Nas vias de interromper ou não a gestação: vivências de gestantes de fetos com anencefalia

Abstract

Resumo A anencefalia é uma malformação caracterizada pela ausência total ou parcial do encéfalo e o Brasil é o quarto colocado em número de nascimentos de fetos anencéfalos no mundo. Existe associação entre anencefalia fetal e maior número de complicações maternas. A partir de 2012 a mulher com gestação de anencéfalo poderá manter ou interromper a gestação, se assim o desejar, sem necessidade de autorização judicial. Objetivos: compreender as vivências das mulheres de fetos com anencefalia e identificar os fatores determinantes para a escolha de interromper ou não interromper a gestação. Estudo qualitativo e método das narrativas de vida, com 12 mulheres, maiores de 18 anos e com diagnóstico de feto anencéfalo, que realizaram a interrupção da gestação ou o parto em uma maternidade pública do Rio de Janeiro. A coleta dos dados foi entre junho e novembro de 2016 e encerrada quando os padrões narrativos alcançaram a saturação progressiva, a partir das recorrências. Os enunciados emergidos após leitura flutuante e aprofundada foram articulados em Núcleos Narrativos e realizada análise comparativa e compreensiva dos dados. Os relatos trouxeram à tona as vivências intensas dessas mulheres, como também as fragilidades existentes em relação ao cuidado e a problemática da interrupção da gestação.

Decision‐making and future pregnancies after a positive fetal anomaly screen: A scoping review

“…Eighteen studies (Baillie et al, 2000; Brandenburg et al, 1992; Bryar, 1997; Carolan & Hodnett, 2009; Dallaire et al, 1995; Evers‐Kiebooms et al, 1988; Fernandes et al, 2020; Gammeltoft et al, 2008; Irani et al, 2019; Kelly, 2009; Lafarge et al, 2013, 2019; Menary, 1987; Ndjapa‐Ndamkou et al, 2013; Pelly, 2003; Rillstone, 1999; White‐Van Mourik, 1989; Wollenschein et al, 2007) highlighted the reasons why parents had a future pregnancy, or tried for one following a screen positive result for a potential or actual fetal anomaly in a previous pregnancy. Parents in seven studies highlighted that giving birth to a healthy child was essential to achieve a closure for their previous pregnancy since they could: (1) heal emotional wounds, (2) restore a sense of equilibrium in the family unit and (3) remove doubts about their reproductive capabilities (Dallaire et al, 1995; Gammeltoft et al, 2008; Lafarge et al, 2013; Menary, 1987; Rillstone, 1999; White‐Van Mourik, 1989).…”

“…Nineteen studies (Baillie et al, 2000; Brandenburg et al, 1992; Bryar, 1997; Carolan & Hodnett, 2009; Dallaire et al, 1995; Evers‐Kiebooms et al, 1988; Fernandes et al, 2020; Gammeltoft et al, 2008; Hammond et al, 2021; Irani et al, 2019; Jones et al, 1984; Kelly, 2009; Leuthner et al, 2003; Menary, 1987; Ndjapa‐Ndamkou et al, 2013; Pelly, 2003; Rillstone, 1999; White‐Van Mourik, 1989; Wollenschein et al, 2007) highlighted the reasons why parents were reluctant to become pregnant again following a diagnosis of a fetal anomaly in a previous pregnancy. For these parents, the fear of the anomaly recurring and reliving the trauma was sufficient to prevent them from becoming pregnant again (Baillie et al, 2000; Brandenburg et al, 1992; Bryar, 1997; Carlsson & Mattsson, 2018; Fernandes et al, 2020; Ferreira da Costa et al, 2005; Gammeltoft et al, 2008; Hammond et al, 2021; Irani et al, 2019; Kelly, 2009; Leuthner et al, 2003; Menary, 1987; Rillstone, 1999; White‐Van Mourik, 1989). This fear also persisted in parents whose children received a normal diagnosis following detailed investigations (Baillie et al, 2000).…”

“…Parents who previously believed a diagnosis of fetal anomaly only happen to others were left feeling vulnerable to a sense of the arbitrariness of a diagnosis, particularly when they had done all they could to ensure a healthy pregnancy (Baillie et al, 2000; Bryar, 1997; Carolan & Hodnett, 2009; Gammeltoft et al, 2008; Kelly, 2009; Leuthner et al, 2003; Menary, 1987; Rillstone, 1999; White‐Van Mourik, 1989). A previous positive diagnosis of fetal anomaly caused women to lose confidence in their reproductive capacity to produce a healthy baby (Carolan & Hodnett, 2009; Fernandes et al, 2020; Hammond et al, 2021; Pelly, 2003), and sowed doubts about their worth as wives and mothers. (Gammeltoft et al, 2008; Menary, 1987).…”

“…However, a new pregnancy also created ambivalence for parents who dealt with feelings of excitement and hope at a chance at regaining normality, while still feeling anxious about their increased risk of adverse obstetrical and perinatal consequences (Bryar, 1997; Lafarge et al, 2019; Pelly, 2003). Parents' determination to conceive again transcended these fears (Carolan & Hodnett, 2009; Ferreira da Costa et al, 2005; Gammeltoft et al, 2008; Menary, 1987; Pelly, 2003; Rillstone, 1999), and this desire was more significant for parents who did not have children and those who had experienced spontaneous fetal loss or terminated their previous pregnancy following a diagnosis of fetal anomaly (Brandenburg et al, 1992; Fernandes et al, 2020; Irani et al, 2019).…”

“…[Colour figure can be viewed at wileyonlinelibrary.com] Bryar, 1997;Carolan & Hodnett, 2009;Gammeltoft et al, 2008;Kelly, 2009;Leuthner et al, 2003;Menary, 1987;Rillstone, 1999;White-Van Mourik, 1989). A previous positive diagnosis of fetal anomaly caused women to lose confidence in their reproductive capacity to produce a healthy baby (Carolan & Hodnett, 2009;Fernandes et al, 2020;Hammond et al, 2021;Pelly, 2003), and sowed doubts about their worth as wives and mothers. (Gammeltoft et al, 2008;Menary, 1987).…”