Prenatal and Obstetric Parameters of Late Terminations: A Retrospective Analysis

Background In Germany, the highly sensitive issue of late terminations of pregnancy and feticide is regulated in Sec. 218a para. 2 of the German Penal Code (medical indication). This study aimed to investigate the prenatal obstetric approach after feticide and the rate of maternal complications. Material and Methods All feticides of singleton pregnancies carried out at Leipzig University Hospital (n = 164) in the period between 01/2016 and 12/2019 were retrospectively analyzed. Selective feticides of multiple pregnancies were excluded from the study. Target indicators for the prenatal obstetric approach were sonographic accuracy of estimation, method used to induce feticide, time between feticide and delivery, and whether curettage was required. The rate of maternal complications was defined as blood loss of ≥ 500 ml. Results The number of feticides as a percentage of the total number of births during the investigation period was 1.6%. None of the terminations were performed primarily because of a serious risk to the motherʼs physical health; all of the indications to terminate the pregnancy were based on the psychosocial burden and the risk to the motherʼs mental health as outlined in Sec. 218a StGB (German Penal Code). The most common fetal diagnoses in the context of a maternal psychosocial emergency were central nervous system abnormalities (29.3%), numerical chromosomal aberrations (29.3%) and structural chromosomal aberrations/syndromes (21.3%). Sonographic measurements were used to estimate fetal weight and the weight of around half of the fetuses was underestimated (− 121.8 ± 155.8 g). The margin of estimation error increased with increasing gestational age (p < 0.001). Misoprostol was the most common drug administered to induce labor. No significant association was found between the method chosen for induction, parity, fetal birth position, fetal anomaly, fetal gender, birth mode or the number of previous cesarean sections and Δdelivery. However, a significantly higher loss of blood was observed with longer Δdelivery (p = 0.02). The likelihood of requiring curettage increased with increasing loss of blood. The number of maternal complications as a percentage of the total patient population was 10.4%. Only 11% of patients agreed to a postmortem examination. Conclusion Late terminations of pregnancy carried out in accordance with Sec. 218a para. 2 StGB are a reality and must be understood and accepted as a possible consequence of modern prenatal medicine. The complication rate after feticide and the subsequent obstetric procedure was 10% for the above-defined maternal complication. Late terminations and their obstetric management should be carried out in specialized perinatal centers which offer interprofessional expertise.

The psychological burden of volunteers in psychosocial emergency care – a qualitative interview study

Psychosocial emergency care personnel provide voluntary psychological support directly after potentially traumatic events. During emergency responses, they experience challenging situations. However, previous quantitative studies suggest that the psychological burden of psychosocial emergency care personnel does not exceed that of the general population. This study aimed to obtain an in-depth analysis of the volunteers’ psychological reactions and resources regarding emergency responses. 36 psychosocial emergency care volunteers (12 pre-training, 12 post-training, 12 experienced) were invited to participate in semi-structured interviews. The volunteers were selected from previous cross-sectional and longitudinal studies on secondary traumatization in psychosocial emergency care volunteers. A qualitative content analysis of the transcribed interviews was performed following the principles of summary and inductive category development. We identified 845 codes which we summarized in three overarching categories: (I) reactions to emergency responses, (II) psychosocial emergency care work related resources and (III) experiences and changes in life perspective related to working in psychosocial emergency care. The volunteers described both emotional and physical reactions to emergency responses. While they perceived social support as a key coping resource and reported a greater appreciation of their own lives and their families due to their work, many volunteers also felt increased concern that something could happen to them. The volunteers’ reactions and symptoms are reasonable responses to stress and not indicative of serious impairment. Nevertheless, emergency responses are both emotionally and physically challenging. Volunteers should be carefully selected, receive regular supervision and determine the frequency of emergency responses.

Psychosocial emergency care in times of COVID-19: the Essen University Hospital concept for corona-infected patients, their relatives, and medical staff

Due to the SARS CoV-2-virus (COVID-19), anxiety, distress, and insecurity occur more frequently. In particular, infected individuals, their relatives, and medical staff face an increased risk of high psychological distress as a result of the ongoing pandemic. Thus, structured psychosocial emergency concepts are needed. The University hospital of Essen has taken up this challenge by creating the PEC concept to reduce psychosocial long-term consequences for infected patients, relatives, and medical staff at the university hospital. The concept includes professional medical as well as psychological support to convey constructive coping strategies and the provision of adequate tools such as the low-threshold online training program (CoPE It), which is accessible via the webpage www.cope-corona.de.

Italian train derailment and the civil protection emergency psychologist intervention: A case report

In the last years the mind-body unity, and so giving both physical and psychological attention, is entering increasingly in the first-responder system. This paper reports the intervention done by the Psychosocial Emergency Team, the Civil Protection Emergency Psychologists, during the multi-forces’ intervention on the Limito di Pioltello train crash, a major accident occurred in Italy in 2018. The attempt is to give a photography of the psychological part of the rescue system in this scenario, showing phases, methods, and some rationales subtended in our actions. The aim is to share procedures and open a constructive dialogue that could bring to more standardized interventions among non-governmental emergency psychologist teams with the aim to always provide better care both to victims and their families.

The Poetics of Heritage: an inquiry into disaster.

This paper argues that heritage is what contemporary culture makes of history and that this may distort our ability to face future realities. Funded by the UK Heritage Lottery Fund, the VIEWPOINT ecological arts project at the confluence of two rivers in Cockermouth, Northwest England, questioned the deployment of art and heritage as a means of community recovery from the 2009 and 2015 flood disasters. As the climate crisis accelerates and the psychosocial emergency increases, this project reassigned a Wordsworth poem and repurposed twelve large rocks to celebrate the potential for communities to live with their rivers in the future and defy their tendency towards nostalgia and memorialization.However, the situation was exacerbated when the United Nations Educational, Scientific and Cultural Organisation World Heritage awarded cultural heritage status on The Lake District National Park, affixing the environmental management of the area to Beatrix Potter’s romanticized notion of sheep farming; thereby ensuring perpetual landscape deforestation and future flooding.

Secondary Traumatization, Psychological Stress, and Resilience in Psychosocial Emergency Care Personnel

Volunteers active in psychosocial emergency care offer psychological first aid to survivors of accidents and trauma, their relatives, eye witnesses, bystanders, and other first responders. So far, there are no studies that investigate the secondary and primary traumatization of this group of first responders. We included N = 75 volunteers, who filled out questionnaires to assess their secondary (QST/FST) and primary traumatization (PDS), and levels of comorbid psychological stress (PHQ-9, GAD-7, SF-12). We investigated factors of resilience by measuring attachment behavior (ECR-RD, RQ-2), level of personality functioning (OPD-SFK), sense of coherence (SOC-29), social support (F-SozU), and mindfulness (MAAS). The volunteers’ levels of secondary and primary traumatization were below cut-off scores. Their levels of comorbid psychological stress were comparable to representative norm samples. Additionally, the volunteers presented high levels of resilience. Gender (β = 0.26; p < 0.05), case discussions (β = −0.37; p < 0.05), and social support (β = 0.45; p < 0.01) were revealed to be predictors of secondary traumatization, while mindfulness turned out to be a predictor of primary traumatization (β = −0.34; p = 0.008). However, we cannot rule out that the low prevalence of traumatization and comorbid psychological stress in our study sample might not be explained by a positive response bias.