The psychological burden of routine prenatal ultrasound on women's state anxiety across the three trimesters of pregnancy.

OBJECTIVE: Although obstetric ultrasound examination has recognizable clinical and psychological benefits, it also involves some psychological burdens, mainly in terms of the woman's state anxiety, the level of which can change during pregnancy. This research aimed to study the influence of routine ultrasound examination on the woman's state anxiety and its relation with her personality background in the three trimesters of pregnancy. STUDY DESIGN: This work was a prospective interventional study. Women who underwent routine-screening ultrasound examinations in the first, second, or third trimester of pregnancy were recruited. The state anxiety level was assessed using the State-Trait Anxiety Inventory - subscale S (S-Anxiety), administered immediately before and after the exams. More stable personality characteristics were evaluated before ultrasound, assessing trait anxiety by State-Trait Anxiety Inventory - subscale T (T-Anxiety) and psychological coping by Coping Orientations to Problem Experienced (COPE). The S-Anxiety scores, collected immediately before and after the exams, were compared by two-tailed paired t-test. Moreover, S-Anxiety scores collected in each one of the three-trimester groups immediately before and after the exams were compared by one-way between groups ANOVA. Relations among S-Anxiety scores with more stable aspects of personality (T-Anxiety and COPE scores) were also studied, by correlation analysis. RESULTS: A total of 285 women were recruited. In all trimesters, S-Anxiety scores decreased significantly after the exam (P < 0.001), with a more relevant reduction in women with higher T-Anxiety scores (P < 0.001). A gradual decrease in S-Anxiety scores before the examination was seen across the three trimesters, with significantly higher scores in the first trimester (P = 0.016). Before ultrasound, S-Anxiety score resulted positively correlated with avoidance coping strategies (P < 0.001), while it was inversely related to active coping style (P < 0.001) and positive aptitude (P < 0.001). CONCLUSIONS: The psychological burden of prenatal ultrasound in the different trimesters of pregnancy was studied. Clinicians should be sensitive to women's state anxiety during prenatal routine-screening ultrasound examination, using a personalized approach. Particular attention should be paid to the psychological burden associated with ultrasound evaluation of the first trimester, when the level of the anxiety state is higher.

Intrauterine versus post-mortem magnetic resonance in second trimester termination of pregnancy for central nervous system abnormalities.

OBJECTIVE: To evaluate if limiting factors of intrauterine magnetic resonance imaging (iuMRI) performed in the early second trimester of pregnancy (19-23 weeks) affect its accuracy in comparison to post-mortem MRI (pmMRI) in fetuses that underwent termination of pregnancy (TOP) for central nervous system (CNS) defects. STUDY DESIGN: This is a secondary analysis of a 10 years prospective observational study. Cases of TOP < 23 weeks for CNS malformation that had undergone neurosonography (NSG), iuMRI, pmMRI and autopsy were included. The agreement between iuMRI and pmMRI was calculated. The autopsy represented the gold-standard. RESULTS: Overall, 143 TOPs for fetal congenital anomaly underwent the post-mortem diagnostic protocol. Of these, 31 cases underwent iuMRI and pmMRI for CNS abnormality. Three cases were excluded due to brain autolysis at autopsy. Corpus callosum defects were the most represented (16/28; 57 %). In only one case of posterior fossa defect, pmMRI identified the presence of vermian hypoplasia not diagnosed at iuMRI. In 2 cases (7%), iuMRI added clinically relevant additional findings to NSG, that were posteriorly confirmed by pmMRI. CONCLUSIONS: The study shows that, at 19-23 weeks and for CNS defects, limiting factors that might influence the performance of iuMRI have little influence on iuMRI accuracy. This finding is particularly important for professionals who work in countries with legal bound for TOP in the early second trimester.

Effectiveness of biological nurturing on early breastfeeding problems: a randomized controlled trial.

BACKGROUND: Biological nurturing is a neurobehavioral approach to breastfeeding support that encourages women to breastfed in a relaxed, laidback position. This approach has the potential to reduce breast problems (e.g., sore nipples), making good latch easier and thus facilitating the initiation of exclusive breastfeeding. However, its effects have not been adequately investigated in a real-life situation. The aim of this randomized controlled trial was to assess the effectiveness of biological nurturing, compared to usual hospital practices, on the frequency of breast problems and on the prevalence of exclusive breastfeeding at discharge from the maternity ward, after 1 week, and at one and 4 months. METHODS: Open randomized parallel controlled trial carried out in a third level maternity ward (IRCCS Burlo Garofolo, Trieste, Italy) between March and December 2018. Two-hundred eight women who planned to give birth at the hospital and who expressed the intention to breastfeed were enrolled during pregnancy and randomized to receive breastfeeding support following either the biological nurturing approach or the usual care protocol based on the WHO/UNICEF 20-h course, in use at the hospital. The primary study outcome was the incidence of breast problems during hospital stay, defined as the presence of one or more of the following outcomes, collected separately: sore nipples, cracked nipples, engorgement and mastitis. The primary analysis was performed by intention to treat. The follow up lasted 4 months. RESULTS: One hundred eighty eight out of 208 women (90.3%) were included in the analysis, 90 allocated to the biological nurturing group and 98 to the usual care group. At discharge from the maternity ward, biological nurturing significantly reduced the risk of breast problems (Relative risk [RR] 0.56, 95% Confidence Interval [CI] 0.40, 0.79), including cracked (RR 0.42, 95% CI 0.24, 0.74) and sore nipples (RR 0.59, 95% CI 0.40, 0.88). No statistically significant difference was observed for exclusive breastfeeding at discharge and up to 4 months. No adverse events occurred. CONCLUSIONS: The biological nurturing approach applied in the real-life situation of a third level hospital was effective in preventing breast problems. TRIAL REGISTRATION: Clinicaltrials.gov NCT03503500. Date of First Submission: 28 March 2018.