independent t-test, Man-Whitney U, Pearson and Spearman correlation test, independent t-test, one-way analysis of variance and, multivariate linear regression were applied for data analysis using spss 21. RESULTS: The results of the study showed that the mean (standard deviation) score of depression was 10.1 (4.4), and it was similar in both overweight and obese women (P = 0.784). Median (quartile 25-75) of physical activity was 891.0 (495.0-1336.0) metabolic equivalent of task -min/week. The total physical activity in obese women was statistically higher than overweight ones (P = 0.032). In linear regression model, the variables of parity, body mass index, physical activity education, protein, fat, oleic acid, monounsaturated fatty acids, potassium, magnesium, and zinc were the strong predictors of depression, and along with the others explained the 80% of variances. CONCLUSION: Considering the fact that nearly one-third of overweight and obese women in the present study were positive for depression screening, it is important to pay attention to strong predictors of depression in these women.

Characteristics of Women Who Present for Abortion Beyond the Legal Limit in Flanders, Belgium.

CONTEXT: Women who seek abortion care beyond the first trimester of gestation are often in a vulnerable socioeconomic position with limited social support, and in Belgium, the details of their circumstances are insufficiently understood. A better understanding of this group is essential to a critical evaluation of Belgian abortion policy, which restricts abortions on request after the first trimester. METHODS: Anonymized patient records were collected between 2013 and 2016 from LUNA centers, which are non-hospital-based abortion clinics in Flanders. Logistic regression analyses were used to identify associations between women's characteristics and whether they presented within or beyond the legal limit, which was 13 weeks and 1 day at the time of the study. RESULTS: A total of 28,741 women requested an abortion, and 972 individuals (3.4%) presented beyond the legal limit; 29% of these latter women were unable to receive abortion care as a result of the mandatory six-day waiting period. Characteristics positively associated with presenting beyond the limit, instead of beforehand, were being younger than 20, as opposed to 20-24 (odds ratio, 1.7); receiving a primary, lower secondary, upper secondary or special-needs education, rather than a higher education (1.8-3.1); being unemployed, rather than employed (1.3); and holding Belgian rather than a foreign nationality (0.8). Being accompanied by someone to the LUNA center (0.8), having irregularly (0.6) or regularly used contraceptives (0.7), and having ever had an abortion (0.8) were negatively associated with presenting beyond, rather than before, the limit. CONCLUSIONS: A fuller consideration of patients' characteristics when evaluating Belgian abortion policy is needed to ensure that the needs and rights of socioeconomically vulnerable women are addressed.

Assessing body dissatisfaction in Japanese women during the second trimester of pregnancy using a new figure rating scale.

During pregnancy, women re-evaluate their body image based on their increasing body weight. They are usually concerned about their body size, which leads to body dissatisfaction. In this study, we investigated body dissatisfaction among Japanese women during the second trimester, when they are recommended to gain adequate weight. A cross-sectional survey of body dissatisfaction among pregnant women was conducted using a new figure rating scale corresponding to body mass index with real-life photographs of women in their sixth month of gestation. Pregnant Japanese women expressed body dissatisfaction and preferred to be thinner by 1.6 kg/m2 of their body mass index. They perceived their body size as larger than their real size, and those with a higher body mass index had more body dissatisfaction, although they were of normal weight or underweight. The results indicated that the new figure rating scale could be a useful tool to identify pregnant women with higher body dissatisfaction during the second trimester, providing an opportunity to discuss adequate gestational weight gain with pregnant women.

Perspectives and pregnancy outcomes of maternal Ramadan fasting in the second trimester of pregnancy.

