Anxiety scores before and after genetic sonogram

Development and clinical validation of real-time artificial intelligence diagnostic companion for fetal ultrasound examination

OBJECTIVE

Prenatal diagnosis of a rare disease on ultrasound relies on a physician's ability to remember an intractable amount of knowledge. We developed a real-time decision support system (DSS) that suggests, at each step of the examination, the next phenotypic feature to assess, optimizing the diagnostic pathway to the smallest number of possible diagnoses. The objective of this study was to evaluate the performance of this real-time DSS using clinical data.

METHODS

This validation study was conducted on a database of 549 perinatal phenotypes collected from two referral centers (one in France and one in the UK). Inclusion criteria were: at least one anomaly was visible on fetal ultrasound after 11 weeks' gestation; the anomaly was confirmed postnatally; an associated rare disease was confirmed or ruled out based on postnatal/postmortem investigation, including physical examination, genetic testing and imaging; and, when confirmed, the syndrome was known by the DSS software. The cases were assessed retrospectively by the software, using either the full phenotype as a single input, or a stepwise input of phenotypic features, as prompted by the software, mimicking its use in a real-life clinical setting. Adjudication of discordant cases, in which there was disagreement between the DSS output and the postnatally confirmed ('ascertained') diagnosis, was performed by a panel of external experts. The proportion of ascertained diagnoses within the software's top-10 differential diagnoses output was evaluated, as well as the sensitivity and specificity of the software to select correctly as its best guess a syndromic or isolated condition.

RESULTS

The dataset covered 110/408 (27%) diagnoses within the software's database, yielding a cumulative prevalence of 83%. For syndromic cases, the ascertained diagnosis was within the top-10 list in 93% and 83% of cases using the full-phenotype and stepwise input, respectively, after adjudication. The full-phenotype and stepwise approaches were associated, respectively, with a specificity of 94% and 96% and a sensitivity of 99% and 84%. The stepwise approach required an average of 13 queries to reach the final set of diagnoses.

CONCLUSIONS

The DSS showed high performance when applied to real-world data. This validation study suggests that such software can improve perinatal care, efficiently providing complex and otherwise overlooked knowledge to care-providers involved in ultrasound-based prenatal diagnosis. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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

AIM

to describe the expectations to and knowledge of antenatal screening of expecting parents, and their experiences concerning the first-trimester screening scan.

DESIGN

survey study with a consecutive sampling method.

SETTING

two hospital districts in Finland, namely the capital area and Eastern Finland. Together these two districts include the six different municipal units in which the first-trimester screening scans discussed in the study were done during spring 2015.

PARTICIPANTS

1037 participants: 654 pregnant women and 346 partners.

MEASUREMENTS AND FINDINGS

the survey was based on an electronic questionnaire containing 29 questions. Almost all the pregnant women involved had received information on screenings during antenatal care, but only 20% reported a good level of familiarity with the various screening methods. Of the respondents, around 30% of the partners and 26% of all participants with lower education considered their knowledge to be poor. Around 30% of nulliparous respondents reported a need for further information. The experiences of the first-trimester screening scans were generally positive, though some of the partners felt they were treated too impersonally. Parents were well informed during the scan.

KEY CONCLUSIONS

the expectations of the antenatal screening of the parents-to-be were realistic, even for those whose knowledge of antenatal screening by their own estimation inadequate. Nulliparous and highly-educated respondents would have needed more counselling. For all respondents the first trimester screening scan generally reinforced the sense of becoming a parent.

IMPLICATIONS FOR PRACTICE

new ways to provide information on antenatal screening are needed. In particular, there should be a focus on making the information more understandable and accessible both to pregnant women and to partners. The results of this study could be used in developing such means of providing such information during antenatal care and services in ultrasound units. The results would also be helpful for improving professional skills of the medical personnel performing the scans, and for providing information on them.

Development and validation of the Prenatal Diagnostic Procedures Anxiety Scale

OBJECTIVES

As there are currently no specific measures of anxiety due to prenatal diagnostic procedures, the aim of the study was to develop and validate a new measure called the Prenatal Diagnostic Procedure Anxiety Scale (PDPAS).

METHODS

Seventy-four pregnant women scheduled for amniocentesis and ultrasound completed the PDPAS, the State-Trait Anxiety Inventory, the Edinburgh Postnatal Depression Scale, and the Perceived Stress Scale before undergoing the diagnostic procedure. Reliability, concurrent validity, factor structure, scale sensitivity, and specificity were analyzed. Differences between amniocentesis and ultrasound groups in the PDPAS score were analyzed with a t-test.

RESULTS

The final scale comprised 11 items and two subscales measuring 'fear of procedure' and 'fear of abnormal result'. Concurrent validity analysis showed that the PDPAS is an independent measure of anxiety. At a cut-off score of >11, sensitivity was 75.0% and specificity was 72.01% with moderate accuracy. Fear of procedure was higher in the amniocentesis group, whereas fear of abnormal result was equally present in both amniocentesis and ultrasound groups.

CONCLUSION

The PDPAS has good internal consistency and concurrent validity with satisfactory psychometric characteristics. As a short measure of situation-specific anxiety, it can be used as a screening tool in prenatal clinical settings.