[Fears of pregnant women if prenatal examination yields or does not yield any findings]

Abstract

Objective: Besides a medical point of view, prenatal diagnosis also has psychological effects on the pregnant woman. We studied the state of anxiety before and after prenatal examination with unsuspicious and suspicious prenatal findings.

Material and methods: In a consecutive sample of 332 pregnant women presenting between the 12th and 21st week of gestation for prenatal malformation scan (level three reference centre, Unit for Prenatal Medicine, Department of Obstetrics and Gynaecology, Medical University of Lübeck) we ascertained state and trait anxiety (Spielberger) before prenatal examination and state anxiety after prenatal examination with unsuspicious and suspicious findings.

Results: In the sample of N = 332 pregnant women prenatal examination showed a suspicious finding in 37 fetuses (11.1 %) and an unsuspicious finding in 295 fetuses (88.9 %). Before prenatal examination there is no difference (Mann-Whitney-Test, P = 0.286) between the group with negative results and the pregnant women with a positive result for the trait anxiety scale; however, there is a significant difference (Mann-Whitney-Test, P = 0.014*) for the scale of state anxiety. After prenatal examination the evaluation of the state anxiety questionnaire shows a significant (Mann-Whitney-Test, P = 0.000*) difference between pregnant women with an unsuspicious finding and pregnant women with a suspicious finding. State-anxiety is significantly reduced after examination if the prenatal scan is unsuspicious (Wilcoxon-Test, P = 0.000*), but there is no significant difference between pre-and post-examination anxiety if there is a positive finding (Wilcoxon-Test, P = 0.399). Evaluating aspects of anxiety as regards content, it can be demonstrated that before prenatal examination the pregnant women are just as much afraid of a malformation being detected as of it being missed.

Conclusions: Suspecting or knowing about a malformation of the unborn means a complex process of coping and an intense psychosocial strain for a pregnant woman. Besides the fear of a detected malformation the pregnant women state equal fear of a malformation being missed. In contrast to this the immediate feedback of a negative finding during ultrasound examination leads to a significant reduction of anxiety and to an emotional relief for the pregnant woman.