BACKGROUND: There are controversies over the effects of Ramadan fasting on pregnancy outcomes, and women's perspectives of fasting are diverse. This study aimed to assess the perspectives and pregnancy outcomes of maternal Ramadan fasting in the second trimester of pregnancy. METHODS: A case-control study was conducted at Hawler Maternity Teaching Hospital of Erbil, Iraq from October 2017 to January 2018. Out of 301 participating women, 155 fasted during the second trimester of their current pregnancy, while the remaining 146 did not. Mothers were asked concerning their fasting behaviors and perception of fasting during pregnancy. The main outcomes of this study were gestational diabetes, preterm labour, preeclampsia, low birth weight, Apgar score, height, weight, and head circumference of the newborn. RESULTS: About 80% of the women in the fasting group fasted for 21-29 days during Ramadan, out of whom 38.7% completed fasting for the entire Ramadan period. The results revealed that the decision to fast during pregnancy was negatively associated with the mother's educational level and occupation. Weight gain during pregnancy in the fasting women was approximately 0.4 kg less than those who did not fast. The incidence of gestational diabetes was 2.6% in the fasting women, while it was 8.3% in the non-fasting mothers (P = 0.02). Regression analysis showed that women who did not fast during the second trimester of pregnancy were 1.51 times more likely to develop gestational diabetes [odd ratio (OR) 1.51; 95% confidence intervals (CI) 0.06, 0.74, P = 0.01]. It was also found that among the women in the fasting categories, those who fasted for 21-29 days during pregnancy had a lower risk of gestational diabetes compared to the other groups. More than half of the mothers in the fasting group (60%) perceived that fasting during pregnancy was compulsory for healthy and non-healthy women, comparing with those who did not fast. CONCLUSION: It was found that fasting during the second trimester of the pregnancy decreased the risk of gestational diabetes and excessive weight gain during pregnancy. Most of Iraqi women did not fully recognize their right to be exempted from fasting during pregnancy by the Islamic law.

Social support and second trimester depression.

BACKGROUND: Depression is the most prevalent psychiatric disease during and after pregnancy (Aktas and Yesilcicek, 2015). Social supportive system (SSS) serves to protect against the development of depressive symptoms (Moshki and Cheravi, 2016). The mitigating effect of SSS on depression among expectant Chinese women is unclear. OBJECTIVES: To evaluate the SSS for pregnant women in Shanghai, China and identify any correlation between social support components and perinatal depression. METHODS: This is a quantitative study using a cross sectional self-reporting survey. Two thousand pregnant women were recruited during their second trimester routine pregnancy check-up. Descriptive statistics were used to analyze the socio-demographic and perinatal characteristics, level of social support and depression among the study group. The correlation analysis was conducted between groups of different socio-economic and perinatal factors and SSS, as well as between different SSS components and perinatal depression. RESULTS: Components of social support most influencing perinatal depression were "Support from partner", "The number of close friends accessible of getting support" and "Support from colleagues" [r = -0.226, 0.206, -0.200, respectively]. Among the different components of the SSS, the items ranking high were: "Support from partner", "The living conditions in the last year" and "Support from parents". Meanwhile, "Support from neighborhood", "Participation in group activities" and "The number of close friends accessible of getting support" ranked low. CONCLUSION: Support from the family may be a protective factor against perinatal depression among Chinese pregnant women. The study of social support during pregnancy could help us preferably understand and effectively use social resources to guide and support women in pregnancy. Context-tailored support enhancement should be based on the availability of social networks.

Accompaniment of second-trimester abortions: the model of the feminist Socorrista network of Argentina.

OBJECTIVE: Legal restrictions on abortion access impact the safety and timing of abortion. Women affected by these laws face barriers to safe care that often result in abortion being delayed. Second-trimester abortion affects vulnerable groups of women disproportionately and is often more difficult to access. In Argentina, where abortion is legally restricted except in cases of rape or threat to the health of the woman, the Socorristas en Red, a feminist network, offers a model of accompaniment wherein they provide information and support to women seeking second-trimester abortions. This qualitative analysis aimed to understand Socorristas' experiences supporting women who have second-trimester medication abortion outside the formal health care system. STUDY DESIGN: We conducted 2 focus groups with 16 Socorristas in total to understand experiences accompanying women having second-trimester medication abortion who were at 14-24 weeks' gestational age. We performed a thematic analysis of the data and present key themes in this article. RESULTS: The Socorristas strived to ensure that women had the power of choice in every step of their abortion. These cases required more attention and logistical, legal and medical risks than first-trimester care. The Socorristas learned how to help women manage the possibility of these risks and were comfortable providing this support. They understood their work as activism through which they aim to destigmatize abortion and advocate against patriarchal systems denying the right to abortion. CONCLUSION: Socorrista groups have shown that they can provide supportive, women-centered accompaniment during second-trimester medication abortions outside the formal health care system in a setting where abortion access is legally restricted. IMPLICATIONS: Second-trimester self-use of medication abortion outside of the formal health system supported by feminist activist groups could provide an alternative model for second-trimester care worldwide. More research is needed to document the safety and effectiveness of this accompaniment service-provision model.

Invasive Prenatal Diagnostic Testing Recommendations are Influenced by Maternal Age, Statistical Misconception and Perceived Liability.

