Ultrasound screening in the 2nd trimester. The pregnant woman's background knowledge, expectations, experiences and acceptances

Parents' experiences of the information provided at the antenatal clinic regarding foetal diagnostics - A qualitative interview study

OBJECTIVE

This study aimed to examine the pregnant women's and their partner's experience of the information given at the antenatal clinic regarding screening methods.

METHODS

A qualitative interview study was conducted in the Gothenburg area in Sweden. Ten women and seven partners expecting their first child were interviewed adjacent to the second-trimester ultrasound examination. The data were analysed using qualitative content analysis.

RESULTS

The findings present an overall theme, three main categories, and ten subcategories. The overall theme showed a nonhomogeneous and individually based picture concerning the meaning and purpose of the methods, need for improvement of information, parents own information seeking, and the encounter with the midwife was also experienced as an influential encounter. The main categories show that diversity relates to the level of information given, voluntariness, the possibility of abnormal findings, and varying needs to thorough information and pre-existing knowledge. The midwifés impact was related to attitude, openness for questions, time for explanations, and the balance between providing enough information to support without worrying the parents.

CONCLUSIONS

Although previous research has pointed out a decade ago that information regarding foetal diagnostics is lacking, this study shows that these shortcomings still exist and that improvement is needed. The given information should be explicit concerning the purpose, limitations, and voluntariness of prenatal testing. Sufficient time for questions and discussion is as important as considering the parents' pre-existing knowledge, individual thoughts or questions, and a neutral attitude from the midwife is desirable.

Impact of expectant mother's knowledge level about fetal anomaly scan on their state anxiety prior to antenatal ultrasound screening

OBJECTIVE

We aimed to investigate the role of expectant mothers' background antenatal ultrasound knowledge on their state anxiety when they apply for the ultrasound examination.

MATERIALS AND METHODS

A cross-sectional study was conducted in perinatology outpatient clinic of a university hospital. Expectant mothers who applied for the first trimester ultrasound scan and second trimester anomaly scan were recruited to the study. A self-report form was applied to participants to assess the sociodemographic characteristics, obstetric history, knowledge and attitudes toward antenatal ultrasound. Expectant mothers' state anxiety prior to ultrasound scan was measured with the state sub-scale of State-Trait Anxiety Inventory.

RESULTS

A total of 500 expectant mothers (220 in the first trimester and 280 in the second trimester) were included to the study. We found a negative correlation between the participants' age and state anxiety level (r = -0.118, p < .01). Also, participants' education level had a significant effect on their state anxiety level (F (2, 497)=5.91, p < .01). Participant's age significantly predicted lower state anxiety level (β = -0.10, t = -2.09, p < .05). We did not find any significant relationship between the mean knowledge level of mothers and state anxiety levels of mothers (r = -0.07, p > .05).

CONCLUSION

Age was the only affecting factor on anxiety levels before ultrasound scan in pregnant participants. There was no significant effect of background knowledge on state anxiety.

Sonographers' communication in obstetrics: Challenges to their professional role and practice in Australia

INTRODUCTION/PURPOSE

Despite the clinical importance of patient-centred care in the sonographer/patient interaction in obstetric ultrasound, there has been very little current research in Australia on sonographer and sonologist communication practices in the event of an adverse finding. This study sought the views, experiences and practices of Australian sonographers, particularly in relation to adverse findings, with consideration of the implications for their professional role and practice.

METHODS

Qualified and trainee sonographers who perform obstetric ultrasound were invited to complete a survey through the Australasian Sonographers Association. Using qualitative methodology, the authors developed themes on a range of issues related to sonographer and sonologist communication practices and roles from responses to three open-ended questions within the survey.

RESULT

Analysis of 249 responses revealed three distinct 'Communicator types'. 'Open Communicators' confidently practice open and direct communication; 'Limited Communicators' perceived barriers preventing them from openly communicating; 'Variable Communicators' indicated various challenging 'grey areas' which created inconsistent communication practices. Variables, such as the complexity of an adverse finding and a reporting sonologist's role, attitude and level of control they exercised over sonographer communication, all influenced respondents' communication practices. Respondents believed professional bodies should agree on a standardised policy regarding sonographers' roles.

DISCUSSION

This paper highlights the complexity of the sonographer/patient interaction and outlines the difficulty in providing true patient-centred care in obstetric ultrasound.

CONCLUSION

The need for a collaborative, patient-focussed policy, which defines and recognises the role of the sonographer in the event of obstetric adverse findings, will improve the current model of care.

