title: An exploration of the parental experience of diagnosis of foetal abnormalities during routine antenatal ultrasound screening
Creators: name: Patterson, Kirsten
Publisher: name: University of Glasgow
Year: 2023

description: Background: Prenatal ultrasound screening is a routine aspect of antenatal care for women in the UK, typically at 12 weeks of gestation to confirm pregnancy and at 20 weeks to screen for foetal abnormalities. The diagnosis of foetal abnormality is likely to be an emotional and stressful time for a woman and her family; however, the impact on maternal mental health in the short-term has not been systematically evaluated. This systematic review aimed to assess the mental health consequences of diagnosis of foetal abnormalities by routine ultrasound screening for women in the perinatal period. Methods: A systematic review of six electronic databases (Embase, Medline, PsycInfo, CINAHL, Scopus, and Web of Science) was conducted to identify relevant studies published before April 2023. A narrative synthesis of findings was produced. Included studies were those using standardised measures to assess maternal mental health following prenatal diagnosis of foetal abnormality. Results: A total of 3221 studies were screened and 13 met inclusion criteria (eight prospective observational and five cross-sectional studies). A narrative synthesis of findings was presented according to three main mental health outcome domains identified: anxiety, depression, and traumatic stress. Women with recent diagnoses of foetal abnormality on average had anxiety reaching clinical threshold for concern, significantly higher than normal controls. Depression symptoms were, on average, higher than those with normal ultrasound findings. Approximately one third of those surveyed demonstrated traumatic stress above threshold for clinical concern. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool for Quasi-Experimental Studies. Conclusions: Prenatal diagnosis of foetal abnormality appears to be associated with poor mental health, and increased risk of anxiety, depression, and traumatic stress symptoms for women during pregnancy. Studies in this area are limited by the lack of assessment of mental health prior to diagnosis. It is recommended that clinicians providing ultrasound screening and prenatal diagnoses should consider the psychological needs of women during this process. Sources of support should be considered to minimise the potential impact of these risks on obstetric and child development outcomes. Background: Congenital pulmonary airway malformation (CPAM) is a term used to describe a range of foetal abnormalities of the lung typically identified during routine antenatal ultrasound screening at 20 weeks' gestation. Babies are typically born without symptoms and as such there is uncertainty about the best course of treatment: to operate, or to watch and wait. This uncertainty can have psychological consequences for the parents receiving such a diagnosis. This study aims to explore the experience of parents who have been involved in decision making about their infant’s care following diagnosis of CPAM in the context of uncertainty about treatment. Methods: This study used a qualitative approach in which four participants participated in a semi-structured interview about their experiences. Interviews were recorded and transcribed verbatim. Transcripts were then analysed using Interpretative Phenomenological Analysis (IPA) to generate group experiential themes. Results: Four group experiential themes were developed across the four interviews conducted: diagnosis changed the expected course of pregnancy; searching for information about the condition; making decisions about surgery; and life after decision making. Eleven subthemes were identified and are discussed. Conclusions: The findings of this study provide an insight into the experiences of parents who received a diagnosis of CPAM during routine antenatal screening. Participants highlighted the changes to the course of pregnancy, the importance of finding out more information about the condition, the process of making decisions about surgery, and the impact this continued to have on their lives in the present day. Recommendations are made for clinicians when providing similar diagnoses, particularly with regards to families’ informational needs. Possible future research directions are also discussed.