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Singal K, Adamczyk K, Hurt L, Woolner A, Paranjothy S. Isolated choroid plexus cysts and health and developmental outcomes in childhood and adolescence - A systematic review. Eur J Obstet Gynecol Reprod Biol 2023; 290:115-122. [PMID: 37778251 DOI: 10.1016/j.ejogrb.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
OBJECTIVES Choroid plexus cysts (CPCs) are incidental findings on ultrasound examination of the fetal brain. It is not known if isolated CPCs are associated with any adverse health or neurodevelopmental outcomes during the life course. This systematic review aimed to collate and synthesize the evidence on whether or not isolated choroid plexus cysts are associated with an increased risk of adverse health or developmental outcomes during childhood and adolescence. METHODS A search strategy was developed specifically for this study and applied to four electronic databases Medline (Ovid), Embase (Ovid), Web of Science, and Google Scholar. Studies were assessed and selected for inclusion if there was a measurement of CPC (including single or multiple; unilateral or bilateral; isolated or presenting alongside other markers) during the antenatal or early neonatal period (<7 days) with follow-up of children and adolescents for health and developmental outcomes measured at any time from age 1 month onwards. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Due to heterogeneity in the types of outcome measures included and the timing of measurement of outcomes across the studies, it was not possible to pool data across studies and a narrative description of findings was presented. RESULTS Eight studies (three cohorts and five case series) met the inclusion criteria. Different methods were used for outcome assessment, such as in-person assessment, parent questionnaires, medical records, and telephone interviews with parents. Six studies measured outcomes only once during the specified duration of follow-up; two studies carried out paediatric reviews of the children several times during follow-up. There were no differences in developmental outcomes or physical health between babies with CPCs reported in the three cohort studies, and no abnormalities were detected in the children that were followed up in four of the five case series studies. Most of the included studies were graded as low quality due to the small sample size, high risk of selection bias, unclear definitions of CPC or lack of a comparison group. CONCLUSIONS The studies conducted to date do not provide evidence of adverse physical health outcomes or neurodevelopmental delays in babies with CPCs. However, most of these studies were small and included a narrow range of outcomes. Further research is needed to explore the relative incidence of outcomes such as ASD, ADHD, epilepsy and educational attainment in children with CPCs.
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Affiliation(s)
- Kusum Singal
- Aberdeen Center for Health Data Sciences, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom.
| | - Krzysztof Adamczyk
- Aberdeen Center for Health Data Sciences, Institute of Applied Health Sciences, University of Aberdeen, Scotland, United Kingdom.
| | - Lisa Hurt
- Division of Population Medicine, Cardiff University, Cardiff, United Kingdom.
| | - Andrea Woolner
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Scotland, United Kingdom.
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Karapanos I, Bolou A, Nazer M, Iliodromiti S, Greco E. Strategies to communicate pregnancy complications: a systematic review and practical points for healthcare professionals. Curr Opin Obstet Gynecol 2023; 35:411-419. [PMID: 37560805 DOI: 10.1097/gco.0000000000000899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
PURPOSE/METHODS This systematic review aims to provide an overview of strategies available for healthcare professionals (HCPs) to effectively communicate unexpected news in pregnancy, specifically for the most common pregnancy complications. Three medical databases and grey literature were searched until March 2023 using subject headings and keywords. Snowball techniques were also used. The articles were reviewed at each stage of screening independently by two separate authors. Qualitative, quantitative and mixed methods studies were included. RECENT FINDINGS Forty-three studies were included and grouped according to the gestational age of the pregnancy complication - miscarriage, increased risk screening, foetal conditions, stillbirth. The main key points for communication were outlined at each specific complication and eventually the six common themes that emerged from all the categories were included in the acronym PRICES (Preparation - Referral - Individualized care - Clarity - Empowerment - Sensitivity). SUMMARY Given the negative impact of failed communications both in pregnancy outcomes and patients' experience, we advocate that communication training for HCP providing pregnancy care should be mandatory, and skills should be updated at regular intervals. Tools like our acronym PRICES can be used during teaching HCPs how to communicate more effectively.
