Background: Almost 20 percent of known pregnancies end in miscarriage. The main reason to why miscarriage occur is chromosome defects. It is of great importance that healthcare professionals provide support and adequate information to women who is experiencing miscarriage. Person-centered care should be implemented which can indicate respect for integrity, autonomy and promotion of women's participation. Aim: The aim of the literature review was to describe women´s experiences of undergoing miscarriage. Method: This study applies a thematic analysis. Eleven articles were included in the analysis. Results: Three main themes with eight subthemes were identified. Lacking information with subthemes expectations, diagnosis and treatment and follow-up care. Psychological effects with subthemes worry, grief and shame and guilt. Emotional processing with subthemes support from partner or related parties and professional support. Conclusion: Lack of information, mental strain and lack of emotional support were factors that influenced woman’s experience and permeated most of the literature study’s results. To provide person-centered and patient-safe care for women who is experiencing miscarriage, further in-depth studies of the subject is essential. / Bakgrund: Ca 20 procent av alla graviditeter slutar i missfall där främsta orsaken är kromosomfel. Det är av stor vikt att vården ger stöd och adekvat information till kvinnor som genomlever missfall. Personcentrerad vård bör tillämpas, vilket kan innebära respekt för integritet, autonomi samt att främja kvinnans delaktighet. Syfte: Syftet med litteraturstudien var att belysa kvinnors erfarenheter av att genomgå missfall. Metod: Litteraturstudien tillämpar en tematisk dataanalys. Elva stycken artiklar inkluderades i dataanalysen. Resultat: Tre huvudsakliga teman och åtta subteman identifierades; Bristfällig information med subteman förväntningar, diagnos och behandling samt uppföljning. Psykisk påfrestning med subteman oro, sorg samt skam och skuld. Emotionellt stöd med subteman stöd från partner eller närstående samt professionellt stöd. Slutsats: Bristfällig information, psykisk påfrestning och brist på emotionellt stöd var faktorer som influerade kvinnors erfarenheter och genomsyrar majoriteten av litteraturstudiens resultat. För att bedriva personcentrerad och patientsäker vård för kvinnor som genomlever missfall är vidare fördjupning i ämnet grundläggande.

No description available.

Bakgrund  Missfall är en vanlig händelse och kan påverka en kvinnas liv markant. Den vanligaste definitionen av missfall är en graviditet som spontant avbryts av kroppen själv innan graviditetsvecka 22. Vid missfall kommer kvinnor i kontakt med vården och omvårdnadsansvarig vårdpersonal är sjuksköterskan.  Syfte  Syftet var att belysa kvinnors syn på omvårdnad i samband med missfall.  Metod  Metoden som valdes var en litteraturöversikt. Datainsamling genomfördes i databaserna Public Medline, Cumulative Index to Nursing and Allied Health Literature och Psychological Information Database. Urval och kvalitetsgranskning genomfördes vartefter 15 vetenskapliga artiklar analyserades enligt Kristenssons integrerade analys.  Resultat  Resultatet består av två kategorier vilka beskrivit kvinnans syn på omvårdnad vid missfall. Dessa övergripande kategorier blev ‘stöd ’och ‘kommunikation’. Avsaknaden av emotionellt stöd, uppföljning och negativt språkbruk påverkade kvinnornas syn på omvårdnaden i samband med missfall negativt.  Slutsats  Att genomgå ett missfall kan vara en emotionellt svårhanterad händelse för en kvinna, och kan leda till depression, ångest eller posttraumatisk stress. Kvinnors syn på och upplevelse av omvårdnaden de fick i samband med deras missfall hade en betydande roll för deras emotionella återhämtning efter förlusten. Resultatet visade på att majoriteten av kvinnorna som deltog i de olika studierna upplevde omvårdnaden som bristande, då den hade kunnat fokusera mer på personcentrerad omvårdnad. Kvinnors syn på god omvårdnad är att få emotionellt stöd genom att bli bekräftade, lyssnade till, informerade, tillfrågade om vad de behöver samt att vårdpersonal inte ska använda emotionellt laddade ord eller svår medicinsk terminologi. Kvinnor vill även få uppföljning samt att deras partners ska bli mer inkluderade. / Background  Miscarriage is a common occurrence and is most commonly defined as a pregnancy that spontaneously is terminated by the body itself within 22 weeks. A miscarriage can significantly affect a woman's life. In the event of a miscarriage, women come into contact with health care and the main responsible care provider is the nurse.  Aim  The aim was to illustrate women’s view on nursing care in conjunction with miscarriage.  Method  The chosen method was a literature review. Data collection was performed through the databases Public Medline, Cumulative Index to Nursing and Allied Health Literature and Psychological Information Database. Selection and quality review were implemented. Fifteen scientific articles were analyzed according to Kristensson's integrated analysis.  Results  The result consists of two categories which describe woman's view of nursing care in the event of a miscarriage. These overarching categories became 'support' and 'communication'. The lack of emotional support, follow-up and care with choice of words negatively affected the women's view of nursing care in connection with miscarriage.  Conclusions  Going through a miscarriage can be an emotionally difficult event for a woman, that can lead to depression, anxiety or post-traumatic stress. Women's views on and experience of the care they receive by health care personnel in connection with their miscarriage has a significant role in their emotional recovery after the loss. The majority of the women who participated in the studies experienced health care as inadequate. Women's view of good care was to receive emotional support by being confirmed, listened to, informed, asked about their needs and that caregivers should not use emotionally charged words or difficult medical terminology. Women also wanted follow-up and that their partners should be more included.

