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Fetal Anomalies (fetal + anomaly)
Selected AbstractsDiscrepant Feeling Rules and Unscripted Emotion Work: Women Coping With Termination for Fetal AnomalyAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 4 2009Judith L. M. McCoyd PhD The sociology of emotion is rapidly evolving and has implications for medical settings. Advancing medical technologies create new contexts for decision-making and emotional reaction that are framed by "feeling rules." Feeling rules guide not only behavior, but also how one believes one should feel, thereby causing one to attempt to bring one's authentic feelings into line with perceived feeling rules. Using qualitative data, the theoretical existence of feeling rules in pregnancy and prenatal testing is confirmed. Further examination extends this analysis: at times of technological development feeling rules are often discrepant, leaving patients with unscripted emotion work. Data from a study of women who interrupted anomalous pregnancies indicate that feeling rules are unclear when competing feeling rules are operating during times of societal and technological change. Because much of this occurs below the level of consciousness, medical and psychological services providers need to be aware of potential discrepancies in feeling rules and assist patients in identifying the salient feeling rules. Patients' struggles ease when they can recognize the discrepancies and assess their implications for decision-making and emotional response. [source] Three-dimensional sonographic evaluation of the fetal lumbar spinal canalJOURNAL OF ANATOMY, Issue 5 2002Thomas Wallny Abstract In a prospective cross-sectional ultrasound study the size of the fetal lumbar spinal canal was evaluated to determine reference values for the lumbar part of the vertebral canal. One hundred and sixty-seven pregnant women undergoing routine obstetric ultrasound were studied between 16 and 41 weeks of gestation. Exclusion criteria consisted of structural fetal anomalies or growth restriction. Area and volume of the vertebral canal at L1, L3 and L5 were calculated by three-dimensional (3D) ultrasound. Length of the lumbar spine was also determined. The size of the spinal canal and spinal length correlated well with gestational age. No gestational-age-dependent differences in area and volume measurements between upper and lower lumbar spine were found. The results provide an in vivo assessment of the spinal canal by 3D ultrasound over the entire gestation period. [source] Doctors' attitudes towards invasive prenatal diagnosisJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2009Somsri Pitukkijronnakorn Abstract Aim:, To assess the influence of a doctor's gender, age group, religion and invasive prenatal diagnosis (PND) knowledge on their attitude towards invasive PND. Methods:, All non,obstetric and gynecologic doctors were surveyed using a structured questionnaire. The questionnaire enquired about demographic information, and doctors' knowledge, attitude and experience regarding invasive PND for themselves, and their spouses, relatives, friends, colleagues and patients. Results:, Responses from the 289 respondents revealed that two-thirds of respondents knew only a little about invasive PND. Most males and females were in the 31,39 and ,30-year-old groups, respectively. There were no statistically significant differences in gender, age group, religion and invasive PND knowledge when recommending of invasive PND. If fetal anomalies were detected, most of the females in the Buddhist group (P < 0.05), males with quite a lot of PND knowledge group (p < 0.05) and younger doctors group (P < 0.05) would their own terminate pregnancies, or those of wives and relatives. Conclusion:, Attitudes towards invasive PND and pregnancy termination was influenced by gender, age group, religion and PND knowledge. Females and younger doctors from both gender groups tended to recommend the termination of pregnancy if they found fetal anomalies. [source] The use of combined ultrasound and magnetic resonance imaging in the detection of fetal anomaliesPRENATAL DIAGNOSIS, Issue 5 2010Xiomara M. Santos Abstract Objective To compare the referral diagnosis based on prenatal ultrasound to diagnoses made following combined ultrasound (US) and magnetic resonance imaging (MRI) evaluation at the Texas Children's Fetal Center (TCFC) and postnatal diagnosis. Methods We performed a retrospective review of patients referred to the TCFC between September 2001 and July 2007 with a fetal structural malformation. Data were abstracted to compare the referral diagnosis to TCFC imaging diagnoses and both were compared to postnatal diagnosis. Results Two hundred and twenty-four patients were referred who had a fetal US and MRI at TCFC. The most frequent indications were for abnormalities of the central nervous system (38%) and lung/thoracic cavity (34%), with congenital diaphragmatic hernia (CDH) the