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Affiliation(s)
- Ioannis Karapanos
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Angeliki Bolou
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
- School of Health Sciences, Institute for Lifecourse Development: Centre for Chronic Illness and Ageing, Faculty of Education, Health & Human Sciences, University of Greenwich
| | - Maya Nazer
- Queen Mary University of London Barts and The London School of Medicine and Dentistry, London, UK
| | - Stamatina Iliodromiti
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
| | - Elena Greco
- Women's Health Research Unit, Wolfson Institute of Population Health Sciences, Queen Mary University of London, Barts and The London School of Medicine and Dentistry
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3
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Roncoroni J, Whitaker S, Magdamo B, Hendrix T, Zaręba K, Yohannes R. Perceptions of Patient-Centered Care and Their Association With Patient Satisfaction in Abortions for Medical Reasons. Womens Health Issues 2023:S1049-3867(23)00069-5. [PMID: 37230927 DOI: 10.1016/j.whi.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Abortions for medical reasons, which happen in the event of fetal abnormalities or maternal life endangerment, are highly politicized and understudied given their prevalence. Our objective was to understand the health care experiences of U.S. individuals who had an abortion of a wanted pregnancy for medical reasons in the second or third trimester. METHODS Participants were recruited on Facebook and completed surveys with their demographic information, their perception of their health provider's cultural sensitivity, their patient satisfaction, and their satisfaction with their decision to proceed with an abortion for medical reasons. RESULTS Participants were 132 women who were mostly between the ages of 31 and 40 (72.7%), highly educated (84.1% had at least a 4-year college degree), and non-Hispanic White (85.6%). There was no statistically significant difference in patients' rated highest average item score on their providers' Competence or Sensitivity; however, average item scores of providers' Competence and Sensitivity were both higher than Respect scores. Linear regression results show that experiencing patient-centered care significantly predicted patient satisfaction (β = .73, t(131) = 12.03, p < .001) and decision satisfaction (β = .37, t(131) = 4.63, p < .001). CONCLUSION Our findings underscore the importance of training providers to deliver patient-centered care that empowers patients to adapt to challenging situations, such as the diagnosis of medical concerns during pregnancy. Providers understanding and supporting the complex process of an abortion for medical reasons can ameliorate the emotional impact of this procedure.
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Affiliation(s)
- Julia Roncoroni
- Department of Counseling Psychology, University of Denver, Denver, Colorado.
| | - Salina Whitaker
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Brigid Magdamo
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Tayler Hendrix
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Kornelia Zaręba
- Obstetrics & Gynecology Department, College of Medicine & Health Sciences (CMHS), United Arab Emirates University (UAEU), Al Ain, United Arab Emirates
| | - Rebekah Yohannes
- Department of Counseling Psychology, University of Denver, Denver, Colorado
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Hart AR, Vollmer B, Howe D, Boxall S, Foulds N, de Lacy P, Vasudevan C, Griffiths PD, Piercy H. Antenatal counselling for prospective parents whose fetus has a neurological anomaly: part 1, experiences and recommendations for service design. Dev Med Child Neurol 2022; 64:14-22. [PMID: 34423423 DOI: 10.1111/dmcn.15022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 06/26/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022]
Abstract
Prospective parents whose fetus is diagnosed with a neurological anomaly go through a complex range of emotions. They describe their discussions of antenatal counselling from health care professionals as focusing too much on the nature of the anomaly involving unintelligible medical terminology, when what they really want is a picture of the best- and worst-case scenarios. Whilst information on the level of risk for their fetus is important, it is not the parents' primary concern. When statistics for risk are given, they may not be as well understood as the health care professionals think. This review discusses the published evidence on antenatal counselling and recommendations for explaining risk to parents of fetuses with neurological anomalies. From this data we make recommendations for the organization of antenatal counselling services.
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Affiliation(s)
- Anthony R Hart
- Department of Perinatal and Paediatric Neurology, Sheffield Children's NHS Foundation Trust, Ryegate Children's Centre, Sheffield, UK
| | - Brigitte Vollmer
- Clinical and Experimental Sciences, Faculty of Medicine, Paediatric and Neonatal Neurology, Southampton Children's Hospital, University Hospital Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - David Howe
- Department of Fetal Maternal Medicine, University Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, UK
| | - Sally Boxall
- Department of Fetal Maternal Medicine, University Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, UK
| | - Nicola Foulds
- Department of Clinical Genetics, University Southampton NHS Foundation Trust, Princess Anne Hospital, Southampton, UK
| | - Patricia de Lacy
- Department of Paediatric Neurosurgery, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Chakra Vasudevan
- Department of Neonatology, Bradford Royal Infirmary, Bradford, UK
| | - Paul D Griffiths
- Academic Unit of Radiology, Royal Hallamshire Hospital, University of Sheffield, Sheffield, UK
| | - Hilary Piercy
- The Centre for Health and Social Care, Sheffield Hallam University, Sheffield, UK
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Moncrieff G, Finlayson K, Cordey S, McCrimmon R, Harris C, Barreix M, Tunçalp Ö, Downe S. First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers. PLoS One 2021; 16:e0261096. [PMID: 34905561 PMCID: PMC8670688 DOI: 10.1371/journal.pone.0261096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/22/2021] [Indexed: 11/18/2022] Open
Abstract
Background The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. Methods We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. Findings From 7076 hits, we included 80 papers (1994–2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Conclusion Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.
