Multiple Gestations and Assisted Reproductive Technologies: Qualitative Study of the Discourse of Health Professionals in Spain.

Multiple gestations have become an increasing phenomenon that has impacted public health globally, largely due to the application of assisted reproductive technologies. The objective of this work was to find out the discourse that the health professionals involved in its follow-up have in our context. For this, a qualitative methodology was chosen, with semi-structured interviews recorded in audio, prior authorisation, and transcribed verbatim. It was based on a script designed for this purpose, with the following analysis categories: the current trend of multiple gestations, impact, and follow-up. The content analysis was based on the experiences, knowledge, and perceptions of the professionals interviewed. Professionals stated that the current socioeconomic and legal context hinders a single embryo transfer policy that decreases multiple gestation rates. They emphasised the importance of the psychic impact of such gestations on the couple, on the mother in particular, as well as the economic effect on families, health, and society in general. They expressed the need to create specific protocols to assist these gestations. Midwives, in particular, demanded that the health administration recognise and support the differentiated care they perform with this type of gestation. Work on specific models is needed to adequately size the impact of multiple gestations, as well as to generate social health policies that lead to co-responsible reconciliation measures that favour women having one pregnancy at a time.

[Pregnancy care during COVID-19 epidemic, a drive for change?] / Atención del embarazo durante la epidemia de COVID-19, ¿un impulso para el cambio?

Prenatal care, understood as routine care provided during pregnancy, should be based on basic pillars, such as taking into account the sociocultural context in which such care is offered, ensuring that the service is appropriate, accessible and of high quality, and also with care personalized. According to World Health Organization, the minimum number of recommended visits during pregnancy should be eight, with the different professionals involved in the process, in addition to preparing for childbirth or maternal education. Since the pandemic erupted due to SARS-CoV-2, many of the usual social health services have had to adapt to provide safety and prevent infection, a priority in vulnerable groups where pregnant women are found. Professionals have had to adapt to telematics care, thus attending consultations to reduce the mobility of pregnant women to health centers, thus avoiding unnecessary risks. Therefore, all this situation has opened a virtual field of work that, although previously carried out in different areas, now more than ever acquires special relevance and for which professional training is necessary, as a complement to face-to-face appointments.

La atención prenatal, entendida como cuidados habituales brindados durante la gestación, debe estar basada en pilares básicos tales como tener en cuenta el contexto sociocultural en el que se ofrece dicha atención, garantizar que el servicio sea apropiado, accesible, y de alta calidad, y además permitir una atención personalizada. Según la Organización Mundial de la Salud el número mínimo de visitas recomendables durante el embarazo debe ser ocho, con los distintos profesionales implicados en el proceso, además de la preparación al nacimiento o educación maternal. Desde que estalló la pandemia provocada por el SARS-CoV-2, muchos de los servicios habituales sociosanitarios han tenido que adaptarse para proporcionar seguridad y evitar el contagio, algo prioritario en los grupos vulnerables en los que encontramos a las embarazadas. Los profesionales han tenido que acomodarse a una atención telemática, aunando consultas para una menor movilidad de la gestante a los centros sanitarios evitando así riesgos innecesarios. Por lo que toda esta situación ha abierto un campo de trabajo virtual que, si bien antes era llevado a cabo en diferentes ámbitos, ahora más que nunca cobra especial relevancia y requiere una formación profesional para que pueda llegar erigirse como complemento a las citas presenciales.

Atención del embarazo durante la epidemia de COVID-19, ¿un impulso para el cambio? / Pregnancy care during COVID-19 epidemic, a drive for change?