Funding policy and medico-legal climate are part of physicians' reality and might permeate clinical decisions. This study evaluates the influence of maternal age and government funding on obstetrician/gynecologist recommendation for invasive prenatal testing (i.e. amniocentesis) for Down syndrome (DS), and its association with the physician's assessment of the risk of liability for medical malpractice unless they recommend amniocentesis. Israeli physicians (N = 171) completed a questionnaire and provided amniocentesis recommendations for women at 18 weeks gestation with normal preliminary screening results, identical except aged 28 and 37. Amniocentesis recommendations were reversed for the younger ('yes' regardless of testing results: 6.4%; 'no' regardless of testing results: 31.6%) versus older woman ('yes' regardless of testing results: 40.9%; 'no' regardless of testing results: 7.0%; χ2 = 71.55, p < .01). About half of the physicians endorsed different recommendations per scenario; of these, 65.6% recommended amniocentesis regardless of testing results for the 37-year-old woman. Physicians routinely performing amniocentesis and those advocating for amniocentesis for all women ≥ age 35 were approximately twice as likely to vary their recommendations per scenario. Physicians who perceived risk of liability for malpractice as large were nearly one-and-a-half times more likely to vary recommendations. The results indicate physicians' recommendations are influenced by maternal age, though age is already incorporated in prenatal DS risk evaluations. The physician's assessment of the risk that they will be sued unless they recommend amniocentesis may contribute to this spurious influence.

[Pregnancy intention and pregnancy-related anxiety in the second and third trimester: a birth cohort study].

Objective: To understand the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester and its strength. Methods: A prospective cohort study was conducted in Ma'anshan, Anhui province. A total of 3 474 eligible pregnant women within 14 weeks of gestation were recruited. The information about their demographic characteristics were collected in early pregnancy. The completed questionnaire of pregnancy-related anxiety were asked to return in the second and third trimester. Logistic regression analysis was conducted to evaluate the association between pregnancy intention and pregnancy-related anxiety in the second and third trimester. Results: A total of 3 083 pregnant women were included in final analysis, The rate of unintentional pregnancy was 15.00% (n=461). The detection rates of pregnancy-related anxiety in the second and third trimester were 29.13% (n=898) and 30.36% (n=936). After controlling potential confounding factors, unintentional pregnancy increased the risk of pregnancy-related anxiety in the second trimester compared with intentional pregnancy (OR=1.85, 95%CI: 1.44-2.38); The risk of pregnancy-related anxiety also increased in the third trimester (OR=1.84, 95%CI: 1.44-2.35). Intentional pregnancy did not increase the risk of pregnancy-related anxiety in the second and third trimester. Conclusion: The study results suggests that unintentional pregnancy could increase the risk of pregnancy-related anxiety in the second and third trimester.

Different patterns of depressive symptoms during pregnancy.

Recently, the US Preventive Services Task Force has advocated to screen pregnant and postpartum women for depression. However, we questioned the meaning of a single elevated depression score: does it represent just one episode of depression or do these symptoms persist throughout the entire pregnancy? This study assessed depressive symptoms at each trimester in a cohort of 1813 pregnant women and evaluated whether women with different patterns of depressive symptoms showed other characteristics. Depending on the trimester, elevated depression scores were prevalent in 10-15% of the pregnant women. Up to 4% reported persistent symptoms of depression throughout pregnancy. Different patterns of depressive symptoms were observed, for which persistent symptoms were related to other characteristics than incidentally elevated symptoms. Besides a previous history of mental health problems as best overall predictor, incidentally elevated depression scores were related to major life events. Furthermore, persistently depressive symptoms were related to unplanned pregnancy and multiparity. An EDS assessment at 12 weeks of gestation including three additional items (history of mental health problems, unplanned pregnancy and multiparity) enabled us to identify 83% of the women with persistent depressive symptoms. A depression screening strategy in pregnant women should take into account the potential chronicity of depressive symptoms by repeated assessments in order to offer an intervention to the most vulnerable women.

War trauma and maternal-fetal attachment predicting maternal mental health, infant development, and dyadic interaction in Palestinian families.

Optimal maternal-fetal attachment (MFA) is believed to be beneficial for infant well-being and dyadic interaction, but research is scarce in general and among risk populations. Our study involved dyads living in war conditions and examined how traumatic war trauma associates with MFA and which factors mediate that association. It also modeled the role of MFA in predicting newborn health, infant development, mother-infant interaction, and maternal postpartum mental health. Palestinian women from the Gaza Strip (N = 511) participated during their second trimester (T1), and when their infants were 4 (T2) and 12 (T3) months. Mothers reported MFA (interaction with, attributions to, and fantasies about the fetus), social support, and prenatal mental health (post-traumatic stress disorder, depression, and anxiety) at T1, newborn health at T2, and the postpartum mental health, infant's sensorimotor and language development, and mother-infant interaction (emotional availability) at T3. Results revealed, first, that war trauma was not directly associated with MFA but that it was mediated through a low level of social support and high level of maternal prenatal mental health problems. Second, intensive MFA predicted optimal mother-reported infant's sensorimotor and language development and mother-infant emotional availability but not newborn health or maternal postpartum mental health.