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Affiliation(s)
- Gill Moncrieff
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Kenneth Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Sarah Cordey
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebekah McCrimmon
- School of Health and Community Studies, University of Central Lancashire, Preston, United Kingdom
| | - Catherine Harris
- Applied Health Research Hub, University of Central Lancashire, Preston, United Kingdom
| | - Maria Barreix
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
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Thirup L, Sandager P, Vogel I, Lou S. The importance of information and support following a suspected second-trimester anomaly that is later discarded: A qualitative study of women's experiences. Acta Obstet Gynecol Scand 2021; 101:94-101. [PMID: 34761374 DOI: 10.1111/aogs.14288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/17/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A second-trimester anatomy scan may identify a suspected minor fetal anomaly and/or "soft marker," such as choroid plexus cysts or femoral shortening. Such findings can raise a medical concern, as they could indicate severe fetal disease; however, they are also often transient or a "false alarm." The aim of this study was to explore the experiences of pregnant women, where a medical concern was raised at the second-trimester ultrasound scan and later discarded after follow-up examinations and diagnostic testing. MATERIAL AND METHODS This study consists of qualitative, in-depth interviews with nine women, where a minor anomaly/soft marker was identified at the second-trimester scan and a severe anomaly was later ruled out. Data were analyzed using thematic analysis. RESULTS The main source of worry was uncertainty about the possible implications for the pregnancy and the baby, particularly concerns about potential termination of pregnancy for a severe fetal condition. The women described four strategies to manage worry and uncertainty during the diagnostic process: (a) seeking additional information to feel more in control, and (b) using social networks to share their concerns. Some women tried to (c) mentally distance themselves from the pregnancy during the diagnostic period, while (d) extra scans could relieve worry and support attachment. The women appreciated when the fetal medicine specialist pointed to normal features in the pregnancy and the baby, as this provided some counterbalance to the sense of uncertainty. In general, the women expressed satisfaction with the information received during the diagnostic process. However, all of them were worried during the diagnostic process, and where this process was prolonged, such worry lingered even after the minor anomaly/soft marker had been discarded. CONCLUSIONS Diagnostic uncertainty cannot be avoided in obstetric ultrasound and the women concerned appreciated being informed about the suspected findings even if it caused increased worry. Expedient diagnostic processes may alleviate worry, but are not always possible. Women in a prolonged diagnostic process may benefit from psychological and social support in parallel with, and even beyond, the obstetric investigation. However, further research is warranted.
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Affiliation(s)
- Lina Thirup
- DEFACTUM-Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark.,Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
| | - Puk Sandager
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Ida Vogel
- Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Stina Lou
- DEFACTUM-Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark.,Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark
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Johnson J, Dunning A, Sattar R, Arezina J, Karkowsky EC, Thomas S, Panagioti M. Delivering unexpected news via obstetric ultrasound: A systematic review and meta‐ethnographic synthesis of expectant parent and staff experiences. SONOGRAPHY 2020. [DOI: 10.1002/sono.12213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Judith Johnson
- School of PsychologyUniversity of Leeds Leeds UK
- Bradford Institute for Health ResearchBradford Royal Infirmary Bradford UK
- School of Public Health and Community MedicineUniversity of New South Wales Sydney New South Wales Australia
| | - Alice Dunning
- School of PsychologyUniversity of Leeds Leeds UK
- Bradford Institute for Health ResearchBradford Royal Infirmary Bradford UK
| | - Raabia Sattar
- School of PsychologyUniversity of Leeds Leeds UK
- Bradford Institute for Health ResearchBradford Royal Infirmary Bradford UK
| | - Jane Arezina
- Faculty of Medicine and Health, Specialist Science Education Department, Leeds Institute of Cardiovascular and Metabolic MedicineUniversity of Leeds Leeds UK
| | - Eve C. Karkowsky
- Division of Maternal‐Fetal Medicine, Department of Obstetrics and Gynecology and Women's HealthMontefiore Medical Center/Albert Einstein College of Medicine The Bronx New York USA
| | - Samantha Thomas
- Sydney School of Health Sciences, Faculty of Medicine and HealthCumberland Campus, University of Sydney Lidcombe NSW 1825 Australia
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care, Research, Manchester Academic Health Science CentreUniversity of Manchester Manchester UK
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Hart AR, Embleton ND, Bradburn M, Connolly DJA, Mandefield L, Mooney C, Griffiths PD. Accuracy of in-utero MRI to detect fetal brain abnormalities and prognosticate developmental outcome: postnatal follow-up of the MERIDIAN cohort. THE LANCET CHILD & ADOLESCENT HEALTH 2019; 4:131-140. [PMID: 31786091 PMCID: PMC6988445 DOI: 10.1016/s2352-4642(19)30349-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND In utero MRI (iuMRI) detects fetal brain abnormalities more accurately than ultrasonography and provides additional clinical information in around half of pregnancies. We aimed to study whether postnatal neuroimaging after age 6 months changes the diagnostic accuracy of iuMRI and its ability to predict developmental outcome. METHODS Families enrolled in the MERIDIAN study whose child survived to age 3 years were invited to have a case note review and assessment of developmental outcome with the Bayley Scales of Infant and Toddler Development, the Ages and Stages Questionnaire, or both. A paediatric neuroradiologist, masked to the iuMRI results, reviewed the postnatal neuroimaging if the clinical report differed from iuMRI findings. Diagnostic accuracy was recalculated. A paediatric neurologist and neonatologist categorised participants' development as normal, at risk, or abnormal, and the ability of iuMRI and ultrasonography to predict developmental outcome were assessed. FINDINGS 210 participants had case note review, of whom 81 (39%) had additional investigations after age 6 months. The diagnostic accuracy of iuMRI remained higher than ultrasonography (proportion of correct cases was 529 [92%] of 574 vs 387 [67%] of 574; absolute difference 25%, 95% CI 21 to 29; p<0·0001). Developmental outcome data were analysed in 156 participants, and 111 (71%) were categorised as normal or at risk. Of these 111 participants, prognosis was normal or favourable for 56 (51%) using ultrasonography and for 76 (69%) using iuMRI (difference in specificity 18%, 95% CI 7 to 29; p=0·0008). No statistically significant difference was seen in infants with abnormal outcome (difference in sensitivity 4%, 95% CI -10 to 19; p=0·73). INTERPRETATION iuMRI remains the optimal tool to identify fetal brain abnormalities. It is less accurate when used to predict developmental outcome, although better than ultrasonography for identifying children with normal outcome. Further work is needed to determine how the prognostic abilities of iuMRI can be improved. FUNDING National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Anthony R Hart
