Terminology and Epidemiology of Perinatal Loss (Nursing)

00:01 Today, we're going to talk about a subject that's not quite as joyful as some of the other topics that we've covered.

00:07 Today, we're going to talk about perinatal grief and loss.

00:11 There are many different types and causes of loss, and I want to break these down by terminology, so that you know exactly what each term means.

00:19 Abortion refers to a pregnancy loss that occurs up to 20 weeks of pregnancy or any pregnancy termination at any stage.

00:28 Anembryonic pregnancy refers to a nonviable pregnancy with a gestational sac and no yolk sac or embryo.

00:37 Early pregnancy loss or embryonic loss occurs very early in the pregnancy, usually before about 13 weeks.

00:45 A fetal demise or intrauterine demise occurs after 20 weeks of gestation.

00:51 Recurrent pregnancy loss refers to two or more spontaneous losses at any gestational age.

00:58 And a neonatal death refers to when the baby dies sometime between birth and the first 28 days.

01:06 Now, we've review a lot of terminology here. These are medical terms.

01:10 When we're talking to the family who've experienced the loss, we might not want to use any of these.

01:16 They're overwhelming and they may not know what they mean.

01:19 So maybe try words like, "I'm sorry about your miscarriage." Or "I'm sorry that your baby died.", "I'm sorry that you experienced a fetal loss." We also want to be careful about terms like abortion because there's a lot of stigma attached to that term.

01:33 So that would be something we might talk amongst our healthcare professional team about, but we may not use that with a client.

01:40 Annually, more than 900,000 families are affected by perinatal loss.

01:46 This is why it's so important that we talk about it both here at Lecturio and hopefully, in your class.

01:52 Now, let's break down this epidemiology a little bit more.

01:55 So around 25% of the perinatal losses happen between 20 and 27 weeks.

02:01 Around 25% happened after 28 weeks. Around 33% happened under the age of 28 days.

02:10 And around 16% happened sometime between 28 days and up to the end of that first year.

02:16 We've talked often about a breakdown in statistics by race and ethnicity.

02:23 I want you to pay attention to this slide.

02:25 What I hope jumps out at you is that 10.53% which is a lot more than all the other racial and ethnic groups.

02:32 The losses are experienced by non-Hispanic Black families.

02:36 So you see the disparities that are related to social drivers of health and racism here in living color.

02:43 Now, let's think about the losses in terms of risk factors.

02:49 So what would make a birthing person at risk for experiencing a perinatal loss? First, a maternal age greater than 35 years.

02:57 If you remember my popcorn analogy from before, the older we get, the eggs are not as genetically normal.

03:04 So we're more likely to have genetic abnormalities which can lead to perinatal loss.

03:10 If someone has experienced a prior pregnancy loss, they're at risk for a repeat.

03:14 Also, maternal medical conditions, things like an infection or diabetes, obesity, thyroid disease can contribute to perinatal loss.

03:24 Having extreme amounts of stress or inherited blood clotting disorders or anything like that that may impact placental formation.

03:33 Other factors that may cause perinatal loss include pregnancy with an intrauterine device in place.

03:40 So hopefully, you don't get pregnant when you have an IUD, but if you do, then you're more likely to experience a loss.

03:47 Also, medication and substance abuse, so things like smoking or using alcohol.

03:53 And when we think about race and ethnicity, I want you to really pay attention to the fact that it's not the fact that someone is Black or someone is Latina that increases their risk.

04:03 It's their exposure to racism and discrimination and that increase in stress is what causes that increase in risk.

04:12 Also, think about environmental exposures.

04:15 So if you think about things like our, oh, maybe our TORCH infections that we talked about before, toxoplasmosis and cytomegalovirus and herpes but also things like where you work.

04:28 So do you work in a factory? Or do you live in a place where you might be exposed to chemicals in a river or in water or in the food that you eat? If the birthing person experiences trauma.

04:39 So this could be an accident, falling down the stairs or being involved in a motor vehicle accident.

04:43 But also think about intimate partner violence or anything like that can also increase someone's risk of perinatal loss.

04:51 And anytime you experience bleeding.

04:53 Bleeding in pregnancy is never normal, but if there's bleeding around the gestational sac, there could be an issue with implantation which would ultimately lead to a perinatal loss.