Experiences of pregnant women with a third trimester routine ultrasound - a qualitative study

Background

Studies showed that pregnant women generally value routine ultrasounds in the first two trimesters because these provide reassurance and a chance to see their unborn baby. This, in turn, might help to decrease maternal anxiety levels and increase the bond with the baby. However, it is unclear whether pregnant women hold the same positive views about a third trimester routine ultrasound, which is increasingly being used in the Netherlands as a screening tool to monitor fetal growth. The aim of this study was to explore pregnant women’s experiences with a third trimester routine ultrasound.

Methods

We held semi-structured interviews with fifteen low-risk pregnant women who received a third trimester routine ultrasound in the context of the Dutch IUGR RIsk Selection (IRIS) study. The IRIS study is a nationwide cluster randomized controlled trial carried out among more than 13,000 women to examine the effectiveness of a third trimester routine ultrasound to monitor fetal growth. For the interviews, participants were purposively selected based on parity, age, ethnicity, and educational level. We performed thematic content analysis using MAXQDA.

Results

Most pregnant women appreciated a third trimester routine ultrasound because it provided them confirmation that their baby was fine and an extra opportunity to see their baby. At the same time they expressed that they already felt confident about the health of their baby, and did not feel that their bond with their baby had increased after the third trimester ultrasound. Women also reported that they were getting used to routine ultrasounds throughout their pregnancy, and that this increased their need for another one.

Conclusions

Pregnant women seem to appreciate a third trimester routine ultrasound, but it does not seem to reduce anxiety or to improve bonding with their baby. Women’s appreciation of a third trimester routine ultrasound might arise from getting used to routine ultrasounds throughout pregnancy. We recommend to examine the psychological impact of third trimester routine ultrasounds in future studies. Results should be taken into consideration when balancing the gains, which are as yet not clear, of introducing a third trimester routine ultrasound against unwanted side effects and costs.

Public Perceptions and Politics

Societal influences have resulted in a shift of diagnostic medical ultrasound, particularly prenatal ultrasound, from its roots as a diagnostic medical tool to the public domains of marketing, entertainment, and the contentious abortion debate. This article examines the impact of ultrasound on society and society on ultrasound by using prenatal ultrasound screening as the catalyst for the discussion. Ultrasound is a powerful tool that has redefined pregnancy for most women in the United States. The medical benefits of ultrasound notwithstanding, the woman's emotional experience in the examination room, as has been closely examined by social scientists, often transcends the diagnostic outcomes; a consideration that must be recognized by the sonographer or sonologist. The trivialization of ultrasound in the mass media further jeopardizes the integrity of the ultrasound technology by creating unrealistic expectations about the nature of the examination. Through patient and community education efforts with regard to the nature of the ultrasound examination and the process of obtaining informed consent, the diagnostic ultrasound professional can safeguard patients and the general public from technological exploitation.

Maternal factors associated with misperceptions of the second-trimester sonogram

OBJECTIVE

Prior studies have shown that patients have poor understanding of prenatal screening tests. The purpose of this study was to evaluate the frequency with which patients have poor understanding of the sensitivity and safety of the second-trimester fetal sonogram and to identify maternal factors associated with poor understanding.

METHOD

One hundred fifty-five women presenting for a routine fetal anatomy scan completed a survey that assessed their understanding of the diagnostic sensitivity and safety of ultrasound, their demographic characteristics, and the sources of information of their knowledge of ultrasound. The frequency of misperception with regard to sonographic sensitivity or safety was determined, and both univariable and multivariable analyses were performed to identify factors associated with misperception.

RESULTS

Fifty-one percent of women had a misperception of the sensitivity or safety of a second-trimester sonogram. Although multiple characteristics (age, ethnicity, education, income, source of ultrasound information) were associated with this misperception in univariable analysis, only education and income remained independently associated with misperception in multivariable regression.

CONCLUSION

Lower educational attainment and lower income are associated with misperception of the sensitivity and safety of a second-trimester sonogram.

Does an informational film increase women's possibility to make an informed choice about second trimester ultrasound?

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.

