Navigating abortion law dilemmas: experiences and attitudes among Ethiopian health care professionals

Background Ethiopia’s 2005 abortion law improved access to legal abortion. In this study we examine the experiences of abortion providers with the revised abortion law, including how they view and resolve perceived moral challenges. Methods Thirty healthcare professionals involved in abortion provisions in Addis Ababa were interviewed. Transcripts were analyzed using systematic text condensation, a qualitative analysis framework. Results Most participants considered the 2005 abortion law a clear improvement—yet it does not solve all problems and has led to new dilemmas. As a main finding, the law appears to have opened a large space for professionals’ individual interpretation and discretion concerning whether criteria for abortion are met or not. Regarding abortion for fetal abnormalities, participants support the woman’s authority in deciding whether to choose abortion or not, although several saw these decisions as moral dilemmas. All thought that abortion was a justified choice when a diagnosis of fetal abnormality had been made. Conclusion Ethiopian practitioners experience moral dilemmas in connection with abortion. The law places significant authority, burden and responsibility on each practitioner.

Knowledge and acceptability of prenatal diagnosis among pregnant women attending antenatal clinic in a tertiary health institution in Sokoto, Nigeria

Background: Technology and advances in research have made it possible for the fetus to become a patient whose illness can be investigated, diagnosed and treated in utero. The study was aimed at assessing the knowledge and acceptability of prenatal diagnosis among pregnant women.Methods: This was a cross-sectional study carried out between December 2016 and March, 2017. Pregnant women attending antennal care clinic at the Usmanu Danfodiyo University Teaching Hospital, Sokoto (UDUTH) were recruited via convenient sampling method using semi-structured interviewer questionnaire.Results: A total of 417 pregnant women were interviewed. The mean maternal age was 28.35±5 years with a range between 17 to 45 years. Up to 188 (69.10%) had at least secondary school level of education. There was an overall poor knowledge of prenatal diagnosis, as 406 (97.36%) had little to no idea. There was statistically significant association between knowledge and educational status at p value- 0.0001. Majority, 353 (87.8%) will accept prenatal diagnosis if offered. There was also statistically significant association between educational status and acceptability as well as knowledge of prenatal diagnosis at p value- 0.001 and 0.001 respectively. The noninvasive method, ultrasound was the most preferred by the majority, 332 (84.3%). Termination of pregnancy as an option of management in fetal abnormality was acceptable by up to 2/3 (63.1%) of the respondents.Conclusions: The knowledge of prenatal diagnosis among the respondents was generally poor. The identifiable factor that determined knowledge and acceptability of prenatal diagnosis was level of education.

Euploid First-Trimester Cystic Hygroma: A More Benign Entity than Previously Thought?

<b><i>Objective:</i></b> Studies summarizing the outcome of first-trimester septated cystic hygroma are generally based on small studies or from multiple centers with limited ascertainment. We reviewed the natural history of a large cohort of such cases from a single tertiary referral center, with the aim being to establish contemporary outcome data, particularly in the setting of normal karyotype. <b><i>Methods:</i></b> A retrospective cohort study from 2007 to 2017 was conducted at a single tertiary referral prenatal diagnosis center. Data were analyzed from a prospectively collated fetal anomaly database. Search terms were “increased nuchal translucency (NT),” “cystic hygroma,” and “septated cystic hygroma.” All cases were confirmed to have NT &#x3e;3 mm with septations. Cases of simple increased NT without septations were excluded. <b><i>Results:</i></b> During the study period, over 110,000 pregnancies were delivered at our center, resulting in 410 cases of septated cystic hygroma diagnosed prior to 14 weeks’ gestation. Pregnancy outcome was obtained in 99% (405/410) of cases, with detailed pathology outcome available in 92% (378/410). A total of 87% (351/405) underwent invasive prenatal testing, and postnatal chromosome status was established in further 27 cases. A total of 61% (230/378) had abnormal chromosomal status. Of the 39% (148/378) with normal chromosomal status, only 13% (19/148) had a significant structural fetal abnormality, which included 7 cardiac and 12 noncardiac abnormalities. Overall, the perinatal loss was 62% (253/405). The total survival rate in the setting of euploid cystic hygroma without structural abnormality was 84% (108/129). <b><i>Conclusions:</i></b> Counseling regarding outcomes in the setting of first-trimester septated cystic hygroma initially focuses on the strong likelihood of an abnormal karyotype, which occurs in 61% of cases. However, once fetal chromosomal abnormality is excluded, our results demonstrate only a 13% incidence of major structural fetal abnormality, which appears significantly less than previously reported. Normal fetuses have a 77% survival rate. These data represent the largest single-center study of first-trimester cystic hygroma with complete outcome data and therefore will be useful for contemporary patient counseling. Such counseling can be more positive than previously expected, once chromosomal abnormality is first excluded.