La atención prenatal, entendida como cuidados habituales brindados durante la gestación, debe estar basada en pilares básicos tales como tener en cuenta el contexto sociocultural en el que se ofrece dicha atención, garantizar que el servicio sea apropiado, accesible, y de alta calidad, y además permitir una atención personalizada. Según la Organización Mundial de la Salud el número mínimo de visitas recomendables durante el embarazo debe ser ocho, con los distintos profesionales implicados en el proceso, además de la preparación al nacimiento o educación maternal. Desde que estalló la pandemia provocada por el SARS-CoV-2, muchos de los servicios habituales sociosanitarios han tenido que adaptarse para proporcionar seguridad y evitar el contagio, algo prioritario en los grupos vulnerables en los que encontramos a las embarazadas. Los profesionales han tenido que acomodarse a una atención telemática, aunando consultas para una menor movilidad de la gestante a los centros sanitarios evitando así riesgos innecesarios. Por lo que toda esta situación ha abierto un campo de trabajo virtual que, si bien antes era llevado a cabo en diferentes ámbitos, ahora más que nunca cobra especial relevancia y requiere una formación profesional para que pueda llegar erigirse como complemento a las citas presenciales

Prenatal care, understood as routine care provided during pregnancy, should be based on basic pillars, such as taking into account the sociocultural context in which such care is offered, ensuring that the service is appropriate, accessible and of high quality, and also with care personalized. According to World Health Organization, the minimum number of recommended visits during pregnancy should be eight, with the different professionals involved in the process, in addition to preparing for childbirth or maternal education. Since the pandemic erupted due to SARS-CoV-2, many of the usual social health services have had to adapt to provide safety and prevent infection, a priority in vulnerable groups where pregnant women are found. Professionals have had to adapt to telematics care, thus attending consultations to reduce the mobility of pregnant women to health centers, thus avoiding unnecessary risks. Therefore, all this situation has opened a virtual field of work that, although previously carried out in different areas, now more than ever acquires special relevance and for which professional training is necessary, as a complement to face-to-face appointments

La mujer ante la finalización de la gestación por anomalías fetales: caso clínico / The woman at the termination of pregnancy for fetal anomalies: Clinical case

Dentro de la asistencia y ayuda al afrontamiento ante una muerte perinatal debemos considerar que existe un grupo de mujeres cuyo proceso cuenta con unas características que otorgan connotaciones específicas. Hablamos de cuando la pérdida perinatal ocurre debido a una decisión materna ante la presencia de una malformación fetal. Estos casos, hoy en día, gracias al avance de las técnicas de control de desarrollo fetal no son infrecuentes. En su asistencia, los profesionales sanitarios deben de tener en cuenta que suele estar presente un gran sentimiento de culpa y la ambivalencia entre la decisión bien tomada y la dureza de haber tenido que tomarla. Se presenta un caso de una gestante que se somete a una fetolisis fetal y el plan de cuidados desarrollado en su atención durante la inducción del parto, parto y puerperio inmediato. Dicho plan incluye los problemas de colaboración y los problemas independientes que son formulados de acuerdo a las taxonomías NANDA, NOC y NIC. La implicación para la práctica tras el estudio de este caso, nos lleva al deber de abordar de igual forma el afrontamiento ante una muerte fetal, haya sido espontánea o decidida su finalización por malformación fetal, ofreciendo a los padres la posibilidad de visualización y el contacto con su hijo/a

Within the assistance and support to coping with perinatal death, it must be considered that there is a group of women whose process has some features that give specific connotations. We talked about when the perinatal loss occurs due to a maternal decision to the presence of a fetal malformation. These cases today, thanks to advances in the techniques of control fetal development, are not uncommon. In their assistance, healthcare professionals should be aware that they often present a great sense of guilt and ambivalence between well-made decision and the hardness of having to come to it. A case of a pregnant woman undergoing a fetal fetolisis and care plan developed in her assistance for the induction of labor, delivery and immediate postpartum period is presented. This plan includes the problems of collaboration and the independent problems that are formulated according to the NANDA, NOC and NIC taxonomies. The implication for practice after studying this case leads to the duty to equally address the coping with a stillbirth, whether it was spontaneous or had it been determined by fetal malformation completion, giving parents the ability to view and contact with their child

[The woman at the termination of pregnancy for fetal anomalies: clinical case]. / La mujer ante la finalización de la gestación por anomalías fetales: caso clínico.