- Department of Paediatric and Perinatal Neurology, Sheffield Children's Hospital NHS Foundation Trust, Ryegate Children's Centre, Sheffield, UK
| | - Nicholas D Embleton
- Newcastle Neonatal Service, Ward 35 Neonatal Unit, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Michael Bradburn
- Clinical Trials Research Unit, School Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel J A Connolly
- Department of Paediatric Neuroradiology, Sheffield Children's Hospital NHS Foundation Trust, Western Bank, Sheffield, UK
| | - Laura Mandefield
- Clinical Trials Research Unit, School Health and Related Research, University of Sheffield, Sheffield, UK
| | - Cara Mooney
- Clinical Trials Research Unit, School Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Paul D Griffiths
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK
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Abstract
BACKGROUND The diagnosis of a fetal anomaly in perinatal medicine forces expectant parents and healthcare providers to face the difficult process of breaking bad news. OBJECTIVES This exploratory literature review was aimed at providing a medical and psychological view of the psychological experience in expectant parents and physicians in the context of prenatal diagnosis of a fetal anomaly. METHOD An exploratory search of PubMed and PsycINFO/PsycARTICLES databases performed by an interdisciplinary team composed of a physician and psychologists. Search terms were: prenatal diagnosis AND bad news; prenatal diagnosis AND psychological consequences; prenatal diagnosis AND psychological sequelae; prenatal diagnosis AND fetal abnormality. The processing of selected articles followed a standardised five-step procedure. RESULTS A total of 860 articles were screened of which 32 were retained for analysis. Four main themes emerged from the explanatory content analysis: (1) parents' subjective experience; (2) physicians' subjective experience; (3) encounters between expectant parents and professionals; and (4) ethical challenges in breaking bad news in prenatal medicine. CONCLUSION Expectant parents go through a complex and multidimensional experience when the diagnosis of a fetal anomaly is disclosed. Simultaneously, physicians consider breaking bad news as a very stressful event and are poorly prepared in this regard. A better knowledge of factors underlying psychological adjustment of the parental dyad and on the subjective experience of physicians delivering these diagnoses could enable better adaptation for both patients and professionals.
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Affiliation(s)
- Rita Luz
- a Université de Lorraine , Metz , France.,c Centre Hospitalier Régional Universitaire, Lorraine Centre for Prenatal Diagnosis, Maternité Régionale , Nancy , France
| | | | | | - Rachel Vieux
- b Université de Lorraine , Vandœuvre-lès-Nancy , France.,d Pediatric Department 1 , Centre Hospitalier Régional Universitaire , Besançon , France.,e Université de Franche-Comté, UFR SMP , Besançon , France
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10
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Marokakis S, Kasparian NA, Kennedy SE. Prenatal counselling for congenital anomalies: a systematic review. Prenat Diagn 2016; 36:662-71. [DOI: 10.1002/pd.4836] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/07/2016] [Accepted: 04/30/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Sarah Marokakis
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
| | - Nadine A. Kasparian
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Heart Centre for Children; The Sydney Children's Hospitals Network (Westmead and Randwick); Sydney NSW Australia
| | - Sean E. Kennedy
- Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine; University of New South Wales; Sydney NSW Australia
- Nephrology; Sydney Children's Hospital; Randwick NSW Australia
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11
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Oscarsson M, Gottvall T, Swahnberg K. When fetal hydronephrosis is suspected antenatally--a qualitative study. BMC Pregnancy Childbirth 2015; 15:349. [PMID: 26694546 PMCID: PMC4689046 DOI: 10.1186/s12884-015-0791-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 12/11/2015] [Indexed: 12/28/2022] Open
Abstract
Background The information about fetal malformation findings during the ultrasound examination often comes unexpectedly, and the women and their partners may not necessarily receive any conclusive statement on the prognosis. A finding such as fetal hydronephrosis range from being a soft markers or mild anomaly, to a serious condition associated with neonatal morbidity and mortality. The aim of this study was to explore women’s reactions to the discovery of fetal hydronephrosis in the context of uncertainty regarding the prognosis. Methods Ten women were interviewed and the interviews were conducted six to twelve months after the women gave birth. They had experience of suspected fetal hydronephrosis in gestational week 18–20. The interviews were recorded, transcribed verbatim and analysed using constant comparative analysis. Results The core category, ‘Going through crisis by knowing that you are doing the right thing’ illustrates the meaning of women’s reactions and feelings. It illuminates the four categories: ‘When the unexpected happens’– on the one hand, women had positive views that the suspicious malformation could be discovered; however, on the other hand, women questioned the screening. ‘To live in suspense during pregnancy’ – the suspicious malformation caused anxiety and was a stressful situation. ‘Difficulties in understanding information’ – the women thought they had limited knowledge and had difficulties in understanding the information. ‘Suppress feelings and hope for the best’ – the women tried to postpone the problem and thought they should deal with it after delivery. Conclusions Women are worried irrespective of suspicious or severe malformations, and in need of information and counselling tailored to their individual needs. Other sources of support could be: written information, links to reliable sources on the Internet and possibilities for ongoing follow-ups.
