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Lucius C, Jenssen C, Nürnberg D, Merkel D, Schreiber-Dietrich DG, Merz E, Dietrich CF. [Clinical Ultrasound Part II - Sonopsychology or Psychological Interactions using Ultrasound]. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2025. [PMID: 40373809 DOI: 10.1055/a-2581-4225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2025]
Abstract
In contrast to cross-sectional imaging using computed tomography, magnetic resonance imaging or positron emission tomography, ultrasound examinations enable direct real-time interaction between examiner and patient and their companions. In this review, we highlight general patient-relevant aspects, whereby endpoints such as emotional factors of general and physical stress caused by the examination are discussed. On the other hand, we take a closer look at specific psychosocial interactions during ultrasound examinations in primary care, gastroenterology, oncology, palliative care, pediatrics, obstetrics and gynecology. Furthermore, we consider ultrasound not only as an intervention in the sense of a needle-guiding procedure, but also as an opportunity to change relationships and initiate lifestyle modifications. The psychological impact of incidental findings and the importance of adequate communication of findings and prognosis is discussed from the patient's perspective.
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Affiliation(s)
- Claudia Lucius
- CED-Zentrum Berlin-Nord, Poliklinik Gastroenterologie, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Christian Jenssen
- Innere Medizin, Krankenhaus Märkisch Oderland GmbH, Strausberg, Germany
- Brandenburgisches Institut für Klinischen Ultraschall (BIKUS), Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Dieter Nürnberg
- Brandenburgisches Institut für Klinischen Ultraschall (BIKUS), Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
| | - Daniel Merkel
- Brandenburgisches Institut für Klinischen Ultraschall (BIKUS), Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin, Germany
- Immanuel Klinik Rüdersdorf, Rudersdorf, Germany
| | | | - Eberhard Merz
- Zentrum für Ultra-schall-dia-gnostik und Pränatalmedizin, Frankfurt, Germany
| | - Christoph F Dietrich
- Allgemeine Innere Medizin (DAIM) Kliniken Beau Site, Salem und Permanence, Kliniken Hirslanden Beau Site, Salem und Permanence, Bern, Switzerland
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2
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Field NK, Venkatesan C, Gano D, Agarwal S, Young KA, Wheeler S, Russ JB, Lemmon ME. Communicating neurological prognosis in the prenatal period: a narrative review and practice guidelines. Pediatr Res 2025:10.1038/s41390-025-03805-8. [PMID: 39809859 DOI: 10.1038/s41390-025-03805-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2024] [Revised: 12/12/2024] [Accepted: 12/15/2024] [Indexed: 01/16/2025]
Abstract
Clinicians may face an array of challenges in conducting fetal neurological consultations including prognostic uncertainty, a lack of training in fetal counseling, and limited opportunity to build rapport with families. In this setting, it is critical to employ high-quality, family-centered care to allow expectant parents to make informed decisions. Despite the challenges and gravity of these consultations, there remains limited data outlining best conduct and communication practices. This narrative review aims to summarize relevant literature around counseling within fetal neurology, focusing on three key themes: (1) discussing neurological prognosis and uncertainty, (2) navigating evolving decision making, (3) recognizing bias and understanding patient context. We provide practical recommendations to clinicians conducting fetal neurological counseling and outline future research priorities. IMPACT: Fetal neurological conditions can have a significant impact on child short- and long-term health outcomes. Prenatal consultations are an important venue to discuss information regarding fetal prognosis and decision making with expectant parents. However, there is limited evidence supporting best communication practices within this setting. This review summarizes current literature around expectant parent prognostic communication preferences and outlines practical recommendations and priorities for future research.
