Objective

To understand the cognition, emotions, and behaviour of women who had recently undergone termination due to a foetal anomaly. In this study, we developed and tested a theoretical model to describe how women went through the process after termination.

Study design

A grounded theory study.

Setting

Three general hospitals and one special hospital in Changsha, Hunan, China.

Participants

41 women who had recently undergone a pregnancy termination.

Methods

In-depth interviews were conducted from May to September 2017. A combination of convenience sampling and theoretical sampling was used, and conceptual depth criteria were used to measure the progress of the theoretical sampling.

Findings

This study developed a cognitive-behavioural experience framework of women undergoing pregnancy termination due to a foetal anomaly. The model included 4 phases: 1. Denial Phase, 2. Confirmation Phase, 3. Decision-making Phase and 4. Recovery Phase. Different cognitive appraisal, emotional, and behavioural reactions were included in each phase, and the different reactions influenced one another.

Key conclusions & implications for practice

We built and tested a theoretical framework by interviewing women who had gone through a pregnancy termination. The framework describes their experiences more clearly from three dimensions, including cognitive appraisal, emotional reaction, and behavioural response in the different phases. This framework provides a basic understanding of the women's emotional process and, therefore, provides baseline data for developing an effective intervention to help women cope with termination stresses.

Background

After China's One-child Policy was replaced with the Two-child Policy in 2013, the rate of second pregnancies with a longer inter-pregnancy interval (IPI) has suddenly increased in that country; however, the effect of long IPIs (≥49 months) on perinatal outcomes remains unreported.

Methods

This was a retrospective cohort study in China from July 2015 through June 2016. We used univariate and multivariate logistic regression models to test the associations among IPI, maternal age, and perinatal outcome (preterm delivery, term low birthweight, and small-for-gestational age). We included baseline factors and variables with biological plausibility as confounders.

Results

Our analytic sample included 3309 second pregnancies. The mean IPI was 75.36 months. Compared with second pregnancies with a short IPI of 7-24 months, those with long IPIs had higher adjusted odds ratios (ORs) of preterm delivery (1.70-2.00 [95% CI 1.20-3.33]) and term low birthweight (2.16-2.68 [1.10-6.17]), but not small-for-gestational age. The mean maternal age at current delivery was 32.0 years. Compared with the reference group (25-29 years), second pregnancies for the oldest maternal age group (≥35 years) showed no statistically significant increased ORs for adverse perinatal outcomes.

Conclusion

Long IPI is a significant contributor to preterm delivery and term low birthweight. Health care providers need to pay close attention to preterm delivery prevention and fetal growth during prenatal care for second pregnancies where the mothers have long IPIs.

Background

Since the One-child Policy was revised to a Two-child policy in 2013, the number of pregnancies with previous cesarean section suddenly increased in China. The aim of this study was to test if a previous cesarean section influenced the neonatal birth weight under Chinese background.

Methods

A retrospective study was conducted. Path analysis was used to test the hypothesized model for the association among previous cesarean section, placenta previa, gestational age and neonatal birth weight. Comparative fit index, the root-mean-square error of approximation and weighted root-mean-square residual were used to evaluate the model fit.

Results

3466 electronic records for second pregnancies met the criteria; a modified model was established (the root-mean-square error of approximation=0.049, comparative fit index=0.992, weighted root-mean-square residual=0.960). The effects of previous cesarean section on neonatal birth weight were mediated via four paths. The direct effects (coefficient: 0.056) showed opposite signs compared to indirect effects (coefficient: -0.127) in this path analysis. It meant that the negative effects of the previous cesarean section were suppressed by other factors which bring positive effects.

Conclusion

This study showed that previous cesarean section had negative effects on neonatal birth weight with increasing incidence of placenta previa and preterm birth. But these effects were suppressed by other positive factors, such as maternal body mass index, just after the child policy updated in China.