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Affiliation(s)
- Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan, 14, 391 82, Kalmar, Sweden.
| | - Tomas Gottvall
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, 581 83, Linköping, Sweden.
| | - Katarina Swahnberg
- Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan, 14, 391 82, Kalmar, Sweden. .,Division of Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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12
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Swedish University Students' Opinion Regarding Information About Soft Markers. J Genet Couns 2015; 25:146-56. [PMID: 26163102 DOI: 10.1007/s10897-015-9852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 06/22/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to investigate the opinions of Swedish university students about information regarding soft markers, when observed at second trimester ultrasound screening. A cross-sectional survey, where 85 Swedish university students completed a study specific questionnaire containing eleven hypothetical scenarios, involving various parameters (disease/syndromes/malformations with different characteristics), and location of the markers. Almost all participants indicated that they would wish to be informed, prior to the ultrasound examination, about the assessment and significance of soft markers. However, the number of respondents who requested information about a potential actual finding was considerably less. Several participants wanted to be informed about detected markers associated to serious conditions but not when the marker indicated an increased risk for a treatable disease. Also, the specific location of the marker was of importance to the participants. The majority of respondents wished to be informed about the soft markers if they were observed in the heart or the brain of the foetus, compared to if they were located in the intestine or the skeleton. The students' opinion, in this study, implicate the importance of pre-examination information to enable expectant parents to make informed choice regarding the second trimester ultrasound screening as well as on reciving information of actual findings.
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Hayat Roshanai A, Ingvoldstad C, Lindgren P. Fetal ultrasound examination and assessment of genetic soft markers in Sweden: are ethical principles respected? Acta Obstet Gynecol Scand 2015; 94:141-7. [DOI: 10.1111/aogs.12554] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 12/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Charlotta Ingvoldstad
- Department of Public Health and Caring Sciences; Uppsala University; Uppsala Sweden
- Department of Clinical Science, Intervention and Technology; Division of Obstetrics and Gynecology; Karolinska University Hospital; Karolinska Institute; Stockholm Sweden
| | - Peter Lindgren
- Department of Clinical Science, Intervention and Technology; Division of Obstetrics and Gynecology; Karolinska University Hospital; Karolinska Institute; Stockholm Sweden
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Ahman A, Axelsson O, Maras G, Rubertsson C, Sarkadi A, Lindgren P. Ultrasonographic fetal soft markers in a low-risk population: prevalence, association with trisomies and invasive tests. Acta Obstet Gynecol Scand 2014; 93:367-73. [PMID: 24433283 DOI: 10.1111/aogs.12334] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Accepted: 01/09/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the prevalence of soft markers identified at second trimester ultrasound in a low-risk population and the association of these markers with trisomies and invasive testing. DESIGN Prospective observational study. SETTING Swedish University Hospital. POPULATION All women with fetuses examined by ultrasound at 15(+0) -22(+0) weeks gestation between July 2008 and March 2011. METHODS Cases with soft markers were compared with non-cases with regard to trisomies and invasive testing. MAIN OUTCOME MEASURES Prevalence of soft markers, likelihood ratio for trisomies and risk ratio for invasive tests after detection of soft markers. RESULTS Second trimester ultrasound was performed on 10 710 fetuses. Markers were detected in 5.9% of fetuses. 5.1% were isolated, 0.7% were multiple and 0.1% were combined with an anomaly. Presence of markers showed a positive likelihood ratio for Down syndrome, but the association (likelihood ratio = 7.1) was only statistically significant for the combined category of any marker (isolated, multiple or combined with anomaly). The risk ratio for invasive testing after the second trimester ultrasound was 24.0 in pregnancies with isolated soft markers compared with those without markers. CONCLUSION In a low-risk population, soft markers were found in 5.9% of fetuses at second trimester ultrasound. The likelihood ratio for Down syndrome was significant only for any marker (isolated, multiple or combined with anomaly). The presence of soft markers increased the incidence of invasive procedures substantially. Soft markers should be noted when information on second trimester ultrasound is formulated, and all units performing fetal ultrasound examinations should have established routines concerning information management when soft markers are identified.