single most common referral diagnosis (n = 39; 17%). In 99 cases (42.7%) the referral diagnosis was concordant with the post-referral diagnosis, however, in 68 cases (29.3%) the post-referral diagnosis changed completely, and in 65 cases (28%) additional findings were discovered. Prenatal diagnoses following imaging at TCFC were concordant with postnatal diagnoses in 94.9% of cases. Conclusions Combined ultrasound and MRI provides additional diagnostic information or a corrected diagnosis in 57% of cases over the referral ultrasound diagnosis. Copyright © 2010 John Wiley & Sons, Ltd. [source] Awareness and attitude toward prenatal diagnosis of chromosomal abnormalities in patients with no access to legal termination of pregnancyPRENATAL DIAGNOSIS, Issue 10 2006E. Gadow Abstract Objective To analyze variables affecting couples' decision making about prenatal cytogenetic diagnosis in patients with no access to legal termination of pregnancy (TOP). Methods Patients undergoing invasive prenatal diagnosis were anonymously surveyed after counseling and before the procedure. The questionnaire enquired about sociodemographic features, medical history, knowledge of and attitudes toward genetic testing and TOP. Results Two genetic units distributed 372 questionnaires. Mean maternal age was 36 ± 4 years. Access to prenatal genetic counseling was mainly patient's own initiative, or ,self-referral'. Most self-referred patients (87%) considered that ,receiving accurate information' was the main issue. Eighty-one per cent of all couples knew that TOP because of fetal anomalies was not legal. In case of a serious anomaly, 68.2% of patients would contemplate TOP, in spite of the risk of being exposed to an unsafe abortion. Conclusions In many countries, prenatal genetic testing is offered, but TOP is not available. In the present study, although most of the couples who decided to undergo prenatal genetic testing were aware of this, they still chose to perform prenatal diagnosis. The main reason given was to obtain reliable information about fetal condition. Finally, if a fetal chromosomal abnormality were detected, most of them would consider TOP. Copyright © 2006 John Wiley & Sons, Ltd. [source] Lack of correlation between elevated maternal serum hCG during second-trimester biochemical screening and fetal congenital anomalyPRENATAL DIAGNOSIS, Issue 3 2005Claudio Celentano Abstract Objective Isolated elevations in midtrimester maternal serum human chorionic gonadotrophin concentrations (MShCG) have been reported to be associated with a substantially increased likelihood of fetal congenital malformations. The reported malformations included a wide range of organ systems, originating at different embryologic developmental stages. The purpose of our study was to determine the significance of an isolated elevated MShCG (>2.5 MoM) in midtrimester for the detection of fetal structural anomalies in a large population. Methods Among 10 144 women who underwent a biochemical triple screen at 15 to 18 weeks' gestation, 463 patients, who had an elevated MShCG, but normal ,-fetoprotein (AFP) and unconjugated estriol (uE3) levels, were identified. Patients with an integrated calculated Down syndrome risk above 1:250 were excluded. Only nonsmokers, at ages <35 years, without a history of prior fetal anomalies were included. The control group consisted of 463 patients with normal serum analyte concentrations and Down syndrome risks below 1:250, who were matched for maternal age and date of biochemical screen. All patients underwent a detailed genetic sonogram in which an anatomic survey and multiple ,soft markers' for aneuploidy were looked for. Newborns were examined by a senior pediatrician trained in dysmorphology. Results MShCG levels were 3.18 ± 0.72 versus 0.99 ± 0.43 MoM (p < 0.0001) in study and control groups respectively. Sonography revealed 8 versus 6 cases of major congenital anomalies among the 463 patients of their respective groups, and 39 versus 36 sonographic ,soft markers' for aneuploidy. Fetal karyotyping and neonatal examination for dysmorphology revealed 6 chromosomal anomalies (4 Down syndrome; 2 Turner syndrome) among the 8 major malformations in the study group, but none in the controls (p < 0.0001). Three of the 39 fetuses with ,soft markers' and elevated MShCG were found to have trisomy 21. Conclusion Isolated elevation of MShCG does not confer an increased risk of fetal congenital anomalies other than chromosomal abnormalities. However, elevated MShCG levels in combination with sonographic ,soft markers' for aneuploidy were associated with a high incidence of chromosomal anomalies, despite a normal biochemical triple screen risk estimate. Copyright © 2005 John Wiley & Sons, Ltd. [source] Reference values of fetal orbital measurements by transvaginal scan in early pregnancyPRENATAL DIAGNOSIS, Issue 10 2002Paolo Rosati Abstract Objective To construct reference ranges of orbital diameters, measured in early pregnancy