‘This is time we’ll never get back’: a qualitative study of mothers’ experiences of care associated with neonatal death

AimsTo explore the perceptions and experience of women whose baby died in the neonatal period about their care in the perinatal period, on delivery suite, in the neonatal unit and afterwards, expressed in their own words.DesignSecondary analysis of the Listening to Parents study, using thematic analysis based on the open text responses from a postal survey of parents whose baby died in the neonatal period in England. Women were asked about care during the pregnancy, labour and birth, around the time the baby died and about neonatal care. Women whose pregnancy was terminated for fetal abnormality were excluded from this analysis.ResultsCompleted questionnaires were received from 249 mothers of whom most (78%) responded with open text. Overarching themes identified were ‘the importance of proximity’, ‘recognition of role and identity as a parent’ and ‘the experience of care’ and subthemes included ‘hours and moments’, ‘barriers to contact’, ‘ being able to parent, even for a short time’, ‘missed opportunities’, ‘being heard’ and ‘sensitive and responsive care’.ConclusionThe findings identify what is most important for mothers in experiencing the life and death of a baby as a newborn. Physical contact with the baby was paramount, as was being treated as a mother and a parent and being able to function as such. The way in which healthcare staff behaved and how their babies were cared for was critical to how mothers felt supported and enabled at this time. If all women whose babies die in the neonatal period after birth are to receive the responsive care they need, greater understanding of the primary need for closeness and proximity, for active recognition of their parental role and staff awareness of the limited time window available is essential.

The Value of Prenatal Systematic Ultrasonic Examination of Fetal Structural Abnormality in Diagnosing Fetal Structural Abnormality

In order to explore the value of prenatal systematic ultrasound examination of fetal structural abnormality in the diagnosis of fetal structural abnormality, this paper retrospectively analyzed 200 cases of fetal abnormality referrals from December 2017 to December 2019 in the prenatal systematic ultrasound examination of the designated hospital in this study of pregnant women. By sorting, summarizing and summarizing the actual conditions of the systematic ultrasound examination of each prenatal fetal abnormal section, this study calculated, recorded and analyzed the detection rate, missed diagnosis rate, sensitivity, and specificity of the systematic ultrasound examination of structural abnormality, and then discussed the value of prenatal systematic ultrasound in the diagnosis of fetal structural abnormality. The results showed that, 185 cases were detected out of 200 fetal abnormality with the detection rate of 92.5%; missed diagnosis rate is 7.3%; detection sensitivity is 87.43%; and specificity is 76.58%. Among them, the detection rate of malformations of different diseases from high to low is cardiovascular system (97.54%), nervous system (93.16%), respiratory system (90.62%), facial system (87.54%), and urinary system (85.47%). Therefore, the prenatal systematic ultrasound fetal structural abnormality examination for pregnant women can achieve good diagnostic results, can provide pregnant women with fetal structural abnormality the opportunity to terminate pregnancy early, and effectively reduce the birth of structural abnormal fetuses and the burden of family and society, having important clinical significance and reducing.

Quantitative evaluation of fetal ventricular function by speckle tracking echocardiography

Methods The study included 59 patients with normal fetal heart structure, blood flow, and heart rhythm (fetal abnormality-negative group) and 50 patients with abnormal fetal heart structure, blood flow, and/or heart rhythm (fetal abnormality-positive group). aCMQ was performed in both groups to obtain left and right ventricular endocardial global longitudinal strain (GLSendo), mid-myocardial global longitudinal strain (GLSmid), and epicardial global longitudinal strain (GLSepi). Parameters between the two groups were compared and correlation analyses performed. A deformation analysis was performed by two trained observers, and reproducibility was assessed. Results The fetal left ventricular and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively) decreased in a gradient from the endocardium to the epicardium. LV-GLS and RV-GLS of all myocardial layers were lower in the fetal abnormality-positive than -negative group (all P<0.05). Correlation analysis showed that neither LV-GLS nor RV-GLS was significantly correlated with gestational age in the fetal abnormality-negative group (all P>0.05), whereas left ventricular GLSendo, GLSmid, and GLSepi were negatively correlated with gestational age in the fetal abnormality-positive group (r=−0.39 to −0.44, all P<0.05). Repeatability testing showed that the inter-observer and intra-observer intraclass correlation coefficients for LV-GLS and RV-GLS in each myocardial layer were >0.75 (all P<0.001). Conclusions As a new speckle tracking echocardiography tool, aCMQ has feasibility and repeatability in evaluating myocardial deformation of the fetal ventricle. This technique might provide helpful information on ventricular myocardial deformation in fetal hearts with abnormal structure or rhythm for clinical guidance in pregnancy.