Scanning for pleasure

Stress and anxiety associated with prenatal diagnosis

Prior to any specific prenatal diagnostic procedure, the pregnant woman should be counselled about the indications for the procedure and how the diagnosis would inform care. In addition, the risks and limitations should be clearly spelt out. The availability of non-invasive prenatal diagnostic procedures such as sonography appears to have led to a higher rate of acceptance of such procedures, especially in younger patients. The expectations of pregnant women and their partners concerning prenatal diagnosis focus on reducing uncertainty in regard to the normality of the pregnancy. However, any prenatal diagnostic procedure can cause emotional stress in the pregnant woman. There are two different types of stress in this situation. There may be anxiety about the invasive nature of the procedure and the attendant risk of the loss of a wanted pregnancy. There may also be anxiety over the outcome of the investigation. Any unexpected finding, especially an abnormal one, often has an adverse impact on the pregnant woman and her partner. Imaging of the unborn child on sonography, and revealing fetal movements and heartbeat, are increasingly a common and key experience in a pregnancy. With the advent of this now commonly shared experience, the male partner also gives up his roll as a passive onlooker and becomes more actively involved in the pregnancy. Couples require multidisciplinary care if an abnormal fetus is found.

Women's response to fetal choroid plexus cysts detected by prenatal ultrasound

OBJECTIVES

To determine maternal responses to detection of a minor structural variant, the choroid plexus cyst (CPC), in their fetus on prenatal ultrasound.

STUDY DESIGN

We interviewed 34 pregnant women with an isolated CPC detected on mid-pregnancy ultrasound about their objective experience at diagnosis, emotional response and subsequent reactions. Audiotaped, transcribed responses were evaluated by two independent raters and analyzed qualitatively and quantitatively.

RESULTS

All women reported negative emotional responses including shock, distress, fear and decreased attachment, despite counseling by 82% of providers that the CPC was probably benign. Three women underwent amniocentesis purely for reassurance after CPC detection. Most (79%) sought information beyond what their physician provided, frequently on the internet. One half of women reported that intense negative responses were temporary. However, weeks after diagnosis, 62% continued to believe that the CPC presented some danger to their baby.

CONCLUSIONS

Detection of CPC prenatally can evoke profound, negative maternal emotional responses despite accurate provider counseling. Practitioners should consider these responses when counseling parents about these and other structural variants of unclear functional significance.

A ultra-sonografia obstétrica e a relação materno-fetal em situações de normalidade e anormalidade fetal

A ultra-sonografia obstétrica já é considerada um exame de rotina no pré-natal. Esse procedimento inaugurou uma nova forma de contato com o universo intra-uterino, além de ter passado a antecipar dados reais do bebê que antes só eram conhecidos após o seu nascimento. Hoje é possível saber o sexo do bebê, visualizar suas características físicas e maneiras de se movimentar, bem como fazer um diagnóstico de anormalidade fetal. Assim, a crescente utilização da ultra-sonografia parece afetar a relação pais-feto. Diversos estudos têm sido realizados a respeito das repercussões psicológicas da ultra-sonografia obstétrica na relação materno-fetal. O presente artigo revisa os principais achados desses estudos destacando tanto as situações de normalidade quanto de anormalidade fetal. Embora não haja consenso quanto ao impacto da ultra-sonografia para a relação materno-fetal, os estudos são unânimes em reconhecer o impacto emocional desse momento em situações de normalidade e, especialmente, nos casos de anormalidade fetal. Assim sendo, é necessário atentar também para os aspectos psicológicos desse exame e para seu potencial de afetar a relação pais-bebê.

Ultrasound screening in pregnancy: advancing technology, soft markers for fetal chromosomal aberrations, and unacknowledged ethical dilemmas

Fetal ultrasound screening has become routine practice in many western countries. During the last decade, such screening has led to frequent situations characterised by clinical uncertainty due to the disclosure of soft markers in the unborn child. Soft markers are minor anatomical variations indicating a somewhat increased likelihood that the fetus has a chromosomal aberration, most frequently trisomy 21 (Down syndrome). This paper presents the results of a comprehensive literature search of the National Library of Medicine with emphasis on the chronological development of scientific knowledge in relation to soft markers and the link between advancing imaging technology and clinical counselling dilemmas. An analysis of the literature makes evident that many ultrasound examiners have counselled individual pregnant women on the basis of insufficient data. Moral dilemmas have thus emerged as a direct result of advancing medical technology, and healthy fetal lives prove to have been lost due to invasive diagnostic testing aimed at resolving clinical uncertainty. Ultrasound examiners have warned against a policy of disclosing all findings of soft markers to expectant parents, but no exploration of experiential aspects linked to the disclosure of fetal soft markers has yet been published in the medical literature. The emotional reactions of mothers are important to consider given their potential impact on the biological development of the fetus. In conclusion, this paper stresses the need for paying close attention to the crucial distinction between technology development and technology implementation in relation to prenatal testing. Furthermore, it provides strong arguments for scrutinising the interface between prenatal testing and human experience.