The effect of the amount of feedback on anxiety levels during ultrasound scanning. The effects of ultrasound examination on maternal anxiety levels. Health beliefs and health care behaviour in pregnancy. Impact of fetal testing on maternal anxiety. Is smoking an indication for prenatal ultrasonography? RADIUS Study Group. Routine ultrasound fetal examination in pregnancy: the 'Alesund' randomized controlled trial. Randomised comparison of routine versus highly selective use of Doppler ultrasound in low risk pregnancies. A psychosomatic intervention in pregnant in-patient women with prenatal somatic risks. Randomized comparison of routine vs highly selective use of Doppler ultrasound and biophysical scoring to investigate high risk pregnancies.
This study examined the influence of different levels of feedback and of other situational and buffering variables on the psychological effects of ultrasound examinations of 211 pregnant women. The patients were randomly assigned to two different experimental conditions: high feedback and low feedback. The subjects' levels of anxiety (both trait- and state-anxiety) were measured immediately before and after the ultrasound examination. Overall, there was a significant decrease in the level of state-anxiety, which could not be explained by the different levels of feedback provided. Situational and buffering variables were not found to be related to the degree of psychological benefit produced by the scan. A study has been conducted to assess the psychological effects of real-time ultrasound on the pregnant woman's attitudes and anxiety levels. A consecutive series of primiparae, fulfilling the selection criteria of obstetrically "low risk," was assigned at random to two conditions of ultrasound, namely, (a) high feedback (N = 67), where the woman saw the moving fetus in utero; and (b) low feedback (N = 62), where the monitor screen was not visible and no specific feedback was provided. A third group of women was assessed following a wait period in order to compare state anxiety levels among the three groups. Attitude assessments showed consistent preultrasound-post-ultrasound change, with more uniformly positive attitudes displayed by the high-feedback group. No between-group differences in state anxiety emerged as a result of ultrasound compared with a wait control period. No differences emerged with respect to anticipatory anxiety measures. The results are considered in the context of evidence on the importance of psychological state on the course and outcome of pregnancy. It is suggested that the low-risk characteristics of this sample may have precluded effects on anxiety and it is concluded that the therapeutic potential of ultrasound warrants further study. Primiparae were randomly assigned to two conditions of routine ultrasound examination at their first antenatal clinic visit: (a) high feedback ultrasound where the monitor screen was visible and the patient was shown the foetal size, shape and movement (N = 67); (b) low feedback ultrasound where the screen was not seen and specific verbal feedback was denied (N = 62). Women were interviewed at 16 weeks gestation. Those receiving high feedback were more likely to report that they had acted on health advice given at the first antenatal visit to reduce their smoking and drinking. We evaluated the impact of fetal testing on maternal anxiety. A consecutive series of high-risk women attending during the third trimester for fetal assessment were each randomly assigned to one of four conditions: (1) high-feedback ultrasonography (n = 11), in which the monitor screen was visible; (2) low-feedback ultrasonography (n = 8), in which specific visual and verbal feedback was denied; (3) fetal heart rate monitoring (n = 11); or (4) a video control (n = 7), in which the women viewed a videotape of an ultrasonographic recording. Assessments were conducted before and after each procedure. No change was found in attitude ratings towards the fetus, although there was a significant reduction in state anxiety from before to after, with the reduction most pronounced in women undergoing high-feedback ultrasonography. To evaluate whether ultrasound screening during pregnancy decreases the frequency of smoking in women who present with a history of smoking.
                The Routine Antenatal Diagnostic Imaging with Ultrasound Study was a multicenter, randomized clinical trial of ultrasound screening during pregnancy. We obtained information on smoking habits during pregnancy from birth certificate records for the subset of women who were delivered of a neonate in Missouri hospitals, and determined the effect of ultrasound screening on smoking habits during pregnancy.
                The study was conducted in multiple practices in six states.
                Women who registered for prenatal care at participating practices.
                Women in the screened group were routinely scheduled for ultrasound screening at 16 to 22 weeks' gestation and at 31 to 35 weeks' gestation. Those in the control group received ultrasound screening only for medical indications, as determined by their physicians.
                Smoking habits were measured by the number of cigarettes smoked per day.
                There was no difference in the rates of smoking cessation between the screened group and the control group. For those who continued smoking, the mean number of cigarettes smoked per day, as reported at the time of delivery, was slightly higher in the screened group.
                Ultrasound screening does not reduce the frequency of smoking during pregnancy. To evaluate the possible benefits of the routine use of ultrasound screening in pregnancy.
                A randomized controlled trial was designed to detect a 50% difference in the incidence of induction for apparent post-term pregnancies between women who were screened with ultrasound and unscreened women. A total of 1628 pregnant women from the general population were included. Eight hundred and twenty-five were allocated to an ultrasound examination at the 18th and 32nd week of pregnancy in addition to receiving routine antenatal care. The remaining 803 women received standard antenatal care, but could only be referred for ultrasound examination on clinical indication.