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Affiliation(s)
| | - Charu Venkatesan
- Division of Neurology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Dawn Gano
- Departments of Neurology and Pediatrics, UCSF Benioff Children's Hospitals, University of California San Francisco, San Francisco, CA, USA
| | - Sonika Agarwal
- Departments of Neurology and Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | | | - Sarahn Wheeler
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | - Jeffrey B Russ
- Division of Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Monica E Lemmon
- Division of Neurology, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
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Damm MF, Lou S, Sandager P, Vogel I, Prinds C, Hvidtjoern D. A time/space bubble: Expectant parents' experience of birth after termination of pregnancy due to fetal anomaly in a midwifery-led, obstetric unit for prenatal loss. Midwifery 2025; 140:104189. [PMID: 39383647 DOI: 10.1016/j.midw.2024.104189] [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: 05/14/2024] [Revised: 09/01/2024] [Accepted: 09/16/2024] [Indexed: 10/11/2024]
Abstract
Termination of pregnancy due to a fetal anomaly is a challenging and mentally stressful experience, associated with trauma-related stress, depression and symptoms of complicated grief. It differs from other types of pregnancy loss because of the role of active decision-making. Expectant parents depend on caring and experienced staff to guide them during a time full of ambiguity and contrasting emotions. This study examines how expectant parents experience the process of birth with termination of pregnancy due to fetal anomaly at a specialised unit for prenatal loss. Data was generated from semi-structured interviews with 11 women and 9 male partners, one to five months after termination of pregnancy. Three themes were identified 1) Suspended time/space bubble; the unit for prenatal loss was described as a time-space bubble, that promoted a sense of meaning, a feeling of togetherness and an awareness of parallel worlds, 2) The midwife matters; participants emphasised midwives' 'invisible', chronological and individualised practice, making it possible to be present and in the process, and 3) Meeting and spending time with the fetus/baby; participants' responses and relation to the fetus were very different, with most of them embracing the fetus as a baby, grateful for the opportunity to have time together. The findings from this study suggest a need for specialised midwives dedicated to prenatal loss, in units designed as private and protected spaces to accommodate the requirements of parents undergoing termination of pregnancy due to fetal anomaly.
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Affiliation(s)
- Maiken F Damm
- Department of Obstetrics and Gynechology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Women's Health, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Stina Lou
- Center for Fetal Diagnostics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; DEFACTUM - Public Health Research, Central Denmark Region, Oluf Palmes Allé 15, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynechology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Ida Vogel
- Department of Obstetrics and Gynechology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Christina Prinds
- Department of Women's Health, University Hospital of Southern Denmark, Kresten Philipsens Vej 15, 6200, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark; Department of Clinical Research, Unit of Gynechology and Obstetrics, University Hospital of Odense, Campusvej 55, 5230, Odense M
| | - Dorte Hvidtjoern
- Department of Obstetrics and Gynechology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark; Department of Clinical Medicine, Health, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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4
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Kaydırak MM, Balkan E, Bacak N, Kızoglu F. Perceived Social Support and Depression, Anxiety and Stress in Pregnant Women Diagnosed With Foetal Anomaly. J Adv Nurs 2024. [PMID: 39494755 DOI: 10.1111/jan.16587] [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: 11/06/2023] [Revised: 09/24/2024] [Accepted: 10/15/2024] [Indexed: 11/05/2024]
Abstract
