Proceso de atención al parto en la muerte fetal tardía / Delivery care process in late fetal death

Objetivo: analizar la evidencia disponible acerca del proceso de atención al parto en la muerte fetal tardía, que permita conocer la experiencia y las necesidades de madres y padres, y la experiencia y dificultades de los profesionales que atienden estos casos. Método: revisión narrativa de estudios cualitativos publicados desde 2005 hasta agosto de 2017 en las bases de datos Pubmed, Cinahl, Embase, Scielo, Cuiden y Lilacs en el campo de la muerte fetal tardía, atendiendo a su definición en el contexto español (a partir de 28 semanas de gestación) y en el internacional (a partir de la semana 24 de gestación). Se llevó a cabo un análisis temático de los artículos seleccionados, identificándose cuatro áreas temáticas en función a la experiencia de las madres y padres, por un lado, y dos áreas temáticas según la experiencia de los profesionales. Resultados: se seleccionaron siete artículos cualitativos (cuatro análisis de contenido, dos análisis fenomenológicos y una teoría fundamentada). Los temas identificados respecto a la experiencia de madres y padres estuvieron relacionados con un diagnóstico devastador, comienzo de la despedida, construcción de la maternidad y la paternidad, e impacto de la actuación de los profesionales. Los temas identificados en relación a la experiencia de los profesionales fueron impacto personal y profesional, y manejo del caso. Conclusiones: esta revisión pone de manifiesto tanto lo traumático de la experiencia de las madres y padres que sufren una pérdida fetal tardía como la afectación personal de los profesionales que les atienden, que presentan dificultades para afrontar adecuadamente el caso, y demandan formación específica para ayudar de forma eficiente en el proceso de duelo

Objective: to analyze the evidence available about the delivery care process in late fetal death, allowing to learn about the experience and needs of mothers and fathers, and the challenges for the professionals managing these cases. Method: a narrative review of qualitative studies published from 2005 to August, 2017 in the following databases: Pubmed, Cinahl, Embase, Scielo, Cuiden and Llilacs, on the area of late fetal death, according to its definition in the Spanish setting (from 28 gestation weeks onwards), and in the international setting (from week 24 of gestation). A themed analysis was conducted on the articles selected, and four theme areas were identified, based on the experience of mothers and fathers on one hand, and two theme areas according to the experience of professionals. Results: seven qualitative articles were selected: four content analyses, two phenomenological analyses, and one grounded theory. The themes identified regarding the experience of mothers and fathers were associated with a devastating diagnosis, the initial goodbye, building maternity and paternity, and the impact of the action by professionals. The themes identified associated with the experience of professionals were: personal and professional impact, and case management. Conclusions: this review shows the traumatic experience of mothers and fathers suffering a late fetal loss, as well as the personal impact on those professionals managing them, who will be faced with difficulties for addressing the case adequately, and demand specific training to help in the mourning process in an efficient way

[Knowledge of and opinions on violence against women among health professionals in specialized care]. / Conocimientos y opiniones de los profesionales de la salud de atención especializada acerca de la violencia de género.

OBJECTIVE: The aim of this study was to evaluate knowledge of gender violence among health workers/medical staff in specialized healthcare and their opinions on the subject. A further aim was to identify the organizational barriers perceived by these workers and their proposals to enhance the early detection of this phenomenon and care of victims. METHOD: We performed an observational, cross sectional study based on an anonymous survey of health workers/medical staff working in the pediatrics, obstetrics or emergency departments of two hospitals in health district 8 of Madrid. RESULTS: Overall, health professionals had average knowledge about gender violence. A total of 58.2% believed that physical abuse of women was associated with the lower social classes, while 72.8% believed that victims were uneducated women, housewives or foreigners; 67.6 % believed that aggressors were alcoholic, drug addicted or unemployed men. Almost all health professionals (97.7%) considered that gender violence against women was an important problem that usually went undetected. However, 66.7% did not include this phenomenon in the differential diagnosis of women with physical injuries. Notable among the organizational obstacles identified were workload, lack of training and information, and the absence of a protocol. CONCLUSIONS: Knowledge of gender violence among health professionals was average, with no significant differences between hospitals or among the three categories of staff surveyed. Stereotyped beliefs were found among health professionals who, nevertheless, believed they had an important role in detecting battered women. Reducing the organizational barriers detected could improve the care of these patients.