Japanese women's attitudes towards routine ultrasound screening during pregnancy

Because there are few published studies from Eastern countries concerning women's experiences of prenatal ultrasound scans, this study investigated this topic in 238 Japanese women in three different prenatal settings. A cross-sectional questionnaire of 33 items was administered to 261 women at 14-37 weeks gestation with no known obstetrical risk, after their ultrasounds. The main reasons for the ultrasounds were evaluation of fetal growth (100%, n = 238); obstetrical conditions (n = 228, 96%); and fetal abnormalities (91%, n = 217). With increasing maternal age, participants worried more about obstetric problems or fetal abnormalities. Many were interested in fetal viability in early pregnancy, and obstetric problems or fetal abnormality in late pregnancy. While most (n = 234, 98%) looked forward to having scans, the majority (n = 235, 99%) wanted to know if their baby had an anomaly, and 72% (n = 171) worried about the detection of abnormalities. Only 50% (n = 118) had obtained information from their care provider. To assist with women's decision-making, prenatal care providers should provide quality information and understand the factors that influence women's concerns.

First-trimester Down syndrome screening: pregnant women's knowledge

OBJECTIVES

The primary aim of this study was to assess pregnant women's knowledge of first-trimester combined Down syndrome screening in a setting of required informed consent. As the secondary aim, we wanted to identify relevant differences in knowledge level among subgroups of pregnant women, including those informed in different ways about prenatal examinations.

METHODS

Data stem from a population-based cross-sectional questionnaire study including 15 multiple-choice questions assessing knowledge of different aspects of screening. Included were 6427 first-trimester pregnant women from three Danish obstetric departments offering prenatal screening free of charge. Both participants and non-participants in the screening program were included. The results are based on 4095 responders (64%). Differences between subgroups were examined using chi-squared tests and logistic regression analysis. Estimates are stated with 95% CI.

RESULTS

The majority of the participants (87.6 (86.6-88.6)% to 92.6 (91.7-93.3)%) correctly identified the test concept and the main condition being screened for. Fewer participants (16.4 (15.3-17.6)% to 43.3 (41.8-44.8)%) correctly recognized test accuracy and the potential risk of adverse findings other than Down syndrome. Knowledge level was positively associated with length of education (adjusted ORs 1.0 (0.8-1.4) to 3.9 (2.4-6.4)) and participation in the screening program (adjusted OR 0.9 (0.6-1.3) to 5.9 (3.9-8.8)). Participation in an individual information session was weakly associated with more knowledge.

CONCLUSION

The majority of the pregnant women correctly identified the test concept and the main condition being screened for. The pregnant women were found less knowledgeable on test accuracy and drawbacks.

Ultrasound screening during pregnancy in Iran: womens' expectations, experiences and number of scans

OBJECTIVE

To determine the number of ultrasound scans received by Iranian mothers during pregnancy and the relationship between scanning and background factors, and to describe the mothers' expectations and experiences of ultrasound scanning.

DESIGN

Descriptive survey.

SETTING

A hospital related to the Social Security Organisation of Urmia City in Iran.

PARTICIPANTS

Over a six-month period, all mothers attending postpartum care and who met the inclusion criteria (n=654) were interviewed two to three days post partum, and asked to complete a questionnaire containing defined closed- and open-ended questions.

FINDINGS

The mean number of ultrasound scans received by each woman during her latest pregnancy was 5.9. None of the participants received written information about the scanning procedure. For 91.1% (n=596) of the women, the most important reason for undergoing the scan was to be assured of their infant's health. However, the majority of women were not shown the monitor screen during any of their scans. The main reasons given for feeling happy after a scan were discovering the infant's gender and assurance about the infant's health. Most women overestimated the diagnostic power of ultrasound scanning. Few mothers reported negative feelings towards scanning, but more than half of the mothers indicated that they would like to see changes in the scanning procedure.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The quality of the information offered prior to scanning and the communication between staff and mothers should be improved. The number of scans should be decreased to be in accordance with the official Iranian public health-care guidelines. Although most women viewed ultrasound as being beneficial, it is essential to offer women appropriate information about the limitations of ultrasound in order to discourage unreasonable expectations and demands.

Did I really want to know this? Pregnant women's reaction to detection of a soft marker during ultrasound screening

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.

Effect of first-trimester ultrasound screening for Down syndrome on maternal-fetal attachment--a randomized controlled trial

OBJECTIVE

The objective was to investigate how ultrasound screening for Down syndrome (DS) in the first trimester, compared with a routine ultrasound examination in the second trimester, affected Maternal-Fetal Attachment (MFA) in mid-pregnancy.

METHOD

This study of 2026 pregnant women was a sub-study of a larger RCT aiming at evaluating the effect of fetal screening for Down syndrome (DS) by means of an ultrasound scan, including measuring fetal nuchal translucency in gestational weeks 12-14. Women were randomly allocated either to the intervention or to a control group where routine care with an ultrasound scan in gestational week 17-20 was offered. Data were collected by questionnaires before randomization and in gestational week 24. MFA was measured by a modified version of the Cranley Maternal-Fetal Attachment Scale (CMFAS).