AIM To examine the relationship between perceived social support level and depression, anxiety and stress in pregnant women diagnosed with foetal anomaly. DESIGN/METHODS This descriptive and correlational study was conducted in an advanced prenatal evaluation unit of a university hospital between December 2021 and May 2022. The study data collected from 131 pregnant women through a personal information form, depression, anxiety and stress scale (DASS-42) and multidimensional scale of perceived social support (MSPSS). RESULTS Most of the pregnant women were in the second trimester of pregnancy, and more than half had been advised by a healthcare professional to terminate their pregnancy. Overall, the pregnant women reported moderate levels of social support, while their depression, anxiety and stress levels varied. There was a weak negative correlation between perceived social support from family, friends and multidimensional sources with stress, but the effect rate was low. CONCLUSION Most pregnant women diagnosed with foetal anomaly have normal levels of depression, stress and anxiety. There is a weak negative correlation between perceived social support and stress, with family and friend support affecting stress levels at a low rate. Professional support should be provided, and both the woman's mental health and social support mechanisms must be evaluated. IMPACT This study highlights the importance of social support in managing stress among pregnant women with foetal anomalies. While most women had normal levels of depression, anxiety and stress, increased social support from family and friends was shown to reduce stress. The findings underscore the need for healthcare professionals to assess and strengthen mental health and social support systems in this vulnerable population, informing interventions to improve psychosocial outcomes. REPORTING METHOD This descriptive and correlational study adhered to the CONSORT guidelines for reporting non-randomised trials. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Meltem Mecdi Kaydırak
- Florence Nightingale Faculty of Nursing, Department of Women Health and Diseases Nursing, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Elif Balkan
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Yalova University, Yalova, Turkey
| | - Nilgul Bacak
- Department of Nursing, Istanbul Health and Technology Unıversıty, Istanbul, Turkey
| | - Filiz Kızoglu
- Istanbul Faculty of Medıcıne, Istanbul Unıversıty, Istanbul, Turkey
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5
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Johnson B, Shakes P, Maylea C. Prenatal testing technologies in Australia: Unintended clinical and emotional complexities in underprepared systems. Soc Sci Med 2024; 361:117368. [PMID: 39353224 DOI: 10.1016/j.socscimed.2024.117368] [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: 09/25/2023] [Revised: 09/05/2024] [Accepted: 09/24/2024] [Indexed: 10/04/2024]
Abstract
The past decade has seen technological advances in prenatal screening technologies rapidly integrated into clinical practice. These technologies have revolutionised healthcare and raised complex socio-ethical issues such as equitable access, medical commercialisation, and new eugenics. However, the important issue of the impact of these technologies on healthcare professionals is receiving less attention. Exploring this issue in the Australian context, we conducted a survey from August to November 2022, targeting health and allied health professionals who work with parents in the perinatal period who have received a fetal diagnosis. We received 75 substantive responses from a diversity of professionals, including sonographers, midwives, genetic counsellors and medical providers. In this article, we consider the unintended impacts of prenatal screening technologies on healthcare workers, drawing from Ziebland et al., 's 2021 unintended consequences framework. Our reflexive thematic analysis produced three key themes: "Unintended Clinical Complexities", "Adapting Work Practices to Keep Up in Systems that Lack", and "Unintended Intensification of Emotional Labour". Prenatal testing technologies have intentionally increased early testing and fetal information, offering veiled promises of increased certainty in pregnancy. However, our analysis highlights that these advancing technologies also generate more ambiguous results, creating unintended clinical and emotional complexities for healthcare providers. Workers must manage increased clinical uncertainty and constant change, creating intensified emotional labour in under-prepared systems. We conclude by identifying the need to recognise the impacts of advancing prenatal screening technologies on healthcare workers and for targeted professional training to prepare healthcare professionals for the complexities introduced by these new technologies.
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Affiliation(s)
- Belinda Johnson
- RMIT University, GPO Box 2476, Melbourne VIC 3001 Australia.
| | - Pieta Shakes
- James Cook University, 1 James Cook Drive, QLD 4811 Australia.
| | - Chris Maylea
- La Trobe University, 5 the Agora, Bundoora VIC 3083, Australia.
