Parental expectations, experiences and reactions, sense of coherence and grade of anxiety related to routine ultrasound examination with normal findings during pregnancy.

OBJECTIVE: To investigate parents' expectations, experiences and reactions, sense of coherence and anxiety before and after a second-trimester routine ultrasound examination, with normal findings. METHODS: Before and after ultrasound questionnaires including the scales parents' expectations, experiences and reactions to routine ultrasound examination (PEER-U state of mind index), sense of coherence (SOC) and state and trait anxiety inventory (STAI), were sent to a 1-year cohort of women and their partners. Replies received were 2183. RESULTS: Both parents had significantly less worried state of mind (PEER-U) after the examination than before. Women had a lower grade of state anxiety after than before, but for men there was no significant change. Before the ultrasound, women had a higher degree of worried state of mind, as well as a higher grade of state and trait anxiety and a lower sense of coherence, than men. The women showed a greater reduction in worried state of mind than the men after the ultrasound examination. There were no significant differences in sense of coherence before and after ultrasound. CONCLUSIONS: Women and men are affected in their psychological well-being in relation to a routine ultrasound examination, but their sense of coherence remains stable.

Applying the case method for teaching within the health professions--teaching the students.

CONTEXT: When using the Case Method in teaching situations, problem-solving is emphasized and taught, in order to acquire the skills and later be able to apply them in new situations. The basis of the learning process is the students' own activity in the situation and is built on critical appraisal and discussion. OBJECTIVES: To explain what the Case Method is, what it is not and to describe when and where to use the Case Method. The objective is also to describe how to write a 'case', how to lead a 'case' discussion and how to deal with problems. Why one should use the Case Method is also highlighted. APPLICATION: The case used should be founded on a real life situation, containing a problem that must be handled. The structure and use of the white board plays a central part. It is important that the setting allows the teacher to interact with all the students. Groups of up to 30 students can be handled with ease, though larger groups are feasible in the right physical setting. Within the health professions, the Case Method can be used at all levels of training and to a certain extent the same case can be used--the depth with which it is addressed depends on the student's prior knowledge. Different professions and specialists can take part. A whole curriculum can be built up around the Case Method, but more often it is used together with other pedagogic methods. CONCLUSION: The Case Method is a well-structured, student-activating way of teaching, well-suited to hone problem-solving skills within health education programmes.

Factors influencing informed choice of prenatal diagnosis: women's feelings and attitudes.

OBJECTIVE: To obtain knowledge about factors that could influence women's informed choice and extent of prenatal diagnosis, her feelings when implementing it, and her satisfaction. METHOD: A questionnaire including Visual Analogue Scale was given to 823 women and replies received from 662 (80.4%). Ease of choice was the basis for the statistical analysis. RESULTS: The factors that most often influenced choice were the fetus health, maternal age, and knowledge of the consequences. The choice was easy to make, only 2% finding it very difficult. The time period from the amniocentesis until the results were available was the most difficult time reported. CONCLUSIONS: The choice of method for prenatal diagnosis was very easy for most women. Satisfaction with choice was high (98%). Extra support can be needed while awaiting results of invasive prenatal diagnosis.

Women's informed choice of prenatal diagnosis: early ultrasound examination-routine ultrasound examination-age-independent amniocentesis.

The antenatal clinics in the catchment area of the Department of Obstetrics and Gynecology, University Hospital, Lund, were divided into a study group and a control group. At the study antenatal clinics during a 15-month period 1,004 pregnant women received a written and verbal information that a routine ultrasound examination during gestational week 18 should be considered as a prenatal diagnostic method. They even got information on alternatives: to decline all, to have an early abdominal ultrasound examination, or to have both a routine ultrasound examination and an amniocentesis performed. At the control antenatal clinics, 1,408 pregnant women received standard information. No women in either group chose not to have an ultrasound examination performed, but 1% chose an early abdominal examination in the study group. The percentage of women older than 35 years who asked for an amniocentesis was equal in the two groups. However, women younger than 35 years in the study group requested amniocentesis significantly more frequently than the women in the control group.

Normal ultrasonic fetal growth ratios evaluated in cases of fetal disproportion.

During a 2-year period, 5476 normal routine obstetrical ultrasound investigations were performed in the 2nd trimester (16th to 20th week). Data on biparietal diameter (BPD), abdominal diameter (AD) and femur length (FL) have been obtained from this material. Ratios between BPD/AD and BPD/FL have been calculated, and from these ratios, graphs were constructed. Only nine normal fetuses (0.2%) were found to be outside mean +/- 3 SD, and none of the normal cases were +/- 4 SD, so this is perhaps a better guideline for those warranting further investigation. To evaluate if these ratios could better reflect disproportional fetal growth, three cases of triploidy and four cases of dwarfism were tested against these ratios. Triploidy was obvious on the BPD/AD graph and dwarfism on the BPD/FL graph. The ratios were not found to be conclusive in the intrauterine diagnosis of trisomy 21 or of trisomy 18, as only 4 of 17 cases were obvious on the graphs.

Intrauterine growth of the fetus at term. A prospective and longitudinal study with real-time ultrasound.

Intrauterine fetal growth was followed in a prospective study of 654 consecutive singleton pregnancies. Ultrasound fetometry was performed in gestational weeks 17, 32, and 39, and then weekly until delivery took place. A total of 408 fetuses were examined in the 39th week and 55 investigations were performed in the postterm period. This enabled us to follow the intrauterine growth of the normal fetus both at term and postterm. We found that the intrauterine rate of growth continued constantly, even postterm, for the biparietal diameter, abdominal diameter, and femur length.