This thesis is comprised of ten Mormon women's miscarriage stories and it is their stories that are used as the text for my analysis. The purpose of the study is to provide a space for these women to share their experiences and to reveal their cultural values and beliefs. Because the women are all Mormon, there are some distinctive cultural and religious values that are shared within their stories and it is these aspects that are analyzed and discussed within the text.Women need to be able to share their miscarriage stories so as to alleviate feelings of isolation and grief. Many of the women in the interviews agreed that talking to others about their miscarriage helped them to feel less isolated and that they were not alone in their experience. Because there is no specific ritual in our society for miscarriage, women struggle to know how to deal with their grief. Again, being able to talk about their experience provides a "marker" to remember the pregnancy--to animate the invisible.A common response found with women who miscarry is a sense of guilt--guilt that they somehow caused the demise of the pregnancy by strenuous physical exercise, feelings of uncertainty about wanting the pregnancy or taking medications that could affect the baby. These feelings of guilt extended into religious issues as some of the women questioned whether the miscarriage was a result of their spiritual state or their relationship with God.The women also talk in detail about the actual physical occurrence of the miscarriage. Many described how they felt about their bodies during and after the miscarriage. There were feelings of embarrassment or weakness and they questioned why their body had reacted the way it did. Enabling the women to talk about their bodies in such an intimate and personal way can be empowering as well as an excellent means to educate the women's societies about the real physical and emotional effects of miscarriage.

Bakgrund: Missfall innebär spontant avbrytande av graviditet fram till graviditetsvecka 22+0. Missfall utgör den vanligaste orsaken till att en graviditet avslutas och ingen behandling finns för att bota ett pågående missfall. Vid missfall sökte kvinnor oftast vård på akutmottagningar eller gynekologiska avdelningar. Kvinnor upplevde att bemötandet var otillfredsställande av sjuksköterskor och var i behov av ytterligare stöd. Syfte: Att undersöka sjuksköterskors erfarenheter av att omhänderta kvinnor med missfall på akutmottagningar och gynekologiska avdelningar. Metod: Litteraturöversikt med kvalitativ design som omfattade 10 vetenskapliga artiklar från databaserna CINAHL och PubMed. Dataanalysen baserades på Elo och Kyngäs (2008) kvalitativa innehållsanalys med en induktiv ansats. Resultat: Huvudkategorin visade på att Sjuksköterskor strävar efter omvårdnad baserad på compassionate care. Tre kategorier identifierades: Arbetsförhållanden, Kompetens och Omvårdnad samt nio underkategorier. Slutsats: Krävande arbetsförhållande och kompetensbrist begränsade omvårdnaden till kvinnor som drabbats av missfall. Avsaknad av riktlinjer, resurser och tidigare adekvat utbildning försvårar tillämpningen av god omvårdnad. Sjuksköterskor upplevde omhändertagandet av kvinnor med missfall som känslomässigt påfrestande. Författarna identifierade ett behov av vidare forskning inom ämnet då sjuksköterskor efterfrågar ökad kunskap, riktlinjer och resurser för att omhänderta kvinnor med missfall. / Background: Miscarriage is defined as spontaneous loss of pregnancy up to gestational week 22+0. The most common cause of pregnancy loss is miscarriage and there is no cure for an ongoing miscarriage. Women most often sought care at an emergency care unit or gynaecological department when experiencing miscarriage. Women described the care provided by nurses as deficient and needed additional support. Aim: Investigate nurses’ experience of caring for women undergoing miscarriage at emergency units and gynaecological departments. Method: Qualitative literary review based on data gathered through databases CINAHL and PubMed. And inductive qualitative data analysis according to Elo and Kyngäs (2008) was conducted. Results: The main category identified that Nurses aim to implement compassionate care. Three categories were identified: Working conditions, Competence and Nursing care with a total of nine sub-categories. Conclusion: Subpar working conditions and lack of competence deteriorated the care provided to women experiencing miscarriage. Lack of guidelines, resources and previous adequate education prevented good nursing care. Nurses found caring for women undergoing miscarriage emotionally distressing. Further research is recommended in the area by the authors, since nurses demanded increased knowledge, guidelines and resources to care for women undergoing miscarriage.