by transvaginal sonography. Methods The study group consisted of 2717 fetuses of pregnant women referred to our center and examined by transvaginal ultrasound between 11,16 week's gestation. Nomograms with confidence intervals (5th and 95th percentile) for each orbital measurement (orbital diameter, interocular and binocular distance) versus gestational age were produced. Results The orbital measurements increased in a linear fashion throughout early pregnancy with a good correlation with gestational age. Conclusion Transvaginal sonography is able to visualize and measure orbital diameters with accuracy in early pregnancy; reference ranges were developed that can be used to evaluate normal orbital development and can be helpful in the detection of syndromes with orbital growth defects and other associated fetal anomalies. Copyright © 2002 John Wiley & Sons, Ltd. [source] Mifepristone and second trimester pregnancy termination for fetal abnormality in Western Australia: Worth the effortAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Jan E. DICKINSON Objective:, To determine the impact on the process of second trimester medical termination for fetal abnormality following the introduction of adjunctive mifepristone in an Australian tertiary hospital. Methods:, All second trimester medical terminations for fetal abnormality between July 2006 and June 2009 were prospectively identified. Two temporal therapeutic cohorts were created: the first (1 July 2006 to 31 December 2007) using vaginal misoprostol alone and the second (1 January 2008 to 30 June 2009) using mifepristone priming prior to the administration of misoprostol. The primary outcome was to evaluate the impact of mifepristone priming upon the duration of pregnancy termination. Results:, During the study period, 388 women with prenatally recognised fetal anomalies between 14 and 24 weeks gestation underwent medical termination: 189 with misoprostol alone and 199 with mifepristone priming followed by misoprostol. There was no difference between the groups for maternal age, parity or prior caesarean delivery. The median abortion duration was 15.5 h (interquartile ranges (IQR) 11.2,22.7) in the misoprostol group and 8.6 h (IQR 5.6,13.8) in the mifepristone primed group (P < 0.001). In both the groups, nulliparity and advancing gestation were associated with a significant prolongation of the abortion interval. Duration of hospitalisation was significantly longer in the misoprostol alone group (31.5 h (27,48.9) vs 27.2 h (22,31.5), misoprostol vs mifepristone priming, respectively, P < 0.001). Conclusions:, The introduction of mifepristone priming prior to second trimester medical termination with misoprostol has resulted in a significant reduction in the duration of the termination procedure and length of inpatient stay. These observed benefits of mifepristone provide objective support for the decision to permit use of this medication in Australia. [source] Long-term psychological consequences of pregnancy termination for fetal abnormality: a cross-sectional studyPRENATAL DIAGNOSIS, Issue 3 2005M. J. Korenromp Abstract Objective We examined women's long-term psychological well-being after termination of pregnancy (TOP) for fetal anomaly in order to identify risk factors for psychological morbidity. Methods A cross-sectional study was performed in 254 women, 2 to 7 years after TOP for fetal anomaly before 24 weeks of gestation. We used standardised questionnaires to investigate grief, posttraumatic symptoms, and psychological and somatic complaints. Results Women generally adapted well to grief. However, a substantial number of the participants (17.3%) showed pathological scores for posttraumatic stress. Low-educated women and women who had experienced little support from their partners had the most unfavourable psychological outcome. Advanced gestational age at TOP was associated with higher levels of grief, and posttraumatic stress symptoms and long-term psychological morbidity was rare in TOP before 14 completed weeks of gestation. Higher levels of grief and doubt were found if the fetal anomaly was presumably compatible with life. Conclusion Termination of pregnancy for fetal anomaly is associated with long-lasting consequences for a substantial number of women. Clinically relevant determinants are gestational age, perceived partner support, and educational level. Copyright © 2005 John Wiley & Sons, Ltd. [source] Psychological impact of the detection of soft markers on routine ultrasound scanning: a pilot study investigating the modifying role of informationPRENATAL DIAGNOSIS, Issue 7 2002Melanie S. Watson Abstract Objectives To determine the impact on maternal anxiety of detecting a soft marker, and the association between anxiety and the information given during the scan. Methods Routine 20-week fetal anomaly scans were audiotaped in the obstetric ultrasound unit of a London teaching hospital, across a four month study period. The study sample