Original Article
Background Knowledge and Attitude of Pregnant Women towards Ultrasound Screening at 20–23 Weeks Gestation Hintergrundwissen und Einstellung schwangerer Frauen bezüglich des Fehlbildungsultraschall zwischen der 20–23 Schwangerschaftswoche Authors
C. Salmoukas1, S. Kundu2, P. Soergel2, P. Hillemanns2, C. von Kaisenberg2, I. Staboulidou2
Affiliations
1
Key words ▶ anomaly scan ● ▶ prenatal diagnosis ● ▶ opinion ● ▶ knowledge ●
Abstract
Zusammenfassung
Background: Prenatal ultrasound screening in the second trimester is widely used in maternal health care. Prenatal diagnosis and prenatal screening is often exposed to several accusation, such as inducing unnecessary anxiety, carrying out a selection and forcing pregnant women into attending ultrasound screening. The aim of this study was to investigate the knowledge and the intention of pregnant women attending the second trimester ultrasound screening. Patients and Methods: This was a prospective study. Women attending the 20 weeks anomaly scan were given an anonymous questionnaire to evaluate the background knowledge about the anomaly scan and their opinion about prenatal screening. Results: 600 (96.7 %) of 620 recruited women filled in the questionnaire completely. To the majority ( > 80 %) of women it is important to exclude severe fetal anomalies and to secure normal fetal growth. The background knowledge of the women was good, but a clear supply of information and a detail counselling would improve the understanding, especially in the group of lower education. The majority of the women stated that the 20 weeks anomaly scan should be offered to every woman. Conclusion: Prenatal ultrasound examination is not only essential from a medical point of view for example for important information regarding the status of the fetus, but also has a major impact as a positive psychological factor for pregnant women.
Einleitung: Die Pränataldiagnostik ist im Rahmen der Schwangerenvorsorge weit verbreitet. Pränatale Screeninguntersuchungen im Rahmen der Pränataldiagnostik sind oft verschiedenen Vorwürfen ausgesetzt, wie z. B. Auslösen von unbegründeter Angst, Selektion sowie das Induzieren eines Zwanges, an pränatalen Ultraschalluntersuchungen teilnehmen zu müssen. Ziel dieser Untersuchung war es, das Wissen und die Intention schwangerer Frauen zu erfragen, die an der pränatalen Ultraschalluntersuchung des zweiten Trimenons teilnehmen. Patienten und Methode: Dies war eine prospektive Studie. Ein anonymer Fragebogen wurde an die Frauen verteilt, die an der Fehlbildungsdiagnostik um 20 Schwangerschaftswochen teilnahmen. Erfragt wurden das Hintergrundwissen und die Meinung über die Fehlbildungsdiagnostik. Ergebnis: 600 (96.7 %) von 620 rekrutierte Frauen füllten den Fragebogen komplett aus. Für die Mehrheit ( > 80 %) der Frauen war es am wichtigsten, schwere fetale Fehlbildungen auszuschließen und ein normale fetales Wachstum sicherzustellen. Das Hintergrundwissen der Frauen war gut. Ein verständlicher Informationsfluss über die anstehenden Untersuchungen und eine detaillierte Beratung würden das Verständnis für diese Untersuchung und ihre Bedeutung deutlich verbessern, besonders bei Frauen mit geringerem Bildungsgrad. Schlussfolgerung: Pränatale Ultraschalldiagnostik ist nicht nur aus medizinischer Sicht unentbehrlich fϋr bspw. die Information und den Status über den Fetus, sondern hat ebenfalls eine wesentliche Bedeutung als positiver psychologischer Faktor fϋr die schwangeren Frauen.
received 23.09.2014 accepted 05.01.2015 after revision Bibliography DOI http://dx.doi.org/ 10.1055/s-0035-1545287 Online-Publikation: 2015 Z Geburtsh Neonatol © Georg Thieme Verlag KG Stuttgart · New York ISSN 0948-2393 Correspondence Dr. Ismini Staboulidou, PD (PhD), Dr. Department of Gynecology and Obstetrics University Medical School of Hanover Carl-Neuberg-Street 1 30625 Hanover Germany Tel.: + 49/176/15323 452 staboulidou.ismini@mh- hannover.de
Department of Cardiothoracic, Transplantation and Vascular Surgery, University School of Hanover, Hanover, Germany Department of Gynecology and Obstetrics, University Medical School of Hanover, Hanover, Germany
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Salmoukas C et al. Background Knowledge and Attitude … Z Geburtsh Neonatol
Downloaded by: Universite Laval. Copyrighted material.