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Affiliation(s)
- Annika Ahman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Giuliani R, Tripani A, Pellizzoni S, Clarici A, Lonciari I, D'Ottavio G, Schleef J. Pregnancy and postpartum following a prenatal diagnosis of fetal thoracoabdominal malformation: the parental perspective. J Pediatr Surg 2014; 49:353-8. [PMID: 24528985 DOI: 10.1016/j.jpedsurg.2013.07.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 07/20/2013] [Accepted: 07/21/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE The study's aim was to evaluate how information related to a prenatal diagnosis of fetal malformation could modify parenthood experience descriptions during pregnancy and after the child's birth. METHODS A longitudinal case-control clinical study was conducted. Data on parenthood experience descriptions collected using a validated semantic differential technique during pregnancy and after the child's birth were compared between seven couples of parents receiving a prenatal diagnosis of fetal malformation and seven couples without any fetal diagnosis. RESULTS Our results show that during pregnancy parents in the clinical group describe themselves as more fragile, passive, and timid [p=0.007] than those in the control group. On the other hand, after the child's birth, there are no significant differences between groups. CONCLUSIONS Data are discussed with reference to better knowledge of the psychological dynamics involved in becoming a parent and to rational planning of support for parents receiving a diagnosis of fetal malformation.
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Affiliation(s)
- Rosella Giuliani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Antonella Tripani
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | - Sandra Pellizzoni
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy.
| | - Andrea Clarici
- Psychiatric Clinic Department of Medical, Surgical and Health Science University of Trieste, Italy
| | - Isabella Lonciari
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Jürgen Schleef
- Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste, Italy
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Ohman SG, Björklund U, Marsk A. Does an informational film increase women's possibility to make an informed choice about second trimester ultrasound? Prenat Diagn 2012; 32:833-9. [PMID: 22718559 DOI: 10.1002/pd.3914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Revised: 05/05/2012] [Accepted: 05/07/2012] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To evaluate effects of an informational film on making an informed choice regarding second trimester ultrasound. METHOD Randomized controlled study. The intervention was an informational film about prenatal examinations. Data were collected at gestational week 26. RESULTS A total of 184 women in the intervention group and 206 women in the control group participated in the study. Of those in the intervention group, 81.3% made an informed choice regarding second trimester ultrasound examination compared with 76.1% in the control group (p = 0.21). Women making an informed choice scored higher in knowledge about the examination (p < 0.001), had higher degree of education (p < 0.001), and spoke more frequently Swedish as mother tongue (89.5% vs 74.7%, p = 0.01). CONCLUSIONS An informational film does not increase women's knowledge or the number of women making an informed choice about the second trimester ultrasound. Women who did not make an informed choice about the second trimester ultrasound had a lower level of education and less knowledge about second trimester ultrasound screening.
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Affiliation(s)
- Susanne Georgsson Ohman
- Sophiahemmet University College and Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden.
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Asplin N, Wessel H, Marions L, Georgsson Öhman S. Pregnant women’s experiences, needs, and preferences regarding information about malformations detected by ultrasound scan. SEXUAL & REPRODUCTIVE HEALTHCARE 2012; 3:73-8. [DOI: 10.1016/j.srhc.2011.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Revised: 11/15/2011] [Accepted: 12/06/2011] [Indexed: 11/27/2022]
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Viaux-Savelon S, Dommergues M, Rosenblum O, Bodeau N, Aidane E, Philippon O, Mazet P, Vibert-Guigue C, Vauthier-Brouzes D, Feldman R, Cohen D. Prenatal ultrasound screening: false positive soft markers may alter maternal representations and mother-infant interaction. PLoS One 2012; 7:e30935. [PMID: 22292077 PMCID: PMC3264650 DOI: 10.1371/journal.pone.0030935] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 12/26/2011] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In up to 5% of pregnancies, ultrasound screening detects a "soft marker" (SM) that places the foetus at risk for a severe abnormality. In most cases, prenatal diagnostic work-up rules out a severe defect. We aimed to study the effects of false positive SM on maternal emotional status, maternal representations of the infant, and mother-infant interaction. METHODOLOGY AND PRINCIPAL FINDINGS Utilizing an extreme-case prospective case control design, we selected from a group of 244 women undergoing ultrasound, 19 pregnant women whose foetus had a positive SM screening and a reassuring diagnostic work up, and 19 controls without SM matched for age and education. In the third trimester of pregnancy, within one week after delivery, and 2 months postpartum, we assessed anxiety, depression, and maternal representations. Mother-infant interactions were videotaped during feeding within one week after delivery and again at 2 months postpartum and coded blindly using the Coding Interactive Behavior (CIB) scales. Anxiety and depression scores were significantly higher at all assessment points in the SM group. Maternal representations were also different between SM and control groups at all study time. Perturbations to early mother-infant interactions were observed in the SM group. These dyads showed greater dysregulation, lower maternal sensitivity, higher maternal intrusive behaviour and higher infant avoidance. Multivariate analysis showed that maternal representation and depression at third trimester predicted mother-infant interaction. CONCLUSION False positive ultrasound screenings for SM are not benign and negatively affect the developing maternal-infant attachment. Medical efforts should be directed to minimize as much as possible such false diagnoses, and to limit their psychological adverse consequences.
