Women's response to fetal choroid plexus cysts detected by prenatal ultrasound

Abstract

Objectives: To determine maternal responses to detection of a minor structural variant, the choroid plexus cyst (CPC), in their fetus on prenatal ultrasound. Study design:We interviewed 34 pregnant women with an isolated CPC detected on mid-pregnancy ultrasound about their objective experience at diagnosis, emotional response and subsequent reactions. Audiotaped, transcribed responses were evaluated by two independent raters and analyzed qualitatively and quantitatively.Results: All women reported negative emotional responses including shock, distress, fear and decreased attachment, despite counseling by 82% of providers that the CPC was probably benign. Three women underwent amniocentesis purely for reassurance after CPC detection. Most (79%) sought information beyond what their physician provided, frequently on the internet. One half of women reported that intense negative responses were temporary. However, weeks after diagnosis, 62% continued to believe that the CPC presented some danger to their baby.Conclusions: Detection of CPC prenatally can evoke profound, negative maternal emotional responses despite accurate provider counseling. Practitioners should consider these responses when counseling parents about these and other structural variants of unclear functional significance.Sponsor: The Thomas Wilson Sanitarium for the Children of Baltimore City.

Choroid plexus cysts do not affect fetal neurodevelopment

“…6,25 Assurances that the variant is benign are consistent with the findings of this study, in which we were unable to detect differences in a broad spectrum of neurobehavioral development measures during the second half of gestation. To our knowledge, this study is the first to examine potential antenatal consequences of mid-gestation CPCs in the developing fetus.…”

Did I really want to know this? Pregnant women's reaction to detection of a soft marker during ultrasound screening

“…Recent evidence indicates that if these markers are found in isolation in an otherwise low-risk pregnancy, there is minimal or no increased risk of trisomy 21 or 18 [10]. Although fetal chromosomal abnormalities may be easily confirmed by invasive tests, these procedures are associated with an increased risk of miscarriage [19], and therefore something many women want to avoid. Due to the disclosure of soft markers in the unborn child routine ultrasound screening in pregnancy has led to frequent situations characterized by clinical uncertainty, counselling dilemmas, and wide variations in management [12,20,21].…”

Referral for fetal echocardiography is associated with increased maternal anxiety

“…Providing additional information about ultrasound testing to patients has been shown to improve knowledge. [15] However, it has also been shown that even with extensive and accurate counseling, communication from the healthcare provider may not be understood by the patient [7]. Furthermore, whether improved doctor-patient communication decreases anxiety levels remains unclear.…”

“…[6] Cristofalo et al found that the detection of a benign structural variant of the brain, the choroid plexus cyst, during routine ultrasounds led to intense negative maternal emotions, despite reassurance from providers. [7] Similarly, Ohman et al demonstrated that women who were told their child might have trisomy 21 based on ultrasound findings were intensely anxious in the interim between the ultrasound and the conclusive amniocentesis. [8]…”