The expectations of antenatal screening and experiences of the first-trimester screening scan

Factors influencing pregnant women's decision to accept or decline prenatal screening and diagnosis - a qualitative study

BACKGROUND AND OBJECTIVE

 Prenatal diagnosis for chromosomal anomalies is frequently used worldwide. It is important that pregnant women receive adequate counselling to make informed decisions regarding prenatal diagnosis. The aim of this study was to explore what factors influence pregnant women's decision-making process when accepting or declining prenatal screening and diagnosis.  Methods: A qualitative study using inductive qualitative content analysis. Individual, semi-structured phone interviews were carried out during a five-month period in 2016-2017 with 24 pregnant women in the first trimester, living in a medium-sized Swedish city.

FINDINGS

 Two main themes emerged: (1)"Individual factors - The women's experiences, perceptions and values" with three categories "Attitude towards anomalies", "Worry and need for reassurance", "Self-perceived risk" and (2)"External factors - The women's perception of the test and others' views" with two categories "Test characteristics" and "Influence from others".  Conclusions: Pregnant women's decision-making process regarding prenatal tests is multidimensional, affected by both individual factors such as experiences, perceptions and values, and external factors such as test characteristics and influence from others. Information about both test characteristics and the conditions tested is of help pregnant women in the decision-making process since it provides a better understanding of how having a child with the condition in question can affect them and their family. It is important that healthcare professionals giving information about and offering prenatal tests for chromosomal anomalies are aware of how their attitudes can influence women's decisions.

Pregnant women's informational needs prior to decisions about prenatal diagnosis for chromosomal anomalies-A Q methodological study

OBJECTIVE

To study pregnant women's subjective viewpoints on what is important when receiving information prior to decision-making regarding prenatal testing for chromosomal anomalies.

METHOD

Data were collected using Q methodology. During January 2020-October 2021, 45 pregnant women in Sweden completed a 50-item Q sort. Statements regarding what is important when receiving information about prenatal screening and diagnosis were prioritized through ranking in a fixed sorting grid on an 11-point scale, from "most important" to "least important." Socio-demographics and coping styles were surveyed through questionnaires.

RESULTS

Three groups represented different viewpoints on what pregnant women consider important when receiving information about prenatal screening and diagnosis. Factor 1: Stepwise information and decision-making: viewing information and decision-making as a step-by-step process. Factor 2: Decision-making as a continuous process based on couple autonomy: Striving for an informed decision as a couple about tests, test results and conditions screened. Factor 3: As much information as early as possible-the importance of personal autonomy in decision-making: Prioritizing autonomous decision-making based on non-directive information early in the pregnancy.

CONCLUSION

This study highlights the complexities involved when providing information. As shown by the differing viewpoints in this study, pregnant women's informational needs differ, making individual and personalized information preferable.

Conditions for autonomous reproductive decision-making in prenatal screening: A mixed methods study

BACKGROUND

Pregnant women should be able to make autonomous and meaningful decisions about prenatal screening for fetal abnormalities. It remains largely unclear which circumstances facilitate or hinder such a decision-making process.

OBJECTIVE

To investigate what conditions Dutch pregnant women and professional experts consider important for autonomous reproductive decision-making in prenatal screening for fetal abnormalities, and the extent to which, according to women, those conditions are met in practice.

METHODS

A mixed methods study was conducted in the Netherlands in 2016-2017. A conceptual model was used to interview professional experts (n = 16) and pregnant women (n = 19). Thematic analysis was performed to identify important conditions. Subsequently, a questionnaire assessed the perceived importance of those conditions and the extent to which these were met, in the experience of pregnant women (n = 200).

RESULTS

Professional experts stressed the importance of information provision, and emphasized a rational decision-making model. Pregnant women differed in what information they felt was needed, and this depended on the screening decision made. Questionnaire findings showed that women prioritized discussion and consensus with partners. Information about test accuracy and miscarriage risk of invasive follow-up testing was also considered important. Two key conditions were not adequately met, in the experience of women: (1) having information about miscarriage risk; (2) not being directed by health professionals in decision-making.

CONCLUSION

According to women, discussion and consensus with partners was considered a highly important condition for an autonomous and meaningful decision-making process. Access to information about safety of testing and ensuring that women are not being directed in their decision-making by health professionals seem to be areas for improvement in prenatal care practice.

Viewing the image? Ultrasound examination during abortion preparations, ethical challenges

During preparation for early abortion in Norway, an ultrasound examination is usually performed to determine gestation and viability. This article aims to provide a deeper understanding of women’s and health care personnel’s (HCP) experiences with ultrasound viewing during abortion preparation in the first trimester. Qualitative in-depth interviews with women who had been prepared for early abortion and focus group interviews with HCP from gynaecological units were carried out. A hermeneutic-phenomenological analysis, inspired by van Manen, was chosen. Thirteen women who were pregnant and considering abortion in their first trimester and 20 HCP, namely, 19 registered nurses and one medical doctor, were recruited from gynaecological units at six hospitals. The study was approved by the ethics committee (2014/1276). The essential meaning structure of ‘autonomy under pressure’ consisted of two themes that expressed the different experiences of both the women and the HCP, namely, expectations versus precautions and choice versus protection. The women and HCP expressed different attitudes before the consultation that affected their experiences of the ultrasound examination. While the women had expectations of a clarification based on their choice to either see or not see the ultrasound image, HCP seemed to be more concerned with predetermined rules that they believed would protect the women. Consequently, the basis for dialogue was not optimal, and women’s autonomy was under pressure. Health care personnel are ethically challenged during preabortion ultrasound examinations. Meeting the individual woman’s needs and respecting her autonomy during preparation for abortion requires sensitivity, involvement, and dialogue skills by health personnel. According to the woman’s desire to be informed about the possibility of viewing the image during the abortion preparations, a dialogue that is focused in this direction should arise before the examination.