Within the assistance and support to coping with perinatal death, it must be considered that there is a group of women whose process has some features that give specific connotations. We talked about when the perinatal loss occurs due to a maternal decision to the presence of a fetal malformation. These cases today, thanks to advances in the techniques of control fetal development, are not uncommon. In their assistance, healthcare professionals should be aware that they often present a great sense of guilt and ambivalence between well-made decision and the hardness of having to come to it. A case of a pregnant woman undergoing a fetal fetolisis and care plan developed in her assistance for the induction of labor, delivery and immediate postpartum period is presented. This plan includes the problems of collaboration and the independent problems that are formulated according to the NANDA, NOC and NIC taxonomies. The implication for practice after studying this case leads to the duty to equally address the coping with a stillbirth, whether it was spontaneous or had it been determined by fetal malformation completion, giving parents the ability to view and contact with their child.

Influencia de la humanización de la atención perinatal en las tasas de inducción del parto / The influence of the humanization of perinatal care in labour induction rates

OBJETIVOS: conocer la evolución de la frecuencia de las inducciones del parto desde la adhesión al Convenio de Colaboración entre el Ministerio de Sanidad y Consumo y la Consejería de Salud de la Junta de Andalucía para la Estrategia de Atención al Parto Normal, así como describir los porcentajes de los distintos tipos de partos de las inducciones realizadas durante el periodo de estudio y estudiar la posible relación entre el número de inducciones y el tipo de parto de las mismas y la adhesión al Convenio para la Estrategia de Atención al Parto Normal. MÉTODO: estudio observacional, descriptivo, transversal de las gestantes atendidas en un hospital durante los años 2007 y 2011. La fuente de información utilizada ha sido el Conjunto Mínimo Básico de Datos (CMBD) al alta hospitalaria de los años 2007-2011.RESULTADOS: en el porcentaje de inducciones se constata que existen diferencias estadísticamente significativas tanto en el porcentaje de inducciones como en el porcentaje de partos eutócicos inducidos, siendo en 2011 dicho porcentaje inferior al 50% respecto a 2007. La instrumentación de los partos y la tasa de cesáreas en los partos inducidos han aumentado en 2011.CONCLUSIONES: la tasa de inducción del parto se ha reducido significativamente en el periodo de tiempo estudiado, adecuándose a las tasas recomendadas por la Organización Mundial de la Salud (OMS), posiblemente debido a la adhesión del hospital al Proyecto de Humanización en la Atención al Parto y Nacimiento de Andalucía

OBJECTIVES: to learn about the evolution of the frequency of labour inductions since joining the Collaboration Agreement between the Ministry of Health and Consumer Affairs and the Regional Ministry of Health from the Junta de Andalucía in terms of the Strategy for Normal Childbirth Care, as well as to describe the percentages of the different types of labours from the inductions conducted during the period under study, and to assess the potential relationship between the number of inductions and the type of labour, and the adherence to the Agreement for the Strategy for Normal Childbirth Care. METHOD: observational, descriptive, transversal study of those pregnant mothers seen at a hospital during 2007 and 2011. The source of information used has been the Minimum Basic Data Set (MBDS) at hospital discharge during the years 2007-2011. RESULTS: within the induction percentage, statistically significant differences were confirmed both in the induction percentage as in the percentage of induced normal labours; in 2011, said percentage was under 50% compared with 2007. Labour instrumentation and caesarean rate in induced childbirth have increased in 2011.CONCLUSIONS: the childbirth induction rate has been significantly reduced in the period of time under study, adapting to the rates recommended by the World Health Organization (WHO), possibly due to the adherence of the hospital to the Project for Humanization in Delivery and Childbirth in Andalusia