First and second trimester ultrasound in pregnancy: A systematic review and metasynthesis of the views and experiences of pregnant women, partners, and health workers

Abstract

Background The World Health Organization (WHO) recommends one ultrasound scan before 24 weeks gestation as part of routine antenatal care (WHO 2016). We explored influences on provision and uptake through views and experiences of pregnant women, partners, and health workers. Methods We undertook a systematic review (PROSPERO CRD42021230926). We derived summaries of findings and overarching themes using metasynthesis methods. We searched MEDLINE, CINAHL, PsycINFO, SocIndex, LILACS, and AIM (Nov 25th 2020) for qualitative studies reporting views and experiences of routine ultrasound provision to 24 weeks gestation, with no language or date restriction. After quality assessment, data were logged and analysed in Excel. We assessed confidence in the findings using Grade-CERQual. Findings From 7076 hits, we included 80 papers (1994–2020, 23 countries, 16 LICs/MICs, over 1500 participants). We identified 17 review findings, (moderate or high confidence: 14/17), and four themes: sociocultural influences and expectations; the power of visual technology; joy and devastation: consequences of ultrasound findings; the significance of relationship in the ultrasound encounter. Providing or receiving ultrasound was positive for most, reportedly increasing parental-fetal engagement. However, abnormal findings were often shocking. Some reported changing future reproductive decisions after equivocal results, even when the eventual diagnosis was positive. Attitudes and behaviours of sonographers influenced service user experience. Ultrasound providers expressed concern about making mistakes, recognising their need for education, training, and adequate time with women. Ultrasound sex determination influenced female feticide in some contexts, in others, termination was not socially acceptable. Overuse was noted to reduce clinical antenatal skills as well as the use and uptake of other forms of antenatal care. These factors influenced utility and equity of ultrasound in some settings. Conclusion Though antenatal ultrasound was largely seen as positive, long-term adverse psychological and reproductive consequences were reported for some. Gender inequity may be reinforced by female feticide following ultrasound in some contexts. Provider attitudes and behaviours, time to engage fully with service users, social norms, access to follow up, and the potential for overuse all need to be considered.

Assessing the Quality of Antenatal Care in King Abdulaziz University Hospital: A Retrospective Study

“…The World Health Organization encourages performing an ultrasound scan before 24 weeks of gestation but not after that. Ultrasound scans can help detect anomalies and multiple pregnancies, improve a woman's pregnancy experience, and determine gestational age [10]. Although ultrasound scans are considered relatively safe during pregnancy, they can have psychological impacts [11].…”

‘Space to talk’: a Portuguese focus group study of parents’ experiences, needs and preferences in parenting support during prenatal and well-child care

“…The impossibility of hearing the baby’s heartbeat through fetal Doppler was perceived to impact parents, on top of not having access to ultrasound in routine visits, as usually happens in private practice in Portugal. Such need for reassurance of the baby’s well-being is well-identified in antenatal ultrasound scan studies 71…”

Strengthening antenatal care services for all: implementing imaging ultrasound before 24 weeks of pregnancy

“…However, implementation considerations have been expanded based on findings of a qualitative evidence synthesis of views and experiences of ultrasound service users and health workers (box 2). 6 The ultimate goal of antenatal ultrasound services should be to support equitably provided, high-quality care (including experience of care) and individual clinical encounters that are safe, informative and integrated as part of the package of ANC.…”

“…Planning proactively with frontline health workers and professional associations (eg, nursing, midwifery, obstetrics and radiology) to address bottlenecks will facilitate allocation of appropriate human and other resources needed to accommodate high-quality implementation of new and routine ANC services. The first barrier to implementation may be cultural and health system barriers to early entry to ANC, including systemic factors that impede positive relationships between health workers and clients 6. Other bottlenecks may include lack of trained staff for ultrasound practice and equipment maintenance, unclear practice and referral guidelines, limited equipment and routine supplies, inconsistent attention to infection prevention and control and environmental controls for equipment, routine quality assurance measures, and importantly, strong capacity to triage and manage complications safely and appropriately.…”