RESULTS

The mean score of MFA was 3.50 in the intervention group and 3.44 in the control group (p=0.04). The mean scores on all subscales were slightly higher in the intervention group, but only statistically significant regarding "Differentiation of self from fetus" (p=0.01).

CONCLUSION

Ultrasound screening for DS in the first trimester may have a modest positive effect on MFA in mid-pregnancy, compared with a ultrasound scan in the second trimester.

Prenatal magnetic resonance imaging: towards optimized patient information

OBJECTIVES

To investigate the perception of fetal magnetic resonance imaging (MRI) by women confronted with the necessity of a targeted prenatal examination because of suspicion of an abnormality, in order to develop a pre-scan information leaflet tailored to the information requirements of these women.

METHODS

Sixty-two women were assessed by qualitative interview immediately before and after scanning. Data were analyzed by means of a qualitative content analysis. The transcribed interviews were coded within established categories, including knowledge of the purpose of the exam, understanding of the procedure, expectation of the baby's reaction, satisfaction with pre-information, experience of fetal MRI, distressing conditions during scanning, anxiety and suggestions for improvement of the scanning procedure.

RESULTS

Pre-scan interviews indicated 66% of our sample to be well-informed about the purpose of fetal MRI. A realistic, detailed description of the examination was given by 37%. Only 32% expected the scanning to be safe for their baby. Despite the overall good tolerance of fetal MRI (63%), post-scan interviews revealed that 58% of women had experienced anxiety during MRI, which was partly due to the fearful perception of intensified fetal body movements during scanning. The quality of the pre-information leaflet was rated as sufficiently informative by 68% of the women. Suggestions for improvement were centered on physical conditions, the presence of the partner during scanning, and the availability of pre-scan briefings.

CONCLUSIONS

Based on women's needs, detailed information about the fetal MRI procedure should be provided, containing clear-cut explanations about the purpose, course, method and possible distressing conditions. A leaflet describing these details should be given to women by the referring physician well in advance of the examination, and the woman given the opportunity to discuss unclear points.

[Fetal MR: evaluation of patient's experiences and practical implications]

PURPOSE

Several studies have evaluated the experience of patients undergoing obstetrical US. No similar study evaluated the impact of fetal MR on patients. Our hypothesis was that the fetal MR is more anxiety-producing than fetal US. The goal was to acquire insight to improve the experience for patients.

PATIENTS AND METHODS

Prospective dual-center study of 100 patients who answered a questionnaire validated by radiologists, obstetricians and psychologists. In one of the two centers, po sedation was routinely used in all patients. The questionnaires were qualitatively and quantitatively analyzed.

RESULTS

Results confirm the more stressful nature of MR compared to US (72%). One third of patients (34%) would have liked information about the procedure, diagnostic limitations, and mainly the impact on the fetus, especially with regards to noise. Most patients reported discomfort (duration, position) (82%) and stated that it would be preferable to be accompanied (83%). The perception of fetal movements by the mother was related to stress, noise and vibration of the MR examination.

CONCLUSION

MR increases the anxiety related to prenatal diagnosis by its setting and sometimes the lack of information, namely the fetal risk. It is important to maintain a dialogue between obstetricians and mothers from the indication to the acquisition of the MR. The diagnostic limitations of MR for prenatal diagnosis should be clearly stated. A discussion between the radiologist and mother after completion of the examination is desirable, if only to discuss the patient's or couple's comments.

Second-trimester routine ultrasound screening: expectations and experiences in a nationwide Swedish sample

OBJECTIVES

To investigate, in a large nationwide Swedish sample, pregnant women's expectations of the routine second-trimester ultrasound examination, with participants expressing themselves in their own words, and to determine whether they had been given sufficient information about why and how the examination was performed, and about possible risks. We focused specifically on reasons for women not having a positive experience.

METHOD

Of 4600 eligible Swedish-speaking women, 3061 were recruited to the study in early pregnancy, during three 1-week periods spread evenly over 1 year (1999-2000), and these women completed a questionnaire at a mean of 16 weeks' gestation. A follow-up questionnaire at 2 months after delivery was completed by 2730 women. The representativeness of the sample was assessed by comparison with the total Swedish birth cohort of 1999.