comprised 28 pregnant women: 14 in whom a soft marker was detected and a comparison group of 14 women in whom no marker was identified. Telephone interviews were conducted within one week of the scan, at 30,weeks' gestation, and one month after the birth of their children. The main outcome was anxiety, assessed using a standardized scale. Information provided during the scan was coded from transcripts. Results In the week following the scan, women with soft markers had clinically significant levels of anxiety. At 30,weeks' gestation and one month post-partum their levels were within the normal range. Women who were told during their scan that their baby would probably be all right, compared with women not told this, were significantly less anxious and worried about their baby. Conclusions Results from this small longitudinal study suggest that the detection of soft markers on routine prenatal ultrasound causes considerable short-term anxiety for women and that providing reassurance during the scan may prevent some of this anxiety. Copyright © 2002 John Wiley & Sons, Ltd. [source] Infection and fetal loss in the mid-second trimester of pregnancyAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 3 2010Ben ALLANSON Introduction:, Chorioamnionitis is a common cause of second trimester pregnancy loss, usually due to ascending infection. This study investigates the prevalence and bacteriology of chorioamnionitis in cases of spontaneous pregnancy loss in previable gestations (16,22 weeks). Methods:, Fetal losses between 16- and 22-week gestation were identified from the institutional database over a three-year period. Cases with an autopsy were identified, pathology reports reviewed, and maternal features noted (clinical symptoms, blood count and vaginal culture results). Second trimester medical termination for fetal abnormality during the same time period served as controls for the confounding influence of labour. Results:, A total of 101 cases of spontaneous non-anomalous non-macerated fetal losses and 103 control cases of induced loss for fetal anomaly were identified. Median gestation of cases was 19 weeks (interquartile range (IQR) 17, 21) and of controls was 20 weeks (IQR 19, 21). Maternal white cell count was higher in cases (median 13.6 IQR 10.8, 16.6) than in controls (9.9 IQR 7.6, 11.5) (P < 0.01). Seventy-eight (77.2%) of 101 cases and no controls had histological chorioamnionitis. A fetal reaction was identified in 48.7% of cases with chorioamnionitis, and the frequency of fetal reaction increased as gestation advanced (5.3% at 16-week gestation vs 33.3% at 22-week gestation). In cases with chorioamnionitis 36/76 (47.4%) were culture positive, whereas 4/25 (16%) without chorioamnionitis were culture positive. Conclusion:, In otherwise normal fetuses, chorioamnionitis is a common finding in mid-trimester pregnancy loss. Routine culture methods have a low sensitivity for isolation of the causative micro-organisms. This inflammatory process seems to predate the onset of labour and appears a primary mechanism in the aetiology of such losses. [source] The hidden mortality of transposition of the great arteries and survival advantage provided by prenatal diagnosisBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2008M Blyth Objective, To describe the sensitivity of fetal anomaly scanning at detecting transposition of the great arteries (TGA) and to investigate whether prenatal detection improves survival. Design, Retrospective review of survival by comparing those who had an antenatal diagnosis with those who did not. Setting, Population-based study in Wessex region over 13 years. Population, Babies with isolated TGA and an intact ventricular septum. Methods, Review of outcomes by comparing those who had an antenatal diagnosis with those who did not. Main outcome measures, Mortality rates in each group. Results, TGA occurred more commonly in boys than in girls. Using the existing national screening policy, the antenatal detection rate of TGA was only 6.9% over the study period, improving to 25% in the last 4 years. This contrasts with a 40% detection rate when TGA was associated with a ventricular septal defect (VSD). All the babies who had TGA diagnosed antenatally survived through surgery. Of those who were not diagnosed antenatally, two were stillborn, five died before the diagnosis was made and four died after surgery. Although the difference in survival rates between those who were antenatally diagnosed and those who were not is not statistically significant (,2= 3.9; P = 0.11), some of these deaths could have been prevented if a prenatal diagnosis had been made. Conclusions, Improved antenatal diagnosis could lead to a significant reduction in the mortality associated with TGA. The current low detection rate of TGA in the UK could be improved by the inclusion of outflow tract views in routine fetal anomaly scans, and we believe that the extra workload is justified. [source] | |||||||||||||