A prospective study on parental coping 4 months after termination of pregnancy for fetal anomalies.

OBJECTIVE: To identify short-term factors influencing psychological outcome of termination of pregnancy for fetal anomaly, in order to define those patients most vulnerable to psychopathology. STUDY DESIGN: A prospective cohort of 217 women and 169 men completed standardized questionnaires 4 months after termination. Psychological adjustment was measured by the Inventory of Complicated Grief (ICG), the Impact of Event Scale (IES), the Edinburgh Postnatal Depression Scale (EPDS), and the Symptom Checklist-90 (SCL-90). RESULTS: Women and men showed high levels of posttraumatic stress (PTS) symptoms (44 and 22%, respectively) and symptoms of depression (28 and 16%, respectively). Determinants of adverse psychological outcome were the following: high level of doubt in the decision period, inadequate partner support, low self-efficacy, lower parental age, being religious, and advanced gestational age. Whether the condition was Down syndrome or another disability was irrelevant to the outcome. Termination did not have an important effect on future reproductive intentions. Only 2% of women and less than 1% of men regretted the decision to terminate. CONCLUSION: Termination of pregnancy (TOP) for fetal anomaly affects parents deeply. Four months after termination a considerable part still suffers from posttraumatic stress symptoms and depressive feelings. Patients who are at high risk could benefit from intensified support.

[Diagnostic image (210). A young woman suffering from abdominal pain]. / Diagnose in beeld (210). Een jonge vrouw met buikpijn.

A 33-year-old pregnant woman presenting with low abdominal pain was diagnosed with left-sided tubal extra-uterine pregnancy, which was surgically removed.

Twin-to-twin transfusion syndrome: a case report. Antepartum prediction of underlying placental vascular pattern in monochorionic twin pregnancies may be possible.

A case of twin-to-twin transfusion syndrome is described. Comparing data of serial antepartum ultrasonography with a haemodynamic model suggests the possibility of predicting the underlying placental vascular anatomy. It is suggested that serial ultrasonography, including full biometry, pulsatility indices of the umbilical arteries, foetal echocardiography, assessment of amniotic fluid indices and foetal bladder filling could serve as ultrasound parameters for pattern recognition of the underlying placental vascular anomaly. Biometry should be plotted serially in a difference/average plot. Future application of such intensive ultrasound monitoring in monochorionic twins, as soon as monochorionicity is established, may distinguish those monochorionic twins who may benefit from treatment from those whom it would be better only to observe.

Physical complaints and emotional stress related to routine diagnostic procedures of the fertility investigation.

The aim of this study was to map out the extent of the physical complaints and emotional stress due to diagnostic routines of the infertility work-up. To this end a questionnaire was sent to 96 consecutive couples visiting an infertility clinic of a university hospital. The results indicate that women often have physical complaints as a result of the hysterosalpingography (59%) and the diagnostic laparoscopy (47%) and mostly experience these diagnostic procedures as very stressful. Both the postcoital test and the semen analysis caused a moderate amount of stress. The other diagnostic procedures, including physical examination of both sexes, recording of the basal temperature and taking blood for hormonal determinations, were accompanied by fewer complaints and much less stress. It is concluded that the role of the hysterosalpingography and the diagnostic laparoscopy in the routine infertility work-up needs to be reconsidered in view of the burden they pose to the women involved.

A randomized controlled trial on the clinical value of umbilical Doppler velocimetry in antenatal care.

OBJECTIVE: Our aim was to assess the clinical value of umbilical Doppler velocimetry with regard to maternal hospitalization policy, obstetric management, and perinatal outcome. STUDY DESIGN: We conducted a randomized controlled trial in a university hospital population. A total of 1598 women participated, of whom 809 were allocated to the Doppler group and 789 to the control group. In the Doppler group umbilical Doppler studies were performed only when indicated. Abnormal pulsatility index values prompted intensified (clinical) fetal monitoring. In the control group Doppler velocimetry was not available. RESULTS: The use of umbilical Doppler velocimetry did not show any clinical or economical benefit with regard to maternal admission rate and duration or neonatal admission policy and requirements of ventilatory support. Neither did the use of Doppler have any beneficial effect on obstetric management during labor and the occurrence of fetal distress during labor. In the control group a higher perinatal mortality rate was observed. In the Doppler group the risk ratio of perinatal mortality of fetuses and infants weighing > or = 500 gm was 0.45 (95% confidence interval 0.21 to 0.94), as compared with the control group. Neonatal mortality was equal in both groups; therefore the reduction in perinatal mortality was not the result of a delay in timing of fetal death. CONCLUSION: Selective use of umbilical Doppler velocimetry in pregnancies "at fetal risk" may be of benefit in antenatal care by a reduction of perinatal mortality and especially late fetal mortality.