RESULTS

The most prominent expectation about the up-coming scan was confirmation that the baby was well, followed by confirmation that the pregnancy was real. Detailed information, such as date of delivery and sex of the baby, was mentioned less often, and very few wrote about the examination as an exciting and joyful experience. After the birth, a large majority was satisfied with information about why (88%) and how (87%) the examination was performed, but only 58% said they had received sufficient information about possible risks. 94% had a positive experience of the scan, and those who had not had more ambivalent feelings about their pregnancy. Women with negative feelings about the scan were more often single and of non-Swedish background, and emotional problems were more common in this group.

CONCLUSION

Women's expectations of the routine second-trimester scan differ from those of caregivers, focusing on general reassurance rather than specific information. Level of satisfaction with the scan was high, but information given about risks could be improved. Women with ambivalent or negative feelings about pregnancy may have difficulties enjoying the examination.

Routine ultrasound examination during pregnancy: a world of possibilities

OBJECTIVE

to identify and describe the meaning of the routine ultrasound scan to pregnant women.

DESIGN

a qualitative descriptive study using a grounded theory approach, with individual interviews to collect data.

SETTING

three antenatal clinics in a Swedish county of approximately 400,000 inhabitants.

PARTICIPANTS

voluntary samples of 10 pregnant Swedish women, 26-38 years of age, were interviewed prior to their first routine ultrasound.

FINDINGS

'making it possible' was the core category that explained and illustrated the meaning of the scan. The core category showed that the women considered the examination to be filled with possibilities to reach different goals during pregnancy. It also explained the categories: ultrasound as an event; ultrasound as a situation; ultrasound as a test; and the effects of ultrasound; as well as how they related to each other. The findings are considered the beginning of a theory concerning the meaning of the first ultrasound to pregnant women.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

pregnant women can see their first ultrasound as a tool that enables them to reach different goals during their pregnancy. Many of the goals concern meeting and connecting with the baby, suggesting that pregnant women consider the examination an important step towards parenthood. An ultrasound examination offered for medical reasons, which has other meanings than the intended for pregnant women, is important knowledge. It can be useful when giving information about the scan, addressing the woman during the examination, and for understanding and handling possible reactions.

Pregnant women's cognitive concept concerning their unborn prior to prenatal diagnosis

OBJECTIVE

We examined pregnant women's expectations concerning their unborn babies prior to prenatal diagnosis and also the possible correlations with emotional characteristics such as anxiety and depression.

METHODS

The consecutive sampling consisted of 324 pregnant women presenting themselves between the 11th and 29th weeks of pregnancy for detection of foetal anomalies. The pregnant women noted their thoughts and expectations concerning their unborn using a choice of 18 adjectives in a 5-point Likert scale in a standardized questionnaire. Anxiety was recorded with the State-Trait Anxiety Inventory and depression with a depression scale.

RESULTS

By means of factor analysis (analysis of the main components by varimax rotation), it was possible to determine 4 factors (inherent value criterion >1) from the 18 items (adjectives). Those 4 factors indicate a total of 58.3% of the variance. The first factor scale, well-being, is characterized by 4 items, 'happy', 'glad', 'carefree' and 'light-hearted'. The second factor scale, nervous, is identified mainly by the items 'fidgety', 'excitable', 'restless' and 'excited'. The third factor scale, passive, is marked by the items 'anxious', 'disheartened' and 'sleepy'. The fourth factor scale, vulnerable, is indicated by 3 items, 'in need of protection', 'vulnerable' and 'clinging'. Scales 1, 2 and 3 gave evidence of significant correlations with trait intensity in the state and trait anxiety scale and in the scale for the assessment of depressive mood prior to prenatal diagnosis and state anxiety after prenatal diagnosis.

CONCLUSION

The individual characteristics and attributes of the unborn child are differentiated prior to prenatal diagnosis. There is most certainly a link between the well-being of the pregnant woman and the effect it has on the emotional characteristics of her unborn child.

Fetal anomaly screening: what do women want to know?

AIM

This paper reports a study exploring women's experiences of receiving an adverse diagnosis at a routine second trimester ultrasound examination, and the factors that influenced their preparedness for an adverse finding.

BACKGROUND

Ultrasound has become a routine part of prenatal care offered to pregnant women in most developed countries and technological advances are making it increasingly possible to detect more anomalies, and at earlier gestations. When fetal anomaly detection can be an outcome of the examination, provision of effective information to ensure informed consent for screening remains a challenge.

METHOD

A grounded theory study (n = 38) was carried out in 2004 and 2005 using an in-depth interview within 4 weeks of diagnosis and constant comparative analysis.