Schlüsselwörter ▶ Fehlbildungsultraschall ● ▶ Pränataldiagnostik ● ▶ Meinung ● ▶ Wissen ●
2
Introduction
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Ultrasound screening in the 2nd trimester, also known as the 20 weeks anomaly scan, is widely used in maternal health care in most countries. Despite this, prenatal ultrasound screening remains a topic of controversial discussion. Benefits for the parents and especially ethical concerns are the main issues of an in general controversial discussion, claiming that the parents are forced or feel obliged to take part in prenatal screening [1, 2]. In addition to that, it has been maintained that counselling and the given information are insufficient before attending an ultrasound examination and the knowledge of pregnant women about this is poor. The aim of this study was to investigate the knowledge and the intentions of pregnant women attending 2nd trimester ultrasound screening.
Methods
▼
620 unselected women attending the 2nd trimester screening ultrasound were recruited over a period of 2 years. The second trimester ultrasound examination is performed between 20 and 23 weeks of gestation. Each woman, after agreeing to take part in this study, was given an anonymous questionnaire. The questionnaire was only available in German, making a sufficient understanding of the German language necessary. The questionnaire contained questions with defined and open answers to evaluate the background knowledge about ultrasound diagnosis in pregnancy as well as to define the expectations of the pregnant women.
Results
▼
600 (96.7 %) of 620 women agreeing to participate in the study and attending the second trimester ultrasound screening filled in the questionnaire completely. Details of the demographic data are summarized in ● ▶ Table 1. To the majority ( > 80 %) of women it is very important to exclude fetal anomalies and to secure normal fetal growth. Reasons for attending the second trimester ultrasound examination are presented in ● ▶ Table 2. The estimation of the women regarding what is detectable during an ultrasound examination was quite good. 87.5 % stated that it should be possible to detect heart defects, while only 9.3 % thought this is not possible. Whereas for mental retardation it was for 89.3 % obvious that this condition is not detectable by prenatal ultrasound. For the detection of brain anomalies and bowel anomalies it was apparently not clear for the women as 52.2 and 41.3 % stated it should be possible to detect brain and bowel anomalies, respectively. The estimations of women for the possibility to detect anomalies at the 20 weeks anomaly scan are shown in ● ▶ Fig. 1.
Table 1 Demographic parameters. Demographics mean maternal age mean gestational week nullipara multipara Religion Catholic Protestant Islam none School education in years > 12 10–11 Up to 9 Less than 9 Nationality German EU non-EU
Aims of investigation were to investigate the women's opinions about (i) the purpose of the 2nd trimester anomaly scan; (ii) their knowledge of what to see in the anomaly scan and what kind of anomalies the scan can pick up; and (iii) their knowledge of what “soft markers” mean. Furthermore, the woman were asked to express if they feel forced to attend ultrasound screening and if yes why and from whom. In addition to that the women completed some basic demographical details. The attending women filled out the questionnaire before the scan. Just the question if they feel happy having attended the scan or if they regretted attending the scan had to be filled out after the performed examination. Next to the knowledge and the intention of pregnant women attending the 2nd trimester ultrasound scan, it was further to investigate whether there were significant differences in knowledge regarding maternal age, previous pregnancies, education, religion and nationality. The local ethics committee approved the study. Statistical analysis was performed using SPSS (Statistical Package for the Social Science Version 16.0 for Windows) and R (Version 2.11.1, The R Foundation for Statistical Computing) in collaboration with the statistical institute of the University of Hannover. Demographic details are given in absolute values and in percentage. Linear regression analysis was performed to investigate the potential impact of the above mentioned characteristics on the given answers. In addition T tests for equality of means, Levene’s test for equality of variances as well as Bonferroni-Holm correction for repeated testing were used. Statistical significance was achieved at p