This dissertation consists of three chapters exploring challenges that many developing countries face in augmenting state capacity and accumulating human capital. In particular, I focus on difficulties in developing state capacity and human capital induced by political violence, natural disasters, and over-reliance on income from foreign countries. The first chapter explores the effects of losing local politicians on the fiscal and personnel capacity of local governments using the outcome of the assassination attempts on mayors in Mexico. The second chapter investigates the effects of exposure to natural disasters on birth outcomes in Indonesia, using the Indian Ocean Tsunami as a natural experiment. In the final chapter, I use a cross-country analysis to study the link between reliance on remittances and the capacity of a country to collect taxes efficiently. The first chapter investigates the effects of losing mayors to successful assassinations on the capacity of local governments. By leveraging the randomness in the outcomes of assassination attempts against mayors in Mexico in 2002-21, I find that the loss of mayors negatively affects the fiscal and personnel capacities of the local governments. Municipal tax collection decreases by 29\%. The share of expenditure on primary services falls by 3 percentage points and is crowded out toward investment in construction. Municipal workers at productive stages in their careers leave the position. The back-of-the-envelope calculation shows that wages should increase by 13\% to retain them after assassinations. Organized criminal groups take advantage of the loss of mayors by increasing their presence in municipalities with successful assassinations. The results are not explained by non-political violence, levels of economic activities, or population changes. The results speak to the significance of leaders in maintaining fiscal capacity and retaining capable personnel in the workforce even in a violent environment. In the second chapter, co-authored with Elizabeth Kayoon Hur (Michigan State University), I evaluate the effect of in-utero exposure to the 2004 Indian Ocean Tsunami on short-term childbirth outcomes in Indonesia. Exploiting variation in the timing of exposure, I find that the probability of successful pregnancies drops by 5.9 percentage points (pp), while miscarriages increase by 5.5 pp for those exposed in the earliest stage of pregnancy. I find suggestive evidence that post-disaster health investments by households may have shielded later cohorts from harmful effects. The results suggest the importance of considering fetal loss in developing countries and highlight that facilitating household investment in health through various policies may mitigate negative birth effects in the aftermath of natural disasters. The third chapter investigates the relationship between a country's reliance on remittances from abroad and its ability to collect taxes from various domestic sources. Despite the increasing flow of remittances in volume and proportion, particularly among developing countries, their role in determining the state's capacity to collect taxes has received little attention. This chapter explores the link between remittances and various tax revenue categories using country-level data. Two-way panel regressions suggest that a 1 percentage point (pp) increase in the inflow of remittances explains a 0.12 pp rise in consumption tax revenues. The same estimate derived from IV methods proxying for migrant network strength and openness of borders increases to 0.9 pp. Decomposing this result reveals that the increase in household consumption expenditure explains all of the statistical association, not the efficient tax-collecting mechanisms such as VAT. Subsample regressions by income category suggest that the association between remittances and consumption tax revenue is stronger in countries with lower income.

