Factors affecting Thai pregnant women's decisions concerning prenatal diagnosis and termination of pregnancy for ß-thalassemia.

AIM: To investigate the factors influencing decisions concerning prenatal diagnosis (PND) and termination of pregnancy for ß-thalassemia in Thai pregnant women. METHODS: A total of 142 Thai Buddhist pregnant women waiting for PND were asked to undertake semi-structured interviews regarding their reasons for PND and their decisions and reasoning concerning pregnancy if the fetus was found to be affected. The interviews were analyzed using a thematic content approach. RESULTS: Thai pregnant women accepted PND for three reasons: to know whether their pregnancies were affected, to confirm that their pregnancies were unaffected and to terminate if their pregnancies were affected. Three decisions identified among the women were to terminate the pregnancy, to continue the pregnancy and undecided. The interview analysis identified five themes and nine sub-themes affecting pregnancy-related decision-making: (i) quality of life (suffering or no disability); (ii) burden (difficulty or acceptability); (iii) sense of motherhood (the best way for the child or I cannot hurt my child); (iv) significant others (support to terminate, support to continue or support to wait for the test result) and (v) conflict in deciding. CONCLUSION: An acceptance of PND in Thai pregnant women was not always associated with pregnancy termination. Multiple factors influenced the decision to terminate, but not their religious affiliation.

Morphology, intrafetal vascular pattern, and umbilical artery Doppler indices of acardiac twins.

BACKGROUND: Twin reversed arterial perfusion (TRAP) sequence consists of acardiac twin (A) paradoxically perfused by pump twin (P) through an umbilical artery (UA). We proposed characterization of acardiac twins with intrafetal vascular pattern (IVP), and assessed its correlation with morphology and UA Doppler indices. METHODS: We prospectively evaluated 21 cases of TRAP sequence. Morphology (acardia vs hemicardia) and IVP (simple vs complex) of acardiac twins were characterized with ultrasound and color Doppler. Twins weight ratio (A/P Wt) and UA Doppler indices of acardiac and pump twins including (1) difference of systolic/diastolic ratio (UA ∆S/D), (2) difference of resistance index (UA ∆RI), and (3) ratio of pulsatility index (UA PI A/P) were calculated. RESULTS: The median (min, max) gestational age at diagnosis was 18 (11, 27) weeks. Acardia (n = 14) were associated with simple IVP (n = 16) (P < .05). After exclusion of acardia with complex IVP (n = 1), the A/P Wt, UA ∆S/D, UA ∆RI, and UA PI A/P of acardia with simple IVP (n = 13), hemicardia with simple IVP (n = 3), and hemicardia with complex IVP (n = 4) were not significantly different (P > .05). CONCLUSIONS: Most of acardiac twins were acardia with simple IVP. Morphology and IVP of acardiac twins were not associated with UA Doppler indices.

Advanced ultrasound for prenatal interventions.

Ultrasound is an integral part of prenatal interventions. Doppler studies and 3-dimensional ultrasound (3DUS) are frequently used to determine whether fetal surgery is required. The operator's experience remains crucial for reducing procedure-related morbidity. Real-time 3DUS (or 4DUS) can simultaneously display the needle tip in three orthogonal planes, providing reassurance that no fetal parts are in the path. In experienced hands, 4DUS guidance may not be more effective than B-mode, but its value for less-experienced operators remains to be determined. Recent developments in needle, shunt, and video endoscopic technologies may compliment the use of image-guided in utero procedures. Future developments of higher-dimensional transducers and image software may improve the utility of ultrasound for invasive obstetric interventions.

Measurement of fetal atrioventricular time intervals: A comparison of 3 spectral Doppler techniques.

OBJECTIVE: To establish nomograms for fetal atrioventricular (AV) time intervals assessed by 3 different pulsed-wave Doppler techniques: left ventricular inflow and outflow tracts (LV in/out), superior vena cava and ascending aorta (SVC/AA), and pulmonary artery and pulmonary vein (PA/PV). METHODS: A cross-sectional study was performed in 311 normal fetuses divided into 5 groups between 16 and 38 weeks. Pulsed-wave Doppler-derived AV intervals were measured by interrogation of flow in LV in/out, SVC/AA, and PA/PV. Linear regression analyses were performed to examine correlations with gestational age (GA) and fetal heart rate (FHR). Intraclass correlation coefficients for reproducibility of each method were compared. RESULTS: Pulmonary artery and pulmonary vein revealed the longest mean AV time intervals (P < .001). The AV intervals in all methods were positively correlated with GA (R2  = 0.20-0.36; P < .001) and negatively correlated with FHR (R2  = 0.09-0.19; P < .001). The SCV/AA time intervals demonstrated the weakest influence of FHR. For LV in/out, SVC/AA, and PA/PV, intraobserver and interobserver reliability coefficients showed excellent agreements (all intraclass correlation coefficients ≥ 0.80). CONCLUSION: All pulsed-wave Doppler-derived AV time intervals increased with advancing GA and decreased with increasing FHR. Fetal AV interval measurements can be obtained in a clinically viable fashion with excellent reproducibility.

Effect of Supportive Information on Anxiety Levels in Pregnant Women Awaiting Amniocentesis Results: A Randomized Controlled Trial.

Objective: To evaluate the effect of supportive information on anxiety levels in women awaiting amniocentesis results. Material and Method: Women underwent amniocentesis were randomized into two groups according to whether they did (group A) or did not (group B) receive supportive information. Anxiety levels were measured using the Spielberger State-Trait Anxiety Inventory at four time points, (1) after amniocentesis, (2) before phoning for test result appointment confirmation, (3) after phoning, during which supportive information was given to group A, and (4) before receiving the test results. Semistructured interviews were conducted after the last anxiety measurement. Results: There were no significant differences in the state anxiety scores between the two groups after amniocentesis and before phoning to confirm that the amniocentesis results were available. The state anxiety scores after telephoning and before receiving the test results in group A were significantly lower than those in group B (36.69 vs. 42.50, p<0.001, and 39.16 vs. 42.82, p<0.05, respectively). We identified three stages of psychological distress, uncertainty of fetal safety, uncertainty of the test results, and hopefulness concerning the test results. Women in group B experienced only the two early stages of distress, whereas after receiving supportive information, the psychological state of women in group A further progressed to the hopefulness concerning the test result Conclusion: Supportive information could alleviate the anxiety level of women awaiting amniocentesis results. Providing appropriate supportive information for each psychological stage should be considered for women underwent amniocentesis.