Maternal emotional wellbeing over time and attachment to the fetus when a malformation is detected.

OBJECTIVES: To explore women's emotional wellbeing and attachment to the fetus when informed during pregnancy of a fetal malformation. METHODS: In a longitudinal community-based study, 56 pregnant women with a detected fetal malformation and continued pregnancy were invited to complete questionnaires in mid-pregnancy, two months postpartum and one year postpartum. The questionnaire included the Edinburgh Postnatal Depression Scale, the Cambridge Worry Scale, the State-Trait Anxiety Inventory, and the Maternal-Fetal Attachment Scale. Socio-demographics and obstetric background data were also collected. Descriptive statistical analyses were performed. RESULTS: Approximately 84% returned the questionnaires and 37% of women in mid-pregnancy, 26.5% two months postpartum and 22% one year postpartum were found to have depressive symptoms. In mid-pregnancy 8.9% had thoughts of harming themselves, and almost all reported at least one major worry. Worry about the relationship with their husband or partner increased two months postpartum and one year postpartum. The means of both state and trait anxiety levels were high on all three measuring occasions and the mean score for maternal-fetal attachment was 3.7 (SD 0.67), indicating a high level of attachment. CONCLUSION: The results highlight the importance of adequate support when fetal malformations are detected on ultrasound examination.

Pregnancy termination due to fetal anomaly: women's reactions, satisfaction and experiences of care.

OBJECTIVE: to explore what women who have had a pregnancy terminated due to a detected fetal malformation perceived as having been important in their encounters with caregivers for promoting their healthy adjustment and well-being. METHOD: an exploratory descriptive design was used. Semi-structured interviews were audiotaped, and the information pathway described. The text was processed through qualitative content analysis in six steps. SETTING: four fetal care referral centres in Stockholm, Sweden. PARTICIPANTS: 11 women opting for pregnancy termination due to fetal malformation. FINDINGS: in-depth understanding and compassion are important factors in providing the feeling of support people need so they are able to adapt to crisis. The women emphasised that the caregivers have to communicate a sense of responsibility, hope and respect and provide on-going care for them to feel assured of receiving good medical care and treatment. Aside from existing psychological conditions, the women identified as having emotional distress directly after termination and for at least the following three months. Most women experienced a range of negative emotions after pregnancy termination, including sadness, meaninglessness, loneliness, tiredness, grief, anger and frustration. Still some of this group had positive reactions because they experienced empathy and well-organised care. CONCLUSION AND IMPLICATIONS FOR PRACTICE: The most important factors associated with satisfaction regarding pregnancy termination due to a fetal malformation are the human aspects of care, namely state-dependent communication and in-depth understanding and compassion. The changes in care most often asked for were improvements in the level of standards and provision of adequate support through state-dependent communication, in-depth understanding and compassion, and complete follow-up routines and increased resources. Targeted education for the caregivers may be suited to ensuring that they properly meet needs of their patients.

Pregnant women's perspectives on decision-making when a fetal malformation is detected by ultrasound examination.

OBJECTIVES: The aims of the study were to explore factors influencing the decision to continue or terminate pregnancy due to detection of fetal malformation following ultrasound examination, to elucidate the need for more information or other routines to facilitate the decision-making process and to assess satisfaction with the decision made. DESIGN: Descriptive study. SETTING: Four fetal care referral centres in Stockholm, Sweden. POPULATION: Pregnant women with a detected fetal malformation. METHODS: Data was collected by questionnaires. 134 women participated, 99 completing the questionnaire. Descriptive statistical analysis was performed. RESULTS: Both women who continued and those who terminated pregnancy based their decision on the severity of the malformation. Other reasons for terminating the pregnancy were aspects including socioeconomic considerations. None stated religious factors. The doctor at the fetal care unit also had an influence on the decision-making. The timeframe receiving information was regarded as long enough in duration but not the number of occasions. In both groups the women made the decision by themselves or together with their partners. The majority experienced that they had made the right decision. Women who terminated their pregnancy had a significant higher rate (51.2%) (p < or = 0.004) of previous abortions than those in the continuing group (23.2%). CONCLUSION: The decision to continue or terminate the pregnancy was to a great extent based on the severity of the malformation. Religious aspects did not seem to influence the decision. Many women expressed a need for additional occasion of information. The vast majority of women were satisfied with their decision.

Education in obstetrical ultrasound--an important factor for increasing the prenatal detection of congenital heart disease.

OBJECTIVE: To evaluate the effects of postgraduate education in obstetrical ultrasound on the prenatal detection rate of congenital heart disease. SETTING: Tertiary care center. POPULATION: Experienced and less experienced midwives performing ultrasound scans. METHODS: Number of fetuses and live-born children with severe congenital heart malformations were extracted from patient records. The detection rates of experienced and less experienced midwives were compared following a postgraduate training program in obstetrical ultrasound. MAIN OUTCOME MEASURES: The prenatal detection rate of complex congenital heart malformations. RESULTS: The prenatal detection rate for the entire unit increased significantly during the study period (32 vs. 69%, p < 0.05). Following education, we observed a significant increase in detection rates (21 vs. 67%, p < 0.01) among experienced midwives. In the group of less experienced midwives, we found a positive effect of training with considerably higher detection rates compared with results achieved by their more experienced colleagues before the program (40 vs. 21%). CONCLUSION: There is a clear improvement in the prenatal detection rates of complex heart malformations following a postgraduate education in obstetrical ultrasound. Similar training should be offered to both midwives and doctors performing routine scans to increase the standards of antenatal screening for congenital heart disease.

Pregnant women's experiences, needs, and preferences regarding information about malformations detected by ultrasound scan.

OBJECTIVES: The aim of the study was to explore pregnant women's experiences of received information in relation to fetal malformation detected on ultrasound. METHOD: An exploratory descriptive design was used. Semi-structured interviews with women who continued their pregnancy and women who chose to terminate were audiotaped, the information pathway described, and the text subjected to qualitative content analysis. RESULTS: Most of the women who expected a baby with an abnormality experienced the information given as insufficient, often misleading, conflicting, or incoherent, and sometimes negative. Important factors for interaction between women and caregivers were timing, duration, and manner of the initial dialog and ongoing support. Positive interactions improved the women's ability to understand the information, fostered feelings of trust and safety which reduced their anxiety. CONCLUSION: Women expressed dissatisfaction both regarding the care-givers' methods of giving information and apply for information from different specialists and continuity. The study highlights important factors which may be helpful to the professionals for improving the information to this vulnerable group of women.