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Einleitung: Der perinatale Kindstod stellt für die betreuenden Pflegepersonen eine extreme Belastungssituation dar und führt zu schwerwiegenden, psychischen Folgen bei den Eltern. Da die vorherrschende Tabuisierung des Themas jedoch oft zu einer inadäquaten Betreuung der Betroffenen führt, soll im Zuge der vorliegenden Arbeit das Erleben der Mütter und Väter sowie den Pflegenden, die Bedürfnisse beider Gruppen und mögliche Konsequenzen daraus dargestellt werden. Methodik: Zur Beantwortung der Forschungsfragen wurde eine umfassende Literaturrecherche im Zeitraum von Juli 2020 bis November 2020 durchgeführt. Die Suche beschränkte sich hauptsächlich auf die elektronischen Datenbanken CINAHL und PubMed. Ergebnisse wurden mithilfe von zuvor festgelegten Ein- und Ausschlusskriterien gefiltert. Insgesamt konnten acht Studien in die Arbeit eingeschlossen werden. Ergebnisse: Auf Basis der verwendeten Literaturquellen wurden die Ergebnisse in drei Hauptkategorien gegliedert: Erleben der betroffenen Eltern, Erleben der involvierten Pflegepersonen und pflegerische Interventionen. Darüber hinaus enthält jede Hauptkategorie mehrere Unterkategorien, welche wesentlich für die Darstellung der Ergebnisse sind. Diskussion: Betroffene Eltern und Pflegepersonen erleben starke Emotionen im Zusammenhang mit perinatalen Todesfällen. Aus den Bedürfnissen der Mütter und Väter in solchen Situationen können pflegerische Interventionen und auch richtungsweisende Verhaltensweisen für das Pflegepersonal abgeleitet werden. Eine Sensibilisierung hinsichtlich dieses Themas muss unbedingt vorgenommen werden, um eine qualitativ hochwertige Pflege bieten zu können. Introduction: The perinatal death poses a significant burden for the treating nursing staff and causes considerable psychological consequences for the parents. The ongoing tabooing of this event often results in an insufficient care for everybody involved, so much that this paper is dedicated to not just demonstrate the impact it has on both parents and nursing staff, but also define each party’s needs and possible consequences to satisfy them. Methodology: To address the research question a thorough study in literature was made between July and November of 2020. The groundwork was mainly limited on the electronic databases CINAHL and PubMed. The findings were narrowed down by previously defined criteria, resulting in the use of eight different publications on their requirements. Results: Based on the imposed criteria, the findings were separated in three main categories: the parents’ ordeal, the experience for the involved nursing staff and possible nursing measures. Each of the categories expands over several minor subcategories to enable an easier presentation of the scientific findings. Discussion: The affected parents and nursing staff experience strong emotions relating to the perinatal death. By acknowledging the needs of the involved parents in those terrible situations proper nursing measures could be derived and directional policies could be put into place for the staff handling such situations. Raising the awareness for this topics sensitivity and detrimental impact could be crucial to ensure a high-quality care.

Zusammenfassung Ziele: Nach Mitteilung einer mit dem Leben nicht zu vereinbarenden Diagnose des Kindes, werden Eltern mit der Entscheidung konfrontiert, die bereits weit fortgeschrittene Schwangerschaft vorzeitig zu beenden oder das Kind auszutragen, bis es spontan während der Schwangerschaft oder kurz nach der Geburt verstirbt. Diese meistens vollkommen überraschende Situation ist von der Unausweichlickeit des Verlustes geprägt und eng mit ethisch schwierigen Entscheidungen verknüpft. Ein solcher Verlust kann die psychische Gesundheit betroffener Eltern massiv belasten. Studien zeigen, dass bedürfnisorientierte Begleitung die Eltern entlastet, unabhängig von ihrer Entscheidung, die Schwangerschaft frühzeitig zu beenden oder fortzuführen. Ziele der Studie sind, das Unterstützungsangebot in der Schweiz aus Sicht betroffener Eltern und beteiligter Fachpersonen zu beleuchten und Entwicklungsmöglichkeiten der Versorgung aufzuzeigen. Dieser Artikel schildert die auf den Erfahrungen der Eltern basierenden Ergebnisse. Methodik: Interviews wurden mit 32 Müttern und Vätern zwischen Dez. 2012 und März 2014 geführt, verbatim transkribiert und thematisch analysiert. Ergebnisse: Es wurden 6 Themen identifiziert, die sich über den Zeitraum zwischen Diagnose und kurz nach der Geburt erstrecken: „Schock“, „Optionen und Dilemmas“, „Verantwortung übernehmen“, „Immer noch schwanger sein“, „Abschied nehmen“ und „die Zukunft planen“. Die Ergebnisse weisen auf Lücken bezüglich Kontinuität und Qualität der Versorgung hin und offenbaren unterschiedliche Sichtweisen auf die Problematik. Schlussfolgerung: Die Studie liefert wertvolle Einsichten in die Erfahrungswelt und Versorgungsbedürfnisse von Eltern, die während der Schwangerschaft mit einer letalen fötalen Diagnose konfrontiert worden sind. Die Resultate tragen dazu bei, die aktuellen Praktiken von involvierten Fachpersonen zu überdenken und den spezifischen Bedürfnissen der Eltern während Schwangerschaft, Geburt und Wochenbett sowie der Palliativpflege des Kindes anzupassen.