Background Knowledge and Attitude of Pregnant Women towards Ultrasound Screening at 20–23 Weeks Gestation Hintergrundwissen und Einstellung schwangerer Frauen bezüglich des Fehlbildungsultraschall zwischen der 20–23 Schwangerschaftswoche Authors
C. Salmoukas1, S. Kundu2, P. Soergel2, P. Hillemanns2, C. von Kaisenberg2, I. Staboulidou2
Affiliations
1
Key words ▶ anomaly scan ● ▶ prenatal diagnosis ● ▶ opinion ● ▶ knowledge ●
Abstract
Zusammenfassung
Background: Prenatal ultrasound screening in the second trimester is widely used in maternal health care. Prenatal diagnosis and prenatal screening is often exposed to several accusation, such as inducing unnecessary anxiety, carrying out a selection and forcing pregnant women into attending ultrasound screening. The aim of this study was to investigate the knowledge and the intention of pregnant women attending the second trimester ultrasound screening. Patients and Methods: This was a prospective study. Women attending the 20 weeks anomaly scan were given an anonymous questionnaire to evaluate the background knowledge about the anomaly scan and their opinion about prenatal screening. Results: 600 (96.7 %) of 620 recruited women filled in the questionnaire completely. To the majority ( > 80 %) of women it is important to exclude severe fetal anomalies and to secure normal fetal growth. The background knowledge of the women was good, but a clear supply of information and a detail counselling would improve the understanding, especially in the group of lower education. The majority of the women stated that the 20 weeks anomaly scan should be offered to every woman. Conclusion: Prenatal ultrasound examination is not only essential from a medical point of view for example for important information regarding the status of the fetus, but also has a major impact as a positive psychological factor for pregnant women.
Einleitung: Die Pränataldiagnostik ist im Rahmen der Schwangerenvorsorge weit verbreitet. Pränatale Screeninguntersuchungen im Rahmen der Pränataldiagnostik sind oft verschiedenen Vorwürfen ausgesetzt, wie z. B. Auslösen von unbegründeter Angst, Selektion sowie das Induzieren eines Zwanges, an pränatalen Ultraschalluntersuchungen teilnehmen zu müssen. Ziel dieser Untersuchung war es, das Wissen und die Intention schwangerer Frauen zu erfragen, die an der pränatalen Ultraschalluntersuchung des zweiten Trimenons teilnehmen. Patienten und Methode: Dies war eine prospektive Studie. Ein anonymer Fragebogen wurde an die Frauen verteilt, die an der Fehlbildungsdiagnostik um 20 Schwangerschaftswochen teilnahmen. Erfragt wurden das Hintergrundwissen und die Meinung über die Fehlbildungsdiagnostik. Ergebnis: 600 (96.7 %) von 620 rekrutierte Frauen füllten den Fragebogen komplett aus. Für die Mehrheit ( > 80 %) der Frauen war es am wichtigsten, schwere fetale Fehlbildungen auszuschließen und ein normale fetales Wachstum sicherzustellen. Das Hintergrundwissen der Frauen war gut. Ein verständlicher Informationsfluss über die anstehenden Untersuchungen und eine detaillierte Beratung würden das Verständnis für diese Untersuchung und ihre Bedeutung deutlich verbessern, besonders bei Frauen mit geringerem Bildungsgrad. Schlussfolgerung: Pränatale Ultraschalldiagnostik ist nicht nur aus medizinischer Sicht unentbehrlich fϋr bspw. die Information und den Status über den Fetus, sondern hat ebenfalls eine wesentliche Bedeutung als positiver psychologischer Faktor fϋr die schwangeren Frauen.
received 23.09.2014 accepted 05.01.2015 after revision Bibliography DOI http://dx.doi.org/ 10.1055/s-0035-1545287 Online-Publikation: 2015 Z Geburtsh Neonatol © Georg Thieme Verlag KG Stuttgart · New York ISSN 0948-2393 Correspondence Dr. Ismini Staboulidou, PD (PhD), Dr. Department of Gynecology and Obstetrics University Medical School of Hanover Carl-Neuberg-Street 1 30625 Hanover Germany Tel.: + 49/176/15323 452 staboulidou.ismini@mh- hannover.de
Department of Cardiothoracic, Transplantation and Vascular Surgery, University School of Hanover, Hanover, Germany Department of Gynecology and Obstetrics, University Medical School of Hanover, Hanover, Germany
▼
▼
Salmoukas C et al. Background Knowledge and Attitude … Z Geburtsh Neonatol
Downloaded by: Universite Laval. Copyrighted material.