"No one to consult! That is the hardest part" choice-making experiences for prenatal screening tests among Japanese women and their spouses in Austria - A qualitative interview study

OBJECTIVE

Japan is the only country in the world that allows abortions due to economic reasons but illegalise them due to foetal anomaly. The objective of this study was to explore the choice-making experiences for prenatal screening among Japanese women and their spouses in Austria.

METHODS

We conducted a qualitative study using semi-structured face-to-face interviews with Japanese women and their spouses in Austria. Data were analysed using thematic analysis.

RESULTS

Twenty-five participants (14 women and 11 men) took part in the interviews. Four themes were identified: 1) Knowledge, information and memory; 2) Communication and interactions with health professionals; 3) Reasons for choice; and 4) Emotional support. Participants had limited knowledge and experienced directive counselling. Women expressed negative emotions in the choice-making processes, did not perceive husbands as a source of support and lacked a person to consult.

CONCLUSION

There are common characteristics among East Asian population despite different context and differences found between our Japanese participants and women in other European countries.

PRACTICE IMPLICATION

Proactive interventions aimed at increasing knowledge that help women to develop their preferences and reflect on their values could be further promoted among women of all socio-cultural backgrounds in Austria.

Experiences of interactive ultrasound examination among women at risk of preterm birth: a qualitative study

BACKGROUND

Pregnant women who are at risk of preterm birth are often stressed, anxious and depressed because of worries and fears related to the health of the unborn baby, their own health and uncertainty about the future. Only a few studies have assessed the types of psychological support that would relieve these stress symptoms among women with high-risk pregnancies. The aim of this study was to describe 1) how women at risk of preterm birth experienced an interactive 3/4-dimensional (3/4D) ultrasound examination, and 2) their need for psychological support during the antenatal period.

METHODS

This qualitative study was conducted at one university hospital in Finland in 2017. Women with a singleton pregnancy of 26-32 gestational weeks (gwks) were included in the study. The interactive 3/4D ultrasound included a joint observation of the baby, based on the mother's wishes, with an obstetrician and psychologist. After the examination, the experiences were explored with a semi-structured interview. The data was analyzed using inductive thematic analysis.

RESULTS

The women enjoyed the fact that the staff were focused on her fetus and genuinely present during the session and also enabled the women to actively participate. Watching the baby and her/his activities made the baby more concrete and relieved their concerns. The need for additional psychological support varied individually.

CONCLUSIONS

Interactive ultrasound examination is an interesting way to awaken mental images, increase attachment, and reduce stress. The results imply that an interactive way of jointly looking at the fetus supports pregnant women at risk of preterm birth and may be useful in clinical practice.

Effects of ultrasound on anxiety and psychosocial adaptation to pregnancy

Ultrasound is a common medical care procedure during pregnancy which has psychological implications. Research has found that it reduces the mother's level of anxiety, but there is not enough literature on the effects of the ultrasound in relation to the trimester it is done (first, second, and third) and the effects on the psychosocial adaptation to pregnancy. The purpose of this study was to investigate the effects of the ultrasound in the first, second, and third trimester on anxiety and variables related to psychosocial adaptation to pregnancy. A pre-post intervention design was used. Participants were 111 pregnant women attending a prenatal diagnosis ultrasound scan procedure, State-Trait Anxiety Inventory (STAI), and Prenatal Self-Evaluation Questionnaire (PSEQ) were used to measure anxiety and psychosocial adaptation to pregnancy, respectively. Previous history was obtained through an interview. Results indicated that anxiety diminished after the ultrasound regardless of the trimester in which the ultrasound took place. However, first trimester ultrasound showed an additional benefit favoring the mother's psychosocial adaptation to pregnancy, identification with the motherhood role, and the quality of the relationship with the partner. These findings suggest that in addition to the medical value of the ultrasound, it also has an important psychological value that has to be considered in order to guarantee an integral care of the pregnant women, especially in the first trimester.

What do expectant parents know about antenatal ultrasound screening?

Objective: We aimed to investigate and compare the background knowledge and attitudes of pregnant women and their partners about antenatal ultrasound scans.Materials and methods: A cross-sectional survey was conducted in a university perinatology clinic. Pregnant women and their partners who underwent the first trimester ultrasound scan or the second trimester anomaly scan were invited to complete a questionnaire which contained items on their sociodemographic characteristics, knowledge, and attitude.Results: In total, 500 eligible expectant mothers and their partners (220 in the first trimester and 280 in the second trimester) were recruited. The knowledge and attitude of expectant mothers and fathers were statistically similar. Working status, education level, and presence of chronic disease were the factors affecting the number of correct answers in both expectant mothers and fathers. The knowledge levels of both the expectant mothers and fathers were similar in the first and second trimesters.Conclusions: Pregnant women's and their partners' attitudes and knowledge on antenatal ultrasound scans were similar and generally satisfactory.