Chromosomal aberrations are common causes of abnormal development of fetuses leading to the birth of malformed indvidual or to the intrauterine death. Half of miscarriages in the first trimester and a third in the second trimester are caused by fetal chromosomal abnormalities, mainly aneuploidies. If fetus is abnormally developed, invasive prenatal cytogenetic diagnosis should be recommended. Positive cytogenetic finding can be reason for induced abortion till the end of 24th week of gestation. We investigated 81 miscarriages, 46 fetuses from induced abortions and 80 fetuses with abnormal development from ongoing pregnancies. G-banding analysis was used as the main method for investigating miscarriages. Genomic DNA isolated from abnormally developed fetuses was screened by array CGH technique. We found 43,75 % chromosomal abnormal miscarried fetuses, majority of them with numerical aberrations (91,4 %). In group of induced abortions, 25,71 % fetuses carried chromosomal abnormality. The lowest rate 11,67 % of chromosoal aberrations was detected in group of prenatally diagnosed fetuses from ongoing pregnancies. Array CGH detected submicroscopic aberrations in 13,41 % fetuses with ultrasound findings. All together 25,74 % microscopic and causal submicroscopic chromosomal abnormalities were found to be...

Introdução: A importância dos níveis pré-concepcionais de hormônio estimulante da tireoide (TSH) em pacientes inférteis submetidas à estimulação ovariana controlada (EOC) para técnicas de reprodução assistida (TRA) permanece controversa. O hipotireoidismo subclínico pode aumentar a morbidade obstétrica e neonatal. Ainda não existe consenso entre endocrinologistas e ginecologistas em relação ao rastreio de doença tireoidiana por meio da medida do TSH em pacientes inférteis, nem em relação aos valores de corte para o TSH no hipotireoidismo subclínico (se devem ser <2,5mIU/L ou <4,0/4,5mIU/L). Avaliar o potencial impacto das diferentes concentrações de TSH nos resultados reprodutivos de pacientes submetidas à EOC para tratamentos com TRA é um importante passo para se estabelecerem políticas de rastreio e abordagens terapêuticas adequadas. Objetivo: Comparar resultados reprodutivos de pacientes submetidas à EOC para fertilização in vitro (FIV)/injeção intracitoplasmática de espermatozoide (ICSI), de acordo com as diferentes concentrações de TSH (<2,5 mIU/L; 2,5 a 4,0 mIU/L; >4,0 e <10,0 mIU/L; pacientes em uso de levotiroxina, independente dos níveis de TSH). Pacientes e Métodos: Foi realizado um estudo de coorte retrospectiva avaliando mulheres submetidas à FIV/ICSI no Laboratório de Ginecologia e Obstetrícia do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, no período de janeiro de 2011 a dezembro de 2012, que apresentavam concentração sérica de TSH descrita em prontuário médico. Foi considerado hipotireoidismo subclínico quando as concentrações de TSH eram de 4,0 mIU/L e <10,0 mIU/L em pacientes assintomáticas, que foram separadas em quatro grupos (TSH <2,5mIU/L; TSH 2.5 e <4,0mIU/L; 4mIU/L e <10mIU/L; em uso levotiroxina). Os desfechos primários avaliados foram: taxa de gestação clínica, de nascidos vivos, de gravidez múltipla e de abortamento. Os desfechos secundários analisados foram: dose total de FSH utilizada e duração da EOC, número de oócitos captados e número de oócitos maduros. Resultados: Das 787 pacientes que realizaram ciclos de FIV/ICSI no período do estudo, 727 foram incluídas na análise. A prevalência de hipotireoidismo subclínico encontrada foi de 15,13%. Sessenta pacientes foram excluídas, pois não havia registro de concentrações de TSH em seus prontuários. Não houve diferença estatisticamente significativa em relação às taxas de gravidez de clínica, nascidos vivos, gestação múltipla e abortamento, entre os grupos estudados. Também não foi detectada diferença significativa na resposta à EOC nos grupos avaliados. Conclusão: A taxa de nascido vivo e de abortamento e a resposta à EOC das mulheres com hipotireoidismo subclínico após FIV/ICSI não foram prejudicadas. Estes achados reforçam as incertezas relacionadas