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Timmer-Murillo SC, Mowrer A, Wang AZ, Jazinski-Chambers K, Piña I, Rundell MR, Bennett JM, Wagner AJ, deRoon-Cassini TA. Examining emotion regulation and inflammation as predictors of maternal mental health after fetal anomaly diagnosis. Brain Behav Immun 2024; 122:1-8. [PMID: 39106938 DOI: 10.1016/j.bbi.2024.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 07/09/2024] [Accepted: 08/01/2024] [Indexed: 08/09/2024] Open
Abstract
OBJECTIVE Fetal anomalies occur in approximately 3% of pregnancies and receiving the diagnosis may be a potentially traumatic experience for families. The mental health of mothers receiving diagnoses and what predicts resilience or poor mental health is understudied. Emotion regulation is an important, modifiable, transdiagnostic factor of mental health, and may be protective post-diagnosis. Evaluating biomarkers of stress, including IL-6 and Allostatic Load (AL), can also serve as early indicators of risk, indicative of early intervention. This study assessed whether reappraisal, suppression, IL-6, and AL was associated with mental health outcomes and resilience in women after receiving a fetal anomaly diagnosis. METHODS Pregnant women (N=108) presenting to a fetal concerns clinic for initial consultation completed measures of emotion regulation (i.e., reappraisal and suppression), depression, anxiety, posttraumatic stress symptoms, and resilience between 2019-2022. A blood draw was used to assess IL-6 and create composite allostatic load measure including: IL-6, blood pressure, heart rate, glucose, cortisol, and body mass index. RESULTS Linear regressions controlling for age, gestational age, and perceived fetal diagnosis severity, demonstrated that IL-6 was negatively associated with resilience and positively associated with depression. Reappraisal was positively associated to resilience and negatively associated with depression, anxiety, and PTSD, whereas state insurance status was positively associated to anxiety and PTS symptoms. Suppression and allostatic load were not significant. CONCLUSIONS Women experiencing fetal anomaly diagnosis represent an understudied population with unaddressed mental health needs. Reappraisal serves as not only a protective factor, but one that can be enhanced to promote maternal resilience and mental health. Furthermore, elevated IL-6 may be a critical early indicator of potential intervention needs among women who are pregnant, to mitigate negative psychological states and enhance resilience.
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Affiliation(s)
- Sydney C Timmer-Murillo
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Alyssa Mowrer
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Amy Z Wang
- University of Wisconsin, Milwaukee, Department of Psychology, 2441 E. Hartford Ave. Milwaukee, WI 53211, USA.
| | - Kelley Jazinski-Chambers
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Isela Piña
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Maddie R Rundell
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Jeanette M Bennett
- UNC Charlotte, Department of Psychological Science, 9201 University City Blvd Charlotte, NC 28223, USA.
| | - Amy J Wagner
- Medical College of Wisconsin, Division of Pediatric Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA.
| | - Terri A deRoon-Cassini
- Medical College of Wisconsin, Division of Trauma and Acute Care Surgery, 8701 W Watertown Plank Rd., Milwaukee, WI 53226, USA; Comprehensive Injury Center, Division of Data Surveillance & Informatics, 10000 Innovation Dr. Milwaukee, WI 53226, USA.
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Hansen K, Kukora SK, Sherman A, Feldman K. Mental health in pregnancy complicated by fetal anomaly: depression screening and referrals in a single fetal care center. J Perinatol 2024:10.1038/s41372-024-02118-8. [PMID: 39289556 DOI: 10.1038/s41372-024-02118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 08/28/2024] [Accepted: 09/06/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE To quantify depression screening rates in a fetal care center, identify characteristics associated with screenings and identify mental health referral uptake rates STUDY DESIGN: This retrospective cohort study of 166 patients in a single fetal care center investigated patients screened during pregnancy with the Edinburgh Postnatal Depression Scale RESULTS: Patients screened positive for depression at a rate of 31.9% using 10 as the cut-off score at their first mental health consult following diagnosis. Patients with a prior mental health diagnosis and lacked insurance or had state insurance were more likely to screen positive. Additionally, patients were more likely to screen positive with a severe fetal diagnosis or uncertain fetal prognosis. Patients were likely to accept a referral for therapy; fewer accepted a referral for pharmacotherapy CONCLUSION: Fetal care center patients are at risk of depressed mood and may be identified through universal screening. Particular attention should be provided to patients with an uncertain fetal prognosis and other identified characteristics.
