Developing the PEER‐U scale to measure parents' expectations, experiences and reactions to routine ultrasound examinations during pregnancy

The influence of antenatal imaging on prenatal bonding in uncomplicated pregnancies: a mixed methods analysis

BACKGROUND

Prenatal bonding describes the emotional connection expectant parents form to their unborn child. Research acknowledges the association between antenatal imaging and enhanced bonding, but the influencing factors are not well understood, particularly for fathers or when using advanced techniques like fetal magnetic resonance imaging (MRI). This study aimed to identify variables which may predict increased bonding after imaging.

METHODS

First-time expectant parents (mothers = 58, fathers = 18) completed a two-part questionnaire (QualtricsXM™) about their expectations and experiences of ultrasound (n = 64) or fetal MRI (n = 12) scans in uncomplicated pregnancies. A modified version of the Prenatal Attachment Inventory (PAI) was used to measure bonding. Qualitative data were collected through open-ended questions. Multivariate linear regression models were used to identify significant parent and imaging predictors for bonding. Qualitative content analysis of free-text responses was conducted to further understand the predictors' influences.

RESULTS

Bonding scores were significantly increased after imaging for mothers and fathers (p < 0.05). MRI-parents reported significantly higher bonding than ultrasound-parents (p = 0.02). In the first regression model of parent factors (adjusted R2 = 0.17, F = 2.88, p < 0.01), employment status (β = -0.38, p < 0.05) was a significant predictor for bonding post-imaging. The second model of imaging factors (adjusted R2 = 0.19, F = 3.85, p < 0.01) showed imaging modality (β = -0.53), imaging experience (β = 0.42) and parental excitement after the scan (β = 0.29) were significantly (p < 0.05) associated with increased bonding. Seventeen coded themes were generated from the qualitative content analysis, describing how scans offered reassurance about fetal wellbeing and the opportunity to connect with the baby through quality interactions with imaging professionals. A positive scan experience helped parents to feel excited about parenthood. Fetal MRI was considered a superior modality to ultrasound.

CONCLUSIONS

Antenatal imaging provides reassurance of fetal development which affirms parents' emotional investment in the pregnancy and supports the growing connection. Imaging professionals are uniquely positioned to provide parent-centred experiences which may enhance parental excitement and facilitate bonding.

Validity and reliability of the Turkish version of the PEER-U scale

Background: Antenatal care is necessary for mother and infant by reducing or eliminating the risks which may occur in the antenatal and postnatal period. Ultrasound is one of the most commonly used examination methods in antenatal monitoring. Evaluating the expectations, experiences and reactions of both parents during routine ultrasound examinations is essential to provide the best antenatal care. Objective: This study aims to test the validity and reliability of the PEER-U scale developed for Sweden by Ekelin et al. Method: The PEER-U scale consists of before and after ultrasound scales. Four hundred and thirty-six parents participated in the study. Interviews were conducted with all participating parents in a private room 15 minutes before and five minutes after the ultrasound. Researchers analysed the PEER-U scale for language, content, construct, criterion-referenced validity and internal consistency reliability. Results: The Turkish version of PEER-U has 21 items in the before ultrasound scale and 21 items in the after ultrasound scale. Cronbach's alpha was 0.65 for the before ultrasound scale and 0.89 for the after ultrasound scale. Conclusion: The study determined that the Turkish version of the PEER-U scale is a valid and reliable scale for Turkish society.

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.

Parents' worried state of mind when fetal ultrasound shows an unexpected finding: a comparative study

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.

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

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.