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Master Thesis

Soins palliatifs périnataux en salle de naissance après une interruption médicale de grossesse sans arrêt de vie fœtale entre 22 et 25 semaines d'aménorrhée

Abstract : Introduction to the study: Most of the time, medical termination of pregnancy (MTP) involve a feticide; yet, if the pathology is rapidly lethal, end-of-life support for the child through palliative care may be offered. In France, neonatal palliative care for born alive infants at the limit of viability, following premature onset within the context of MTP, raises controversy. This care can alleviate part of the couple’s and caregivers’ anxiety. However, this issue remains complex because it raises ethical, legal and medical questions. Objectives of the study: To identify midwives' perceptions of peri-natal palliative care in the childbirth room within the context of MTP, performed between 22 and 25 weeks, without any fetal end-of-life, and the factors influencing these perceptions. Materials and methods: This is a qualitative study of midwives who have state-certified midwives diplomas and who have already performed in the birth room. It was carried out from May to October 2018 in 3 maternities in the city of Marseille. It includes 10 semi-structured interviews conducted using previously tested concept cards. Results: This study shows an ambivalence of midwives' feelings about this care. However, it was found that they all have a favorable opinion on this subject. Proposals on the implementation of support for the couple and the unborn child were exposed, highlighting the training of perinatal professionals, since generalized misreading have been pointed out. However, the practicalities of perinatal palliative care seem to be known. Conclusion: These investigations have highlighted the various midwives’ perceptions about this care, inherent to its emotional and therefore ethical dimension. In order to respect the legal framework, this support requires a meticulous and patient-friendly organization, even though the procedure remains identical to “standard” perinatal palliative care. It should be noted that perinatal palliative care in the birth room following a MTP with no foetal life-limiting at the limit of viability cannot be a systematic substitute for MTP with feticide since it is a "shared medical decision" involving both the couple and caregivers.
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https://dumas.ccsd.cnrs.fr/dumas-02382875
Contributor : École Universitaire de Maïeutique Marseille Méditerranée (eu3m) <>
Submitted on : Wednesday, November 27, 2019 - 2:02:17 PM
Last modification on : Wednesday, October 21, 2020 - 3:12:56 AM

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  • HAL Id : dumas-02382875, version 1

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Roxane Pamart. Soins palliatifs périnataux en salle de naissance après une interruption médicale de grossesse sans arrêt de vie fœtale entre 22 et 25 semaines d'aménorrhée. Gynécologie et obstétrique. 2019. ⟨dumas-02382875⟩

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