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Affiliation(s)
- Kara Hansen
- Fetal Health Center, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Stephanie K Kukora
- Bioethics Center and Division of Neonatology, Children's Mercy Kansas City, Kansas City MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA
| | - Ashley Sherman
- Biostatistics and Epidemiology Core and Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Keith Feldman
- Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City (UMKC) School of Medicine, Kansas City, MO, USA
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Attia Hussein Mahmoud H, Lakkimsetti M, Barroso Alverde MJ, Shukla PS, Nazeer AT, Shah S, Chougule Y, Nimawat A, Pradhan S. Impact of Paternal Postpartum Depression on Maternal and Infant Health: A Narrative Review of the Literature. Cureus 2024; 16:e66478. [PMID: 39246890 PMCID: PMC11380704 DOI: 10.7759/cureus.66478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2024] [Indexed: 09/10/2024] Open
Abstract
Postpartum depression (PPD) has been widely studied, assessed, and promptly intervened in new mothers. However, paternal postpartum depression gained attention not long ago. Postpartum depression in men could present over one year following the birth of the child, frequently presenting with symptoms like irritability, low mood, sleep disturbances, changes in appetite, fatigue, and loss of interest in everyday activities; amongst other symptoms of Major Depressive Disorder which may hinder them from taking care of themselves and the baby. Paternal PPD significantly impacts partner relationships causing maternal PPD, poor infant bonding, and therefore, affecting overall child development. The following narrative review is based on a literature search of articles published on paternal postnatal depression. The primary emphasis of this review has been to provide an overview of the current comprehension of paternal postpartum depression regarding prevalence, global incidence, and risk factors and to explore potential diagnostic tools for assessment and interventional strategies to treat this condition. Interestingly, pandemic-related stressors have been positively attributed to an increase in PPD prevalence post-pandemic. While more research is being conducted on this subject, research on the measurement characteristics of the diagnostic tools is highly recommended to implement well-defined criteria for early diagnosis of paternal PPD. The significant adverse consequences of PPD for not just the new mother, but also the infants, necessitate proper and timely diagnosis of PPD. Despite its severity, there have been no specific treatment modalities.
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Affiliation(s)
| | | | | | - Pranav S Shukla
- Medical School, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, IND
| | - Alviya T Nazeer
- Obstetrics and Gynaecology, Government Medical College and Hospital, Pudukkottai, IND
| | - Sukesh Shah
- Medical School, American University of Integrative Sciences, Bridgetown, BRB
| | | | - Amisha Nimawat
- Internal Medicine, Interfaith Medical Center, New York, USA
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9
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Bekkhus M, Oftedal A, Haugen G, Mortensen B, Kaasen A. Acute symptoms of depression and traumatic stress in men and women who terminate pregnancy after the detection of fetal anomaly: A prospective observational study. BJOG 2024. [PMID: 38899436 DOI: 10.1111/1471-0528.17884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 05/28/2024] [Accepted: 06/02/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE To assess acute and long-term stress in men and women after the detection of fetal anomalies leading to pregnancy termination. DESIGN Prospective observational study. SETTING Tertiary referral centre for fetal medicine. POPULATION From the initial sample of 180 pregnant women with a fetal anomaly detected by ultrasound examination, a total of 87 women terminated their pregnancy, with 72 partners included in the sample. At the time of detection, the group of women (n = 93) and their partners (n = 81) who did not terminate the pregnancy following a diagnosis were included as a comparison group. METHODS These women and their partners were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale (IES) questionnaires, both at the time of initial detection and at 6 weeks after the termination of the pregnancy. MAIN OUTCOME MEASURES Responses to the EPDS and the IES at the time of initial detection and at 6 weeks after pregnancy termination. RESULTS Women who underwent pregnancy termination reported higher symptom levels of depression, but not traumatic stress, prior to the termination than women who chose not to terminate their pregnancy. Among men, there was a difference across depression and all subscales of traumatic stress (e.g. IES intrusion: mean difference 5.31; 95% CI 2.32-8.31). Women experienced more depressive symptoms over time than men (β = 4.33, P < 0.001) and higher symptom levels on all subscales of traumatic stress (e.g. IES intrusion: β = 5.27; P < 0.001). CONCLUSIONS Overall, our study underscores the heightened levels of depression and traumatic stress experienced by prospective parents, particularly prior to the decision to terminate a pregnancy following the detection of a fetal anomaly. Although women generally report more pronounced symptoms, it is noteworthy that men also experience considerable traumatic stress during this challenging time.
