Quality assessment of medical care for females with stillbirth according to a questionnaire

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Abstract

BACKGROUND: Death is a leading factor in post-traumatic stress disorder development. The adequacy of medical and psychological support for childbirth with a dead fetus plays a key role in severe psychological disorder prevention.

MATERIALS AND METHODS: The authors have developed a questionnaire to assess the quality of obstetric, anesthesiological, and psychological assistance to females with death. The questionnaires of 173 respondents were analyzed. The duty factor or completeness of answers was 0.96. Of the cases, 55% of childbirth with a dead fetus occurred after 34 weeks of gestation, whereas the time interval from the moment of delivery to the questionnaire did not exceed 2 years in 60% of cases.

RESULTS: The heavy emotional state was rated by 70% of females. Psychological assistance was recognized as unsatisfactory in 52% of cases. Most females (63%) wanted to be conscious at the time of the birth of a child and contact with him. This issue was not discussed with females in labor in 51% of cases. Neuroaxial methods of analgesia were used in 36% of cases in vaginal childbirth, whereas anesthesia was not performed in 40% of patients. Sedative therapy was needed by 76% of females in the postpartum period, which was prescribed only in 25% of cases. A third of respondents rated unsatisfactory medical care provided, and 94% of females believe that special training and seminars on communication with patients who have had a stillbirth are necessary for medical workers.

CONCLUSION: The analysis of questionnaires filled out by women with stillbirth revealed several problems in the quality of medical care provided to them, wherein the most significant was the insufficient realization of the patient’s desire for contact with a dead child, insufficient anesthesia in childbirth, and sedation in the postpartum period, as well as unsatisfactory psychological care provided by doctors of an interdisciplinary team and a clinical psychologist, according to respondents.

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About the authors

Yulya S. Mysovskaya

Saratov City Clinical Hospital № 1 named after Yu.Ya. Gordeev

Author for correspondence.
Email: yulya-mys@yandex.ru
ORCID iD: 0000-0002-0544-7886

obstetrician-gynecologist

Russian Federation, 19 Kholzunova str., 410017, Saratov

Dmitriy V. Marshalov

Saratov State Medical University named after V.I. Razumovsky

Email: marshald@mail.ru
ORCID iD: 0000-0002-8774-0700

M.D., Dr. Sci. (Med.), Associate Professor

Russian Federation, 19 Kholzunova str., 410017, Saratov

Efim M. Shifman

M.F. Vladimirskiy Moscow Regional Research Clinical Institute

Email: eshifman@mail.ru
ORCID iD: 0000-0002-6113-8498

M.D., Dr. Sci. (Med.), professor

Russian Federation, Moscow

Aleksandr V. Kuligin

Saratov State Medical University named after V.I. Razumovsky

Email: avkuligin@yandex.ru
ORCID iD: 0000-0001-5705-215X

M.D., Dr. Sci. (Med.), Associate Professor

Russian Federation, 19 Kholzunova str., 410017, Saratov

Ekaterina E. Zeulina

Saratov State Medical University named after V.I. Razumovsky

Email: zeulina@list.ru
ORCID iD: 0000-0003-1297-5123

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, 19 Kholzunova str., 410017, Saratov

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Supplementary files

Supplementary Files
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1. Fig. 1. Women’s satisfaction with the quality of psychological care provided at the hospital stage, abs. (%).

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2. Fig. 2. A source of psychological assistance to patients with stillbirth.

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3. Fig. 3. Realization of the patient’s preferences regarding her stay in consciousness at the time of delivery of a dead fetus.

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