FINDINGS

The core category of balancing information emerged, whereby women balanced the expectation of a healthy baby and the non-threatening nature of the ultrasound examination with the shock of an adverse diagnosis. Assumed fetal health was contributed to by being in good health, experiencing normal symptoms of pregnancy and having other healthy children. The majority of women believed that provision of extensive and detailed lists regarding fetal anomaly detection would only cause unnecessary anxiety and worry, and suggested that a less detailed approach is required for a routine screening programme for low-risk pregnancy.

CONCLUSION

The drive to inform all women fully of ultrasound detection rates for specific anomalies may be counter-productive as it will enhance the worry pregnant women already feel in relation to the health of their unborn baby.

Why women want prenatal ultrasound in normal pregnancy

OBJECTIVES

To investigate women's reasons for requesting prenatal ultrasound in the absence of clinical indications.

METHODS

A postal questionnaire was completed by 370 pregnant women with no apparent obstetric risk factors, who had expressed a desire to have ultrasound scanning in their current pregnancy. The women were asked to indicate, from a list of 12 items, their three most important reasons for wanting scanning. Ninety per cent of the women were in the first trimester of pregnancy, and 10% in the second trimester.

RESULTS

The items most frequently identified as important reasons for ultrasound were to check for fetal abnormalities (60% of women), to see that all was normal (55%) and for own reassurance (44%). Lower income was related to wanting to see the baby (P = 0.028) and wanting an ultrasound picture (P = 0.017); higher income was related to checking that all was normal (P = 0.003) and for own reassurance (P = 0.015). Women in their first pregnancy were more likely to want themselves and the father to see the baby (P = 0.001); women who had given birth previously were more likely to want reassurance (P = 0.002), as were women with a previous miscarriage or induced abortion. Women who believed that the presence of fetal trisomy justifies abortion or who would vote for free abortion were more likely to want to know about abnormalities (P < 0.001 and P < 0.004, respectively). Women in the second trimester were more likely to want to check for abnormalities (P = 0.041) and appropriate fetal growth (P = 0.047) than those in the first trimester.

CONCLUSIONS

It would appear that women in normal pregnancy have specific reasons for wanting prenatal ultrasound that are influenced by sociodemographic, obstetric and attitudinal factors.

[Ultrasonographic view and women's behaviour before first-trimester induced abortion]

Women's behaviour before induced abortion during an ultrasonographic exam was described. A psychosomatic analysis was carried out in the discussion to try to explain the different women's attitudes. Most women do not want to see ultrasonographic scan or keep photographs. One must of course respect women's choices as to their desire to see or not the ultrasound image of their foetus when pre-induced abortion ultrasound examination is performed. One should nonetheless be able to listen to their request, be it implicit.

Women's views of pregnancy ultrasound: a systematic review

BACKGROUND

Ultrasound has become a routine part of care for pregnant women in most countries with developed health services. It is one of a range of techniques used in screening and diagnosis, but it differs from most others because of the direct access that it gives parents to images of the fetus. A review of women's views of ultrasound was commissioned as part of a larger study of the clinical and economic aspects of routine antenatal ultrasound use.

METHODS

Studies of women's views about antenatal screening and diagnosis were searched for on electronic databases. Studies about pregnancy ultrasound were then identified from this material. Further studies were found by contacting researchers, hand searches, and following up references. The searches were not intentionally limited by date or language. Studies that reported direct data from women about pregnancy ultrasound were then included in a structured review. Studies were not excluded on the basis of methodological quality unless they were impossible to understand. They were read by one author and tabulated. The review then addressed a series of questions in a nonquantitative way.

RESULTS

The structured review included 74 primary studies represented by 98 reports. Studies from 18 countries were included, and they employed methods ranging from qualitative interviewing to psychometric testing. The review included studies from the very early period of ultrasound use up to reports of research on contemporary practice. Ultrasound is very attractive to women and families. Women's early concerns about the safety of ultrasound were rarely reported in more recent research. Women often lack information about the purposes for which an ultrasound scan is being done and the technical limitations of the procedure. The strong appeal of diagnostic ultrasound use may contribute to the fact that pregnant women are often unprepared for adverse findings.

CONCLUSIONS

Despite the highly varied study designs and contexts for the research included, this review provided useful information about women's views of pregnancy ultrasound. One key finding for clinicians was the need for all staff, women, and partners to be well informed about the specific purposes of ultrasound scans and what they can and cannot achieve.