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Affiliation(s)
- Mona Bekkhus
- Department of Psychology, PROMENTA Research Centre, University of Oslo, Oslo, Norway
| | - Aurora Oftedal
- Division of Mental and Physical Health, Department of Children and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Guttorm Haugen
- Division of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Berit Mortensen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Anne Kaasen
- Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
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Vibert F, Schmidt G, Löffler K, Gasiorek-Wiens A, Henrich W, Verlohren S. Accuracy of prenatal detection of facial clefts and relation between facial clefts, additional malformations and chromosomal abnormalities: a large referral-center cohort. Arch Gynecol Obstet 2024; 309:1971-1980. [PMID: 37326856 PMCID: PMC11018668 DOI: 10.1007/s00404-023-07084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE Facial clefts belong to the most common congenital malformations and their prenatal diagnosis is a constant challenge. The aim of this study was to determine the accuracy of prenatal ultrasound in correctly classifying facial clefts. Furthermore, we aimed to specify the distribution of the type of clefts and underlying genetic conditions. METHODS All fetuses seen with suspected facial cleft in the Department of Obstetrics, Charité - Universitätsmedizin Berlin during a period of 23 years (1999-2022) were included in this retrospective study. Clefts were classified according to the classification of Nyberg. All additional prenatal findings were assessed and correlated with the outcome. The accuracy of prenatal diagnosis was assessed. RESULTS 292 patients were included in the study. The most common type of clefts were unilateral cleft lip and palate (CL-P) (53.6%) and bilateral CL-P (30.6%), followed by CL (8.1%), CP (5.1%) and median CL-P (2.6%). The overall pre- and postnatal concordance rate corresponding to a correct prenatal diagnosis was high, 88.9%, ranging from 73.7% (CL) to 93.7% (unilateral CL-P). Most of the median clefts (95.2%) and CP (93.3%) were associated with other sonographic abnormalities, as well as 52.2% of bilateral CL-P. Chromosomal abnormalities, mostly trisomy 13 and trisomy 18, were observed in in the median CL-P (47.6%), bilateral CL-P (31.1%) and CP (26.7%) groups, in contrast to the CL (9.1%) and unilateral CL-P (12.9%) groups. It was exceptional to have a chromosomal abnormality without additional malformations (4.8%). The mortality rate including one late miscarriage, 5 IUFD's, 74 TOPs and 6 palliative cares at birth was 29.8%, particularly high for median clefts (90.5%). CONCLUSION Prenatal ultrasound exhibited a high accuracy to assess the type of facial clefts with an average rate of 88.9% (73.7%-93.7%) and a concordance rate of up to 93.7%, depending on the type of cleft. The search for additional malformations as well as clarifying underlying genetic conditions is essential. This allows for a targeted counseling of the parents and to best prepare for postnatal care, including surgery by the maxillofacial team.
