Objective. Ultrasound scans have become a routine part of antenatal care. Recent developments have meant that ultrasound has gone beyond monitoring the pregnancy and diagnosis of major abnormalities. Its routine use now includes screening for subtle fetal abnormalities and indications of chromosomal abnormality. Unfortunately ultrasound screening for chromosomal abnormalities has a low positive predictive value (similar to maternal serum screening), and only about 2% of pregnancies identified as ‘high risk’ will be diagnosed with a chromosomal abnormality. The other 98% of ‘high risk’ results are termed ‘false positive’. The aim of this paper is to elucidate the range of subjective experiences of women in response to having these results. Method. The approach employed was interpretative phenomenological analysis. Semi‐structured interviews were carried out with 24 pregnant women after ‘false positive’ ultrasound results. These were subjected to a qualitative analysis. Results. Participants perceived the ultrasound scan primarily as a social, non‐medical event and were unprepared for the result the scan elicited. Two‐thirds described residual feelings of anxiety even after normal diagnostic results were known, sometimes attributed to continued fears about fetal abnormality, but more often attributed to a generalized feeling that something else unexpected could happen to threaten the pregnancy. Conclusions. The paper has pointed to important discrepancies in the experiences of women undergoing ultrasound screening and the aims of informed choice. We would suggest consideration should be given to providing information on both the medical purposes of screening and on possible outcomes from it. The study also points to the possible need for counselling support for the majority of women who go on to receive confirmation of a negative diagnosis, counselling addressed at helping women to readjust to having a ‘low risk’ pregnancy.
BACKGROUND AND PURPOSE:Fetal ventriculomegaly (VM) is important because of its high prevalence and high risk of association with other brain abnormalities. The purpose of this article was to investigate the hypotheses that including in utero MR imaging (iuMR) in the diagnostic pathway for fetuses with isolated VM on antenatal imaging will show other brain abnormalities in a high proportion of cases and that these will have a significant effect on clinical management.
On behalf of the Yorkshire Obstetric Critical Care GroupObjective To establish the risk of serious complications from severe pre-eclampsia and eclampsia in a region using a common guideline for the management of these conditions. Design A five-year prospective study.Setting Sixteen maternity units in Yorkshire.Population All women managed with severe pre-eclampsia and eclampsia.Methods A common guideline was developed for the management of women with these conditions. A network of midwives prospectively collected outcome data. Main outcome measure Incidence of the conditions and serious complication rates.Results A total of 210,631 women delivered in the 16 units between 1 January 1999 and 31 December 2003.One thousand eighty-seven women were diagnosed with severe pre-eclampsia or eclampsia (5.2/1000). One hundred and fifty-one women had serious complications including 82 women (39/10,000) having eclamptic seizures and 49 women (23/10,000) requiring ICU admission. There were no maternal deaths but 54 out of 1145 babies died before discharge, giving a mortality rate of 47.2/1000. Of the 82 cases of eclampsia, 45 occurred antenatally (55%), 18 before admission to the maternity unit. Eleven cases occurred in labour (13%), including 1 during a caesarean section, and 26 cases occurred following delivery (32%). Twenty-five women developed pulmonary oedema (2.3% of cases) and six women required renal dialysis (0.55% of cases). One hundred and sixty-five (15%) required no antihypertensive therapy and 489 (53%) of the remainder required only oral therapy. Two hundred and one (18.5%) required more than one drug. Conclusion A regional guideline for severe pre-eclampsia and eclampsia can be developed and implemented.Its use may contribute to a low rate of serious complications.
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