ao impacto das concentrações de TSH nos resultados reprodutivos de mulheres submetidas à EOC para TRA, principalmente em pacientes com concentrações de TSH entre 2,5 e 4,0 mIU/L, e tabém a ausência de dados confiáveis que justifiquem diminuir o limite do TSH para 2,5 mIU/L para a definição de hipotireoidismo subclínico. / Background: The relevance of preconception TSH (thyroid-stimulating hormone) serum concentration in infertile patients undergoing controlled ovarian stimulation (COS) for assisted reproductive techniques (ART) treatments remains controversial. Subclinical hypothyroidism may increase pregnancy e neonatal morbidity. There is no consensus among endocrinologists and gynecologists regarding screening of thyroid disease neither by measurement of TSH in infertile patients nor about the cut-off values for TSH in subclinical hypothyroidism (whether <2.5mIU/L or <4.0/4.5mIU/L). Evaluating the potential impact of different TSH concentrations in reproductive outcomes of patients undergoing COS for assisted reproductive techniques is an important step to establish screening policies and adequate therapeutic approaches. The aim of this study is to compare reproductive outcomes of patients undergoing COS for in vitro fertilization (IVF)/ICSI according to TSH serum concentrations (<2.5 mIU/L, 2.5 to 4.0 mIU/L, and >4.0 e <10mIU/L and those patients using levothyroxine irrespective TSH concentrations. Patients and Methods: Retrospective cohort study evaluating all women who underwent in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) between January 2011 and December 2012 and who had TSH sérum concentration described at medical records. Subclinical hypothyroidism was considered when TSH concentrations 4,0mIU/L and <10.0 mIU/L in asymptomatic patients, but the patients were separated between 4 groups (TSH <2.5mIU/L; TSH 2.5 and <4.0mIU/L; 4m e <10IU/L; patients using levothyroxine irrespective TSH concentrations. The primary endpoints assessed were clinical pregnancy, miscarriage, live birth and multiple pregnancy. Secondary endpoints evaluated were total dose of FSH (follicle-stimulating hormone) and duration of COS, number of retrieved oocytes and number of mature oocytes. Results: 787 women underwent IVF/ICSI in within the period of the study. Sixty of these women were excluded because they didn´t had TSH concentrations available in medical records. The prevalence of hypothyroidism, in the present study was 15.13%. No significant difference was observed between the four groups according to clinical pregnancy, miscarriage, live birth and multiple pregnancy rates. There were no differences between the four groups in regard to the response to COS. Conclusion: The live birth rate, miscarriage rate, and response to COS of women with subclinical hypothyroidism following IVF/ICSI were not impaired. These findings reinforce the uncertainties related to the impact of TSH concentrations on reproductive outcomes of women undergoing COS for ART, mainly in patients with TSH ranging from 2.5-4.0 mIU/L, and the absence of reliable data that justify changing the threshold for the definition of subclinical hypothyroidism for 2,5 mIU/L in this population.

Made available in DSpace on 2016-08-19T18:16:00Z (GMT). No. of bitstreams: 1 FABIO FRANCA SILVA.pdf: 387985 bytes, checksum: b614ae131f06a658fbdac4196b4d623c (MD5) Previous issue date: 2009-04-06 / FUNDAÇÃO DE AMPARO À PESQUISA E AO DESENVOLVIMENTO CIENTIFICO E TECNOLÓGICO DO MARANHÃO / Recurrent spontaneous abortion (RSA) is defined as two or more consecutive spontaneous pregnancy losses before the 20th week of gestation, a situation that occurs in 1 to 2% of women in reproductive age. Genetic, anatomical, endocrine, infectious and immunologic factors through mechanisms that relate to the Major Histocompatibility Complex (MHC) and the presence of certain HLA (Human Leukocyte Antigens) are associated to RSA. HLA gene is located on the short arm of chromosome 6 between the 6p21.31 and 6p21.33 regions. This gene is inherited in haplotypes and expressed in codominance, having influence