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Affiliation(s)
- Florence Vibert
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Guel Schmidt
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Kerstin Löffler
- Department of Oral and Maxillofacial Surgery, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Adam Gasiorek-Wiens
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Stefan Verlohren
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Campus Charité-Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Almoammar KA. Harnessing the Power of Artificial Intelligence in Cleft Lip and Palate: An In-Depth Analysis from Diagnosis to Treatment, a Comprehensive Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:140. [PMID: 38397252 PMCID: PMC10886996 DOI: 10.3390/children11020140] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/09/2024] [Accepted: 01/14/2024] [Indexed: 02/25/2024]
Abstract
Cleft lip and palate (CLP) is the most common craniofacial malformation, with a range of physical, psychological, and aesthetic consequences. In this comprehensive review, our main objective is to thoroughly examine the relationship between CLP anomalies and the use of artificial intelligence (AI) in children. Additionally, we aim to explore how the integration of AI technology can bring about significant advancements in the fields of diagnosis, treatment methods, and predictive outcomes. By analyzing the existing evidence, we will highlight state-of-the-art algorithms and predictive AI models that play a crucial role in achieving precise diagnosis, susceptibility assessment, and treatment planning for children with CLP anomalies. Our focus will specifically be on the efficacy of alveolar bone graft and orthodontic interventions. The findings of this review showed that deep learning (DL) models revolutionize the diagnostic process, predict susceptibility to CLP, and enhance alveolar bone grafts and orthodontic treatment. DL models surpass human capabilities in terms of precision, and AI algorithms applied to large datasets can uncover the intricate genetic and environmental factors contributing to CLP. Additionally, Machine learning aids in preoperative planning for alveolar bone grafts and provides personalized treatment plans in orthodontic treatment. In conclusion, these advancements inspire optimism for a future where AI seamlessly integrates with CLP management, augmenting its analytical capabilities.
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Affiliation(s)
- Khalid A Almoammar
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, P.O. Box 60169, Riyadh 11545, Saudi Arabia
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Mutti G, Ait Ali L, Marotta M, Nunno S, Consigli V, Baratta S, Orsi ML, Mastorci F, Vecoli C, Pingitore A, Festa P, Costa S, Foffa I. Psychological Impact of a Prenatal Diagnosis of Congenital Heart Disease on Parents: Is It Time for Tailored Psychological Support? J Cardiovasc Dev Dis 2024; 11:31. [PMID: 38276657 PMCID: PMC10816578 DOI: 10.3390/jcdd11010031] [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: 12/21/2023] [Revised: 01/12/2024] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
The prenatal diagnosis of congenital heart disease (CHD) represents, for both parents, a particularly stressful and traumatic life event from a psychological point of view. The present review sought to summarize the findings of the most relevant literature on the psychological impact of prenatal diagnosis of CHD on parents, describing the most common mechanisms employed in order to face this unexpected finding. We also highlight the importance of counseling and the current gaps in the effects of psychological support on this population.
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Affiliation(s)
- Giulia Mutti
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Lamia Ait Ali
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
- Istituto di Fisiologia Clinica CNR, Via Aurelia Sud, 54100 Massa, Italy
| | - Marco Marotta
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Silvia Nunno
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Veronica Consigli
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Stefania Baratta
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Maria Letizia Orsi
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Francesca Mastorci
- Istituto di Fisiologia Clinica CNR, Via Moruzzi 1, 56124 Pisa, Italy; (F.M.); (A.P.)
| | - Cecilia Vecoli
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
- Istituto di Fisiologia Clinica CNR, Via Aurelia Sud, 54100 Massa, Italy
| | - Alessandro Pingitore
- Istituto di Fisiologia Clinica CNR, Via Moruzzi 1, 56124 Pisa, Italy; (F.M.); (A.P.)
| | - Pierluigi Festa
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Sabrina Costa
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
| | - Ilenia Foffa
- Fondazione Toscana, G. Monasterio, Via Aurelia Sud, 54100 Massa, Italy (M.M.); (V.C.); (C.V.); (P.F.); (S.C.); (I.F.)