Physical and psychological morbidities among selected antenatal females in Kegalle district of Sri Lanka: A cross sectional study.

While motherhood is often a positive and satisfying experience, for some women, it is linked with suffering and ill-health. A woman should be able to feel physically and mentally content during pregnancy. Discomforts in pregnancy may be considered as insignificant by the physician. Therefore, the objective of this study was to determine physical and psychological morbidities among primigravid antenatal females in the Kegalle District, Sri Lanka. A sample of 1017 second and third trimester primigravid antenatal females selected by a two-stage probability proportional to size cluster sampling method, were assessed for physical and psychological problems. Data analysis was done using SPSS 16 package and associations were found using Chi square test with p values. The presence of any physical health problem during the preceding 14 days was reported by 75.7% (95% CI 73.0-78.2) of females though each individual physical problem was reported by less than or around one-third. Prevalence of psychological distress and depression was 22.7% (95% CI 20.2-25.4) and 10.4% (95% CI 8.7-12.4), respectively. The self-rated health was very good in 24.7% and good in 55.9%. Older employed females had significantly higher physical problems. It is concluded that although the self-rated wellbeing during pregnancy is high, the presence of physical and psychological ill-health is substantial. Impact statement Pregnancy is a time of intense physical change and is associated with emotional upheaval in many women. Obstetric morbidity is defined as morbidity in a woman who has been pregnant regardless of the site or the duration of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. It is classified into three categories namely; direct, indirect and psychological obstetric morbidity. For one maternal death, there can be between 9 and 16 females with obstetric morbidity depending on the level of development of a country. As a country with good health indicators, this study was conducted to determine physical and psychological problems among primigravid antenatal females in the Kegalle District,p Sri Lanka to improve service quality further. The presence of any physical health problem during the preceding 14 days was reported by a quarter of females and backache, fatigue, body aches, psychological distress, urinary incontinence and headache was commonly reported individual problems. Older employed females had significantly higher physical problems. Though trivial for health workers, physical and psychological problems are prevalent. These should be actively sought and remedied by health workers to improve the quality of life.

Women's experiences of labour and birth when having a termination of pregnancy for fetal abnormality in the second trimester of pregnancy: A qualitative meta-synthesis.

OBJECTIVE: to explore women's experiences of labour and birth in the context of a termination of pregnancy for fetal abnormality in the second trimester of pregnancy. DESIGN: meta-synthesis of 10 qualitative studies which included the experiences of 581 women. Data analysis was informed by van Manen's four lifeworld existentials (lived body, lived space, lived time and lived human relationships) and focused only on women's experiences of their labour and birth when terminating a pregnancy in the second trimester for fetal abnormality. KEY FINDINGS: eight themes were generated by the analysis. In my head: a storm of emotion reflected the lived or felt space. In this space women make meaning of the experience. Too late to turn back time and Living and escaping the moment considered lived time; it is lived time that enables a woman to reinterpret who they once were and who they are becoming. The existential concept of lived body represented the women's physical or bodily presence and was reflected in the themes; The language of labour: un-describable torture, The meaning of pain; punishment and protection and Being a mother in the space where birth meets death. Relational or the lived human relationship is reflected in See me… talk to me…hear me… be with me and Sorry baby. These themes describe the women's lived sense of others in the interpersonal space that they share with them. KEY CONCLUSIONS: the findings of this meta-synthesis provide insight into how emotionally and physically traumatic a woman's labour and birth experiences can be in this context. Women wanted to spend time with their baby constructing lasting memories that they could hold onto and share. They needed acknowledgment that their baby existed and their loss was tangible and real. What happened within the space of the relationship women shared with care providers was seen as vital, especially when respectful and dignified interaction was experienced. The women's need for human contact and support through their experience was also seen as critical. IMPLICATIONS FOR PRACTICE: the need for greater understanding and acknowledgement of the woman's experience by all caregivers is required. Woman-centred and situation sensitive care provision should be prioritised. Further research that acknowledges and prioritises the feminine voice and the lived experience of women is required.