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Affiliation(s)
- Sylvie Viaux-Savelon
- Department of Child and Adolescent Psychiatry, APHP, GH Pitié-Salpétrière, Paris, France
- CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
| | - Marc Dommergues
- Service de Gynécologie Obstétrique, Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie, Paris, France
| | - Ouriel Rosenblum
- Department of Child and Adolescent Psychiatry, APHP, GH Pitié-Salpétrière, Paris, France
- Laboratoire de Psychopathologie et de Psychologie Médicale, Université de Bourgogne, Dijon, France
| | - Nicolas Bodeau
- Department of Child and Adolescent Psychiatry, APHP, GH Pitié-Salpétrière, Paris, France
| | - Elizabeth Aidane
- Department of Child and Adolescent Psychiatry, APHP, GH Pitié-Salpétrière, Paris, France
| | - Odile Philippon
- Service de Gynécologie Obstétrique, Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie, Paris, France
| | - Philippe Mazet
- Department of Child and Adolescent Psychiatry, APHP, GH Pitié-Salpétrière, Paris, France
| | - Claude Vibert-Guigue
- Service de Gynécologie Obstétrique, Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie, Paris, France
| | - Danièle Vauthier-Brouzes
- Service de Gynécologie Obstétrique, Groupe Hospitalier Pitié-Salpêtrière, APHP, Université Pierre et Marie Curie, Paris, France
| | - Ruth Feldman
- Gonda Brain Research and Psychology Department, Bar Ilan University, Tel Aviv, Israël
| | - David Cohen
- Department of Child and Adolescent Psychiatry, APHP, GH Pitié-Salpétrière, Paris, France
- CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
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Åhman A, Lindgren P, Sarkadi A. Facts first, then reaction--expectant fathers' experiences of an ultrasound screening identifying soft markers. Midwifery 2011; 28:e667-75. [PMID: 21920645 DOI: 10.1016/j.midw.2011.07.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 07/08/2011] [Accepted: 07/24/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND expectant fathers often attend pregnancy ultrasound but their needs are poorly examined, especially in connection with adverse findings. OBJECTIVE to explore men's expectations of routine ultrasound and experiences when soft markers were discovered. DESIGN/SETTING a qualitative study at Uppsala University Hospital in Sweden where semi-structured, in-depth interviews were conducted with 17 expectant fathers 6-12 weeks after the discovery of a soft marker at the routine ultrasound scan. FINDINGS five major themes emerged: (1) 'immediate reaction: frustration and thoughts about consequences', (2) 'need for facts to gain control', (3) 'concern about the partner', (4) 'in retrospect: almost okay but routines need changing' and (5) 'amniocenteses or not: a joint decision with several considerations'. CONCLUSIONS AND IMPLICATIONS FOR PRACTISE these findings contribute important knowledge about men's needs related to pregnancy ultrasound with unexpected findings, and their role in decision-making concerning fetal diagnostics. Our results show that men enter a role of a kind of fact manager and have both a psychological need as well as the capacity to perceive important information during the process following the detection of a soft marker in the fetus. Practitioners conducting pregnancy ultrasound should therefore have relevant knowledge to be able to provide immediate information about soft markers, including risk assessment for chromosomal defects. In addition to this, written information about soft markers should be available to expecting parents in this situation.
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Affiliation(s)
- Annika Åhman
- Department of Women's and Children's Health, Uppsala university, Child Public Health Unit, Samariterhemmet, SE-751 25 Uppsala, Sweden.
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Ahman A, Runestam K, Sarkadi A. Did I really want to know this? Pregnant women's reaction to detection of a soft marker during ultrasound screening. PATIENT EDUCATION AND COUNSELING 2010; 81:87-93. [PMID: 20083367 DOI: 10.1016/j.pec.2009.12.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 12/16/2009] [Accepted: 12/20/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To investigate women's expectations of routine ultrasound and experiences when soft markers were discovered: what the disclosure meant, how it affected them, how they experienced the information given and why they did or did not choose amniocentesis. DESIGN Semi-structured, in-depth interviews were conducted with 11 women 25-30 weeks into the pregnancy, 7-13 weeks after the discovery of a soft marker. FINDINGS Women lacked knowledge about the potential of the scan and detection of soft markers created strong emotional reactions that women thought could have been alleviated by prior information about potential findings. Information in connection with the scan was perceived as insufficient. Decision about amniocentesis was affected by attitudes to disability, anxiety about fetal loss due to the procedure, need for certainty by a diagnostic test, and partner's opinion. CONCLUSIONS Women were shocked by the unexpected and sometimes unwanted information on elevated risk for a chromosomal aberration for which they lacked any preparation. Because this event often has long-lasting effects on the pregnancy, models of information that are efficient in promoting informed decisions are imperative. PRACTICE IMPLICATIONS Both women and their partners need relevant information before and in connection with ultrasound scan to be able to make informed choices.