- Istituto di Fisiologia Clinica CNR, Via Aurelia Sud, 54100 Massa, Italy
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Shakes P, Cashin A, Hurley J. Threat and adaptation: The maternal lived experience of continuing pregnancy after receiving a prenatal diagnosis of agenesis of the corpus callosum. Soc Sci Med 2023; 339:116391. [PMID: 37956619 DOI: 10.1016/j.socscimed.2023.116391] [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: 07/17/2023] [Revised: 10/11/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
One stated objective of prenatal screening and diagnosis is the preparation for delivering a baby with medical needs or disability, however, psychosocial outcomes of parents who received a prenatal diagnosis suggest that this objective is not yet realised. Preparation may be complicated by diagnostic and prognostic uncertainty. A prenatal diagnosis that includes significant uncertainty due to the heterogeneous presentations, classifications, causes and outcomes is agenesis of the corpus callosum. As a neuroanatomical anomaly identified in the second or third trimesters, the diagnosis is likely to cause distress for expectant mothers, yet there is limited guidance for holistic support. To begin to address the paucity of research, this hermeneutic phenomenological study sought to explore, and provide a telling of the maternal experience of continuing pregnancy after a prenatal diagnosis of agenesis of the corpus callosum. Through interviews and a series of online, asynchronous and facilitated focus groups, lived experiences during pregnancy from the time of diagnosis to birth were explored with 26 mothers who participated in this international study. Themes were constructed through reflexive thematic analysis to describe the experience of the lived phenomenon. The first theme, Under Threat, included subthemes of The Threat to the Life of the Baby and Threatened Image of the Expected Family. The second theme, Day to Day Toward Adaptation, included subthemes of Holding it Together and Falling Apart, and More Than Information, Searching for Meaning, Hope and Control. To realise the commonly stated objective of prenatal diagnosis, to support maternal preparation, healthcare professionals require awareness of the profound, yet individual experience of prenatal diagnosis to adequately respond and support mothers through their continued pregnancies. Healthcare services should be designed to flexibly respond in a woman- and family-centred manner to reduce the threat and support maternal adaptation after a prenatal diagnosis.
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Affiliation(s)
- Pieta Shakes
- Faculty of Health, Southern Cross University, PO Box 157, Lismore, NSW, 2480, Australia.
| | - Andrew Cashin
- Faculty of Health, Southern Cross University, PO Box 157, Lismore, NSW, 2480, Australia.
| | - John Hurley
- Faculty of Health, Southern Cross University, Hogbin Drive, Coffs Harbour, NSW, 2450, Australia.
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Theroux R, Violette C. Fetal Anomaly: Family Experiences and Preferences for Care: An Integrative Review. J Perinat Neonatal Nurs 2023; 37:310-324. [PMID: 37878516 DOI: 10.1097/jpn.0000000000000752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND The prenatal diagnosis of a fetal anomaly is unexpected, creating a family crisis. Expectant parents are at an increased risk for perinatal depression and traumatic stress. Prior reviews examined parents' experiences when terminating but not continuing the pregnancy. This review synthesized qualitative research to describe the experiences, emotional responses, and needs of families continuing their pregnancy. METHODS An integrative review was performed using the Whitemore and Knafl methodology and PRISMA guidelines. A systematic review of peer-reviewed articles published between 2000 and 2200 on the experiences of fetal anomaly was performed using 5 databases. Eligible articles included qualitative studies describing families' experiences with a fetal anomaly diagnosis who elected to continue their pregnancy. Methodological quality was evaluated using the Critical Skills Appraisal Program checklist. RESULTS Of the 678 article results, 16 met inclusion criteria. There were 298 participants from 5 countries. The major overarching theme of Response to the Diagnosis of Fetal Anomaly was identified. The major categories were emotional response, coping strategies, influences, health care experiences, and family needs. Uncertainty and grief were the most common emotions. DISCUSSION Parents choosing to continue pregnancy benefit from compassionate, sensitive care, and accurate, concise information, provided in tailored instruction using multiple styles.
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Affiliation(s)
- Rosemary Theroux
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester (Dr Theroux); and UMASS Chan Medical School Obstetrics and Gynecology & Tan Chingfen Graduate School of Nursing, Worcester (Dr Violette)
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