                The incidence of induced labor due to apparent post-term pregnancies was approximately 70% lower in the ultrasound-screened group. Inductions from all causes were also less frequent among ultrasound-screened women. There were six perinatal deaths among the screened and seven among the controls after excluding three lethal malformations among the controls. There was no difference in Apgar score after 1 min, but the proportion with Apgar score less than 8 after 5 min was lower among the screened group (P = 0.04). The need for positive pressure ventilation for more than 1 min was lower among the screened group (P = 0.02). Birth weight was slightly higher in the screened group (39 g), but the difference was not statistically significant. Among the controls three pairs of twins remained undiagnosed until the mothers were admitted to the hospital in labor at between 36 and 38 weeks gestation.
                These results suggest that for women who were screened with ultrasound, obstetricians were less likely to induce labor due to apparent post-term pregnancy, than for women who were not screened. All 10 pairs of twins in the screened group were diagnosed at the routine examination. These data also suggest that perinatal morbidity might be slightly lower in the screened group. To help answer the question: should Doppler ultrasound of the umbilical circulation be made available to all pregnant women as part of their routine antenatal care?
                A randomised trial.
                St James's University Hospital, Leeds.
                2025 low risk primigravid women.
                Obstetric intervention rates and short term neonatal morbidity.
                The incidence of abnormal Doppler was low (1.7%) with complete absence of end diastolic flow in only 0.3% of cases. No significant differences could be demonstrated between control and study women in any of the outcomes measured.
                This study did not demonstrate any benefit or harm from Doppler ultrasound as a routine screening test for all low risk women, whereas our previous studies have suggested that it is useful in high risk pregnancies. Any marginal returns on extending access to Doppler ultrasound from high risk to all women must be small. Since this test has excellent performance characteristics (sensitivity and specificity) for the prediction of fetal hypoxia and acidosis our results call into question the cost to benefit ratio of all tests designed to predict these outcomes in low risk women. This study examined whether a short-term psychosomatic intervention during pregnancy had effects on characteristics of labour and delivery as well as on the long-term course of anxiety, depression and physical complaints in pregnant in-patient women.
                All gynaecological and obstetric inpatients of a university hospital, who had either exhibited complications during their pregnancy or were considered high-risk pregnancies, were examined. Symptoms of anxiety and depression (HADS) and physical symptoms (GBB) were assessed by standardised questionnaires. Women with elevated scores on either the HADS or the GBB were randomly assigned to either a treatment group, which had received a psychosomatic intervention or an untreated control group. Of the n = 238 women who were assessed during their stay in our hospital, n = 135 were included in the follow-up 1-year later.
                More than one-third of the participants (38.7%) had elevated scores of anxiety, depression and/or physical symptoms. The psychosomatic intervention had a significant effect on anxiety scores (p = 0.006), but not on depression scores, physical complaints and characteristics of labour and delivery.
                Findings suggest that a short-term psychosomatic intervention can have a positive long-term effect on anxiety symptoms. Future studies are needed to show whether the reduction of anxiety symptoms in turn can lead to a reduction of postnatal complications and lower rates of disturbed mother-child interactions. To compare routine versus highly selective use of Doppler ultrasound and biophysical scoring in higher risk pregnancy.
                A pragmatic randomized trial.
                St James's University Hospital, Leeds.
                500 pregnant women at high risk of intrauterine growth retardation or still birth.
                Regular monitoring with biophysical profile assessment and Doppler velocity waveform recording in umbilical and uteroplacental arteries. Results immediately available to clinicians.
                Gestational age at delivery, obstetric intervention rates and short-term neonatal morbidity.
                Risk factors were distributed very evenly between the 250 patients in the study and control groups respectively. A total of 902 biophysical profile and Doppler assessments were done in the 250 study group patients and only in 12 patients in the control group. In the study group, absent end-diastolic flow was found in only 2.7% of all 902 measurements. A persistently abnormal biophysical score was always associated with absence of end-diastolic flow. The mean gestational age at induction of labour was statistically and clinically similar in the two groups and there was no overall statistically significant difference in intervention rates between the two groups. There was a statistically significant lower frequency of depressed 5-min Apgar scores in the study group. Serious neonatal morbidity was also statistically significantly more common in the control group than in the study group.
                The use of Doppler ultrasound in higher risk pregnancies does not lead to an increase in iatrogenic preterm delivery. The total rate of positive tests on Doppler ultrasound is very low and persistently abnormal biophysical scores are unlikely to be found in patients where umbilical end-diastolic blood flow is present. Surrogate measures for fetal damage seem to be improved when clinicians have access to Doppler ultrasound assessments.
There is insufficient evidence to support either high or low feedback during a prenatal ultrasound to reduce maternal anxiety and promote health behaviour.