on modulation and induction of mother tolerance during the pregnancy. The aim of this study was to compare the allelic frequencies of HLA-A*, HLA-B* and HLA-DRB1* loci in women with and without RSA. It was a case-control study in 200 women (100 for each group) between 18 and 35 years of age. All samples were typified by the PCR-SSOP method (Polymerase Chain Reaction-Sequence Specific Oligonucleotide Probes). The most frequent alleles observed in the group of women with and without RSA were: HLAA* 02 (56%) and (49%), HLA-DRB1*13 (31%) and (39%) respectively - there was no statistical significative difference when compared among the groups for this alleles; HLA-A*24 (12%) e (25%), (OR: 0.41; 95% CI: 0.18-0.92; p=0.028); HLA-A*34 (8%) e (1%), (OR: 8.61; 95% CI: 1.06-187.04; p=0.034); HLA-B*35 (16%) e (41%) (OR: 0.27; 95% CI: 0.13 0.56; p=0.0002). The most frequent haplotypes observed in the group of women with and without RSA were: A*02DRB1*16 (12%) e (2%) (OR: 6.68; 95% CI: 1.36 44.52; p=0.012) respectively. In this research, DRB1* locus in women with RSA was in linkage disequilibrium (p=0.01.). The high frequency of HLA-A*02 and HLA-DRB1*13 alleles in this study was due to the wide distribution of this allele in the population of Maranhão. HLA-A*24 e HLA-B*35 alleles were considered as a protection factor and HLA-A*34 allele was considered as a risk factor to RSA. The A*02DRB1*16 haplotype was the most frequent and considered as a risk factor to RSA. In order to confirm the observed results in this research, a study involving a higher sample size is necessary as well as genetic epidemiology researches to shed light on the role of HLA antigens and/or its connection to other genes as a risk factor. / Abortamento Espontâneo Recorrente (AER) caracteriza-se por duas ou mais perdas conceptuais espontâneas e consecutivas antes da 20ª semana de gestação, acometendo entre 1% e 2% das mulheres em idade reprodutiva. Fatores genéticos, anatômicos, endócrinos, infecciosos e imunológicos, por meio de mecanismos que relacionam o Complexo Principal de Histocompatibilidade (CPH) e a frequência de determinados antígenos HLA (Antígeno Leucocitário Humano), estão associados ao AER. O gene HLA localiza-se no braço curto do cromossomo 6 entre as regiões 6p21.31 e 6p21.33, é herdado em bloco e expresso em co-dominância. O mesmo exerce uma grande influência na modulação e indução da tolerância materna durante a gestação. Esta pesquisa teve como objetivo verificar as frequências alélicas dos loci HLA-A*, -B* e - DRB1* em mulheres com e sem AER. Realizou-se um estudo caso-controle em 200 mulheres (100 para cada grupo), entre 18 e 35 anos de idade. Todas as amostras foram tipificadas pelo método PCR-SSOP (Reação em cadeia da Polimerase Sondas de Oligonucleotídios de Sequências Especificas). Os alelos mais frequentes tanto em mulheres com e sem AER foram, respectivamente: HLA-A*02 (56%) e (49%), HLADRB1* 13 (31%) e (39%)-embora sem resultado estatisticamente significante; HLAA* 24 (12%) e (25%), (OR: 0,41; 95% IC: 0,18-0,92; p=0,028); HLA-A*34 (8%) e (1%), (OR: 8,61; 95% IC: 1,06-187,04; p=0,034); HLA-B*35 (16%) e (41%) (OR: 0,27; 95% IC: 0,13 0,56; p=0,0002). Os haplótipos mais frequentes em mulheres com e sem AER foram, respectivamente: A*02DRB1*16 (12%) e (2%) (OR 6,68; 95% IC: 1,36 44,52; p=0,012). No presente estudo, apenas o locus DRB1* apresentou desequilíbrio de ligação significante (p=0,01) em mulheres com AER. A elevada frequência dos alelos HLA-A*02 e HLA-DRB1*13 é justificada pela ampla distribuição desses alelos na população maranhense. Os alelos HLA-A*24 e HLA-B*35 apresentaram-se como um fator de proteção e o alelo HLA-A*34 um fator de risco para AER. Para as associações haplotípicas, o haplótipo A*02DRB1*16 foi mais frequente em mulheres com AER, sendo um fator de risco para este grupo. Para a ratificação dos resultados deste trabalho, faz-se necessário aumentar o número amostral, bem como estudos de epidemiologia genética para o melhor entendimento do papel dos antígenos HLA e/ou sua ligação a outros genes como fator de risco para o AER.