Schlüsselwörter ▶ Fehlbildungsultraschall ● ▶ Pränataldiagnostik ● ▶ Meinung ● ▶ Wissen ●
2
Introduction
▼
Ultrasound screening in the 2nd trimester, also known as the 20 weeks anomaly scan, is widely used in maternal health care in most countries. Despite this, prenatal ultrasound screening remains a topic of controversial discussion. Benefits for the parents and especially ethical concerns are the main issues of an in general controversial discussion, claiming that the parents are forced or feel obliged to take part in prenatal screening [1, 2]. In addition to that, it has been maintained that counselling and the given information are insufficient before attending an ultrasound examination and the knowledge of pregnant women about this is poor. The aim of this study was to investigate the knowledge and the intentions of pregnant women attending 2nd trimester ultrasound screening.
Methods
▼
620 unselected women attending the 2nd trimester screening ultrasound were recruited over a period of 2 years. The second trimester ultrasound examination is performed between 20 and 23 weeks of gestation. Each woman, after agreeing to take part in this study, was given an anonymous questionnaire. The questionnaire was only available in German, making a sufficient understanding of the German language necessary. The questionnaire contained questions with defined and open answers to evaluate the background knowledge about ultrasound diagnosis in pregnancy as well as to define the expectations of the pregnant women.
Results
▼
600 (96.7 %) of 620 women agreeing to participate in the study and attending the second trimester ultrasound screening filled in the questionnaire completely. Details of the demographic data are summarized in ● ▶ Table 1. To the majority ( > 80 %) of women it is very important to exclude fetal anomalies and to secure normal fetal growth. Reasons for attending the second trimester ultrasound examination are presented in ● ▶ Table 2. The estimation of the women regarding what is detectable during an ultrasound examination was quite good. 87.5 % stated that it should be possible to detect heart defects, while only 9.3 % thought this is not possible. Whereas for mental retardation it was for 89.3 % obvious that this condition is not detectable by prenatal ultrasound. For the detection of brain anomalies and bowel anomalies it was apparently not clear for the women as 52.2 and 41.3 % stated it should be possible to detect brain and bowel anomalies, respectively. The estimations of women for the possibility to detect anomalies at the 20 weeks anomaly scan are shown in ● ▶ Fig. 1.
Table 1 Demographic parameters. Demographics mean maternal age mean gestational week nullipara multipara Religion Catholic Protestant Islam none School education in years > 12 10–11 Up to 9 Less than 9 Nationality German EU non-EU
Aims of investigation were to investigate the women's opinions about (i) the purpose of the 2nd trimester anomaly scan; (ii) their knowledge of what to see in the anomaly scan and what kind of anomalies the scan can pick up; and (iii) their knowledge of what “soft markers” mean. Furthermore, the woman were asked to express if they feel forced to attend ultrasound screening and if yes why and from whom. In addition to that the women completed some basic demographical details. The attending women filled out the questionnaire before the scan. Just the question if they feel happy having attended the scan or if they regretted attending the scan had to be filled out after the performed examination. Next to the knowledge and the intention of pregnant women attending the 2nd trimester ultrasound scan, it was further to investigate whether there were significant differences in knowledge regarding maternal age, previous pregnancies, education, religion and nationality. The local ethics committee approved the study. Statistical analysis was performed using SPSS (Statistical Package for the Social Science Version 16.0 for Windows) and R (Version 2.11.1, The R Foundation for Statistical Computing) in collaboration with the statistical institute of the University of Hannover. Demographic details are given in absolute values and in percentage. Linear regression analysis was performed to investigate the potential impact of the above mentioned characteristics on the given answers. In addition T tests for equality of means, Levene’s test for equality of variances as well as Bonferroni-Holm correction for repeated testing were used. Statistical significance was achieved at p
