Patients perspectives on single survival following intrauterine interventions for complicated twin pregnancies – a qualitative approach

Introduction:

Prenatal intrauterine interventions, most notably intrauterine laser ablation of inter-fetal vessels in case of twin-to-twin transfusion syndrome (TTTS), have been shown to decrease mortality and morbidity in affected monochorionic twin pregnancies. However, laser ablation may still result in fetal death of one twin in some cases. The aim of this qualitative study was to detect patients' perspective focusing on burdens and reliefs concerning the death of one twin. We focused on individual experiences to enhance our understanding about the needs of women and couples in the treatment process.

Methods:

Two exemplary cases were selected and women invited to report their experiences retrospectively one year after the treatment using a semi-structured interview.

Measurements:

The semi-structured interview was developed including questions related to different milestones during the pregnancies: the onset of complications, the time-span of the treatment process and the perinatal and postpartum period. The content of the interview were 1. first reactions, 2. distress and 3. coping strategies during the whole period.

Demographic and medical data, including information regarding the monochorionic twin pregnancy, the applied intervention and the selective IUFD were obtained from medical data sheets.

Data analyses:

A qualitative content analysis according to Mayring was conducted. Two main categories emerged: 1. experienced emotions and 2. support/coping strategies.

Results:

Category I: Experienced emotions.

Both women reported ambivalent feelings from the onset of complications until the postpartum period. The most frequently expressed emotions can be summarized as feelings of helplessness and anxiety. Despite of negative emotions, both women expressed also feelings of confidence to cope with the situation, gratefulness for the support and optimism.

Category II: Support/Coping strategies.

In the patients“ perspective, the most important support was provided by the professional staff. Additionally, both patients reported to frequently share an inner dialogue with both of the fetuses, even after single demise. It was helpful to talk about positive and negative emotions, thoughts and about their interpretation of the situation.

Discussion:

Experiencing the death of one twin was a critical life event for the women. A close relationship with the interdisciplinary treatment team was obviously the most helpful support for both women in our study and may be seen as a resilience factor. Offering relevant and comprehensive information on medical and psychological conditions during these pregnancies allows women to play an active role and to cope with the situation. After the death of one child it was most important for the women, to have the opportunity to grief and to choose how to grief for the death baby.