In Germany, 9% of babies are born preterm, 32 % of them die. A neonatal death is a challenge for both parents and neonatal health care professionals alike. In 1994 the Department of pediatric nursing of the Klinik für Neonatologie/Charité launched an initiative to offer bereavement care for parents who have experienced a perinatal death.The aim of this study was to determine the needs of parents after the perinatal loss of their child from the perspective of health care professionals (HCP).Six interviews were conducted with the HCP in Neonatology, Charité – University of Medicine in Berlin and analyzed using qualitative content analysis according to Mayring.The results show the differing needs of the parents and are focused on five main points: “Avoid and protection of overtaxing”, “express emotions”, “safety and family support”, “bonding with the child” and “give understanding and meaning”.The parents needs connected with the Caring Theory of Swanson show that they mostly correspond with the dimension of “Being with”. It underlines the importance of the emotional and educational support of parents in bereavement care during the perimortal period. A major requirement here is to “get to know” the parents and their needs and to accompany them individually. Offering compassionate care and interaction between nurses and bereaved parents complys with the “doing for” and “enabling” from Swanson's model.

The prevention and treatment of preterm birth remains an unsolved problem in modern obstetrics. Progesterone has a variety of actions on the myometrium and the cervix, among others inhibition of myometrial contractility and a cervix strengthening effect by inhibiting the production of proinflammatory cytokines and prostaglandins as well as by reducing the synthesis of proteins, which play a crucial role in initiating labour. Consequently, progesterone may be a promising candidate for the prevention of preterm birth.We searched PubMed from 1956 to August 2014 using a combination of key words and text words related to preterm birth and progesterone. ('progesterone', progestins, 17-OHPC). The aim of the literature search was to determine evidence-based indications for the use of progesterone in the prevention of preterm birth.(i) Patients with a singleton pregnancy and history of preterm birth should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) from 16+0 to 36+0 weeks of gestation (alternatively 250 mg intramuscular 17-OHPC weekly): level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone reduces the incidence of preterm birth34 and37 weeks of gestation and perinatal mortality significantly. (ii) Patients with singleton pregnancies and a sonographically short cervix (≤25 mm) before 24 weeks of gestation should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) until 36+6 weeks of gestation: level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone leads to a significant reduction in the incidence of preterm birth28,33, and35 weeks of gestation and is associated with a significant reduction of neonatal morbidity. (III) There is a lack of evidence to recommend vaginal progesterone or intramuscular 17-OHPC for primary tocolysis or for "adjunctive" tocolysis (in combination with conventional tocolytic agents). (IV) There is a growing body of evidence that vaginal progesterone (400 mg/day) after successful tocolysis ("maintenance therapy") is a promising option for prolongation of pregnancy: level of evidence 1b, grade of recommendation +. (V) Data from the literature are insufficient to recommend progesterone in patients with preterm rupture of membranes or in the perioperative management of patients requiring transvaginal cervical cerclage. (VI) The vaginal administration of progesterone is well-tolerated by the patients and has only minor maternal side effects, whereas intramuscular injections of 17-OHPC are associated with a significant higher rate of side effects (e. g. local pain, nausea, diarrhoea). It is mandatory to inform patients on the off-label use of progesterone in pregnancy.Prophylactic progesterone administration is an evidence-based method for the prevention of preterm birth in women with a previous preterm birth and in pregnant women with a sonographically short cervix (≤25 mm) before 24 weeks of gestation. Vaginal progesterone is favoured over intramuscularly applied 17-OHPC, especially because of the lower rate of maternal side effects. Whether progesterone is an effective approach for the treatment of preterm birth as a tocolytic agent (primary, adjunctive) or for maintenance therapy after arrest of preterm labour has to be shown in further well-designed randomised and controlled trials with adequate statistical power.

Even though vaginal birth after Caesarean section (VBAC) is recommended, an out-of-hospital setting is discussed controversially. First of all, uterine rupture and placental complications are named. Nevertheless, an increasing number of women with a prior Caesarean section decide to give birth in an out-of-hospital setting. What is the maternal and neonatal outcome in international studies in these cases?The databases of Medline, Cinahl, Embase and Cochrane Library on vaginal birth after Caesarean section in out-of-hospital settings were searched. Included are studies in German and English language without a limit on year of publication, which describe maternal and neonatal outcomes.5 studies were found. All of them describe a high VBAC rate (73.5-98%). Only one study found uterine ruptures. Haemorrhage/placental complications were described in 2 studies (0.5 and 1.7%). None of the studies found maternal deaths. Neonatal death was described in 3 studies in a range from 0 -1.7%.There is a wide difference in the population of the studies. An important difference is the parity of the women and the prior mode of birth. 4 of the 5 studies do not see a reason not to try VBAC in an out-of-hospital setting. Further studies are necessary to inform the increasing number of women who decide to try VBAC in an out-of-hospital setting.