Bakgrund: I Sverige definieras begreppet upprepade missfall som att en kvinna har fått tre eller flera missfall i följd och det uppskattas drabba ca en procent av världens alla par i fertil ålder. Då detta är en liten grupp kvinnor kan det vara svårt för den drabbade kvinnan att veta var hon kan vända sig med sina funderingar och vad hon har rätt till för vidare hjälp. Vid flera upprepade missfall växer behovet av att få svar på vad som sker och varför samtidigt som behovet av stöd och förståelse från sina närstående blir större. Tillgången till utredning och behandling ser olika ut men med hjälp från barnmorskans och vårdens sida kan lämplig planering utifrån kvinnan situation utvecklas. Syfte: Syftet med denna studie är att undersöka kvinnans upplevelse av upprepade missfall och belysa hennes behov under och tiden efter missfallet. Metod: Metoden för denna uppsats var en kvalitativ metasyntes med metaetnografisk analysmetod. Totalt kvalitetsgranskades 29 artiklar varav 16 gick igenom kvalitetsgranskningen och sammanställdes till ett resultat. Resultat: Sju kategorier med nyckelbegrepp bildades. Kategorierna som identifierades var missfallsprocessen, utrymme för sorg, undvikande beteende, partnerrollen, socialt stöd, förväntningar på vården och att bli gravid igen. Slutsats: Då alla kvinnor är olika varierar upplevelsen och behoven vid en missfallsprocess. Genom att ha kunskap om vad kvinnan går igenom både fysiskt- och psykiskt vid upprepade missfall bidrar det till en ökad förståelse för vad kvinnan behöver, både från sin omgivning men även från vårdens sida. Klinisk tillämpbarhet: Studien skulle kunna bidra till att utforska möjligheten att ändra på kriterierna för utredning vid upprepade missfall. Studien skulle även kunna leda till en förbättring av kunskapsläget både för individen, samhället och vården gällande hur bemötandet av denna grupp av kvinnor ser ut. Barnmorskor kan som yrkesgrupp stödja och hjälpa denna grupp kvinnor genom uppföljning i samband med att de kommer i kontakt med barnmorskemottagningen för att meddela att graviditeten har slutat i ännu ett missfall. Vidare kan etableringen av stödgrupper inom vården vara ett bra stöd för kvinnor som är med om upprepade missfall och dessa grupper skulle potentiellt ledas och samordnas av en barnmorska som innehar kompetens inom området upprepade missfall. / Background: In Sweden, the concept of recurrent miscarriage is defined as a woman having three or more miscarriages in succession and it is estimated to affect about one percent of all couples of childbearing age worldwide. Since this is a small group of women, it can be difficult for the effected woman to know where she can turn with her thoughts and what she is entitled to regarding further help. After enduring multiple recurrent miscarriages, the need to get some answers and at the same time the need to receive support and understanding from their close surroundings increases. The access to further investigation and treatment is different depending on where you are but with some help from a midwife and other healthcare providers, an appropriate plan based on the woman's situation can be developed. Purpose: The aim of this essay was to investigate the experiences of women who have endured recurrent miscarriages and their further needs that occurred during and the time after the miscarriage. Methods: The method used in this essay was a qualitative metasynthesis with metaethnographic analysis method. In total, 29 articles were collected of which 16 of them went through the quality review and were compiled to a result. Results: seven categories containing of key concepts were formed. The categories identified were the process of miscarrying, room for griefing, avoiding behavior, the partners role, social support, expectations of the healthcare and becoming pregnant again. Conclusion: Due to the fact that all women are different, the experiences and needs during a miscarrying process varies. By having the knowledge of what the woman goes through both physically and mentally during recurrent miscarriages, it contributes to a greater understanding of what the woman needs, both from her surroundings but also from the healthcare. Clinical applicability: This essay could help to explore the possibilities of modifying the criteria for an investigation of recurrent miscarriages. The essay could also lead to improvement of the knowledge situation for the individual, the society and the care providers regarding how this group of women wants to be treated. Midwives as a profession could help to support this group of women by initiating contact with the women when or after she has contacted the midwife clinic to announce another pregnancy loss. Furthermore, the establishment of support groups for women with recurrent miscarriages could be helpful and supportive for these women. The support groups could potentially be coordinated by a midwife with specific knowledge about recurrent miscarriage.