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Affiliation(s)
- Annika Ahman
- Department of Women's and Children's Health, Uppsala University Hospital, Sweden.
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Larsson AK, Svalenius EC, Lundqvist A, Dykes AK. Parents' experiences of an abnormal ultrasound examination - vacillating between emotional confusion and sense of reality. Reprod Health 2010; 7:10. [PMID: 20546610 PMCID: PMC2904723 DOI: 10.1186/1742-4755-7-10] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 06/14/2010] [Indexed: 11/15/2022] Open
Abstract
Background An ultrasound examination is an important confirmation of the pregnancy and is accepted without reflection to any prenatal diagnostic aspects. An abnormal finding often comes unexpectedly and is a shock for the parents. The aim was to generate a theoretical understanding of parents' experiences of the situation when their fetus is found to have an abnormality at a routine ultrasound examination. Methods Sixteen parents, mothers and fathers, whose fetus had been diagnosed with an abnormality during an ultrasound scan in the second or third trimester, were interviewed. The study employed a grounded theory approach. Results The core category vacillating between the emotional confusion and sense of reality is related to the main concern assessment of the diagnosis impact on the well-being of the fetus. Two other categories Entering uncertainty and Involved in an ongoing change and adaptation have each five sub-categories. Conclusions Parents are aware of that ultrasound examination is a tool for identifying abnormalities prenatally. The information about the abnormality initially results in broken expectations and anxiety. Parents become involved in ongoing change and adaptation. They need information about the ultrasound findings and the treatment without prolonged delay and in a suitable environment. The examiner who performs the ultrasound examination must be aware of how anxiety can be intensified by environmental factors. All parents should to be offered a professional person to give them support as a part of the routine management of this situation.
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Affiliation(s)
- Anna-Karin Larsson
- Faculty of Medicine, Department of Health Sciences, Division of Nursing, Lund University, PO Box 157, SE-221 00 Lund, Sweden.
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Current world literature. Curr Opin Obstet Gynecol 2010; 22:166-75. [PMID: 20216348 DOI: 10.1097/gco.0b013e328338c956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Larsson AK, Svalenius EC, Marsál K, Ekelin M, Nyberg P, Dykes AK. Parents' worried state of mind when fetal ultrasound shows an unexpected finding: a comparative study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2009; 28:1663-1670. [PMID: 19933480 DOI: 10.7863/jum.2009.28.12.1663] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Most parents yearn for a second-trimester ultrasound examination and feel excitement about it, but some also worry about what the examination will show. According to prior research, using only generic instruments or specific questionnaires, anxiety decreases when the ultrasound findings are normal. The aim of this study was to compare parents' worry (Parents' Expectations, Experiences, and Reactions to Ultrasound [PEER-U] State of Mind Index) and sense of coherence before and after a routine second-trimester ultrasound examination when it showed normal or abnormal findings. METHODS A 1-year cohort study was performed at a Swedish university hospital. A total of 2049 parents who had their second-trimester ultrasound examinations there filled in a questionnaire consisting of 2 parts before and after the examinations. RESULTS Parents with normal ultrasound findings were less worried than parents with abnormal findings. The group with normal findings also showed less worry after the examination than before. A sex analysis showed similar patterns. CONCLUSIONS Parents with abnormal ultrasound findings are more worried and anxious. The new instrument, the PEER-U State of Mind Index, not only measures parents' worry but can also expose what influences their ultrasound examination experience.
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Affiliation(s)
- Anna-Karin Larsson
- Division of Nursing, Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, SE-22100 Lund, Sweden.
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Hofmeyr GJ. Routine ultrasound examination in early pregnancy: is it worthwhile in low-income countries? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 34:367-370. [PMID: 19790097 DOI: 10.1002/uog.7352] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Larsson AK, Svalenius EC, Marsal K, Dykes AK. Parental level of anxiety, sense of coherence and state of mind when choroid plexus cysts have been identified at a routine ultrasound examination in the second trimester of pregnancy: a case control study. J Psychosom Obstet Gynaecol 2009; 30:95-100. [PMID: 19533488 DOI: 10.1080/01674820903030173] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The aim of the study was to compare parents' experience of a routine ultrasound examination in the second trimester, when a choroid plexus cyst/cysts (CPC) were found (Study group; n = 22), with matched controls where no fetal deviations were identified (Control group, n = 66). All the parents had participated in a larger cohort study. The instruments used for measuring anxiety were STAI-state/trait, sense of coherence (SOC) and Parents' Expectations, Experiences, Reactions to an Ultrasound examination during pregnancy (PEER-U, State of Mind Index). Regarding the SOC and STAI-state/trait no significant differences were found between the cases and controls or within the respective group before and after the ultrasound examination. The cases had an increase in anxiety (more anxious) as measured by the instrument PEER-U after the examination, while the controls showed a significant better level of State of Mind Index (less anxious) after the examination, compared to before. Therefore PEER-U can be a more reliable instrument when studying state of mind (anxiety) in connection with ultrasound examinations, and as it is specific for this situation it does not appear to be time dependent.
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Affiliation(s)
- Anna-Karin Larsson
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden.
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