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High feedback versus low feedback of prenatal ultrasound for reducing maternal anxiety and improving maternal health behaviour in pregnancy

  1. Ashraf F Nabhan*,
  2. Mohammed A Faris

Editorial Group: Cochrane Pregnancy and Childbirth Group

Published Online: 14 APR 2010

Assessed as up-to-date: 28 FEB 2010

DOI: 10.1002/14651858.CD007208.pub2


How to Cite

Nabhan AF, Faris MA. High feedback versus low feedback of prenatal ultrasound for reducing maternal anxiety and improving maternal health behaviour in pregnancy. Cochrane Database of Systematic Reviews 2010, Issue 4. Art. No.: CD007208. DOI: 10.1002/14651858.CD007208.pub2.

Author Information

  1. Ain Shams University, Department of Obstetrics and Gynecology, Cairo, Egypt

*Ashraf F Nabhan, Department of Obstetrics and Gynecology, Ain Shams University, 16 Ali Fahmi Kamel Street, Heliopolis, Cairo, 11351, Egypt. ashraf.nabhan@gmail.com. afnabhan@aol.com.

Publication History

  1. Publication Status: New
  2. Published Online: 14 APR 2010

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This is not the most recent version of the article. View current version (04 AUG 2015)

 

Background

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms
 

Routine prenatal care and ultrasonography

Ultrasound may be used as a tool to diagnose complications that may arise during pregnancy (including multiple pregnancy, fetal growth restriction, placenta praevia). It may also be offered as part of routine obstetric care in many countries with developed healthcare services (Bricker 2000; Garcia 2002; Jahn 2002; Lalor 2006; Sen 2003).

Routine prenatal ultrasonography has become an integral part of the psychological experience of having a baby (Harris 2004). Women may seek prenatal ultrasonography for reassurance and to make informed decisions later in pregnancy. Other reasons why pregnant women request a prenatal ultrasound in the absence of clinical indications include their desire to know the sex of the fetus, to exclude fetal anomalies, to verify fetal life and to assess fetal growth. Those reasons vary according to the parity; duration of gestation; prior obstetric history (e.g. prior miscarriage or fetal loss); and personal factors. Lower income was more significantly related to wanting to see the baby and wanting an ultrasound picture, whereas higher income was more significantly related to checking that all was normal and for reassurance. Women in their first pregnancy were more likely to want themselves and the father to see the baby. Women who had given birth previously were more likely to want reassurance, as were women with a previous miscarriage or induced abortion. Women who would agree to an abortion in case of fetal trisomies were more likely to want to know about abnormalities. Women in the second trimester were more likely to want to check for abnormalities and appropriate fetal growth than those in the first trimester (Gudex 2006).

 

Description of the intervention

The prenatal real time ultrasound is one of a range of techniques used in screening and diagnosis, but it differs from most others because it gives parents instant access to the images of the fetus (Garcia 2002). In addition to instant access to a fetal image, the care giver provides information (feedback) to the pregnant woman. In current practice there are two types of feedback depending on the amount of information given to the pregnant woman. During high feedback ultrasound scans, women can see the screen and receive detailed explanations, while in low feedback ultrasound scans, only the operator can see the screen and the women are told the results at the end of the scan (Bricker 2000; Field 1985; Reading 1982; Reading 1985; Zlotogorski 1996). Feedback includes how the physicians provide information about the examination procedure itself, as well as how they inform the pregnant woman about her pregnancy and whether or not a complication is detected (Gotzmann 2001).

 

How the intervention might work

The amount of information given to the pregnant woman may have an impact on the level of state anxiety of a pregnant woman, maternal-fetal attachment and health attitudes during pregnancy e.g. cessation of smoking and alcohol consumption (Crandon 1979; Janus 1980; Lobel 2008; Sjöström 2002; Teixeira 1999). The impact of the amount of feedback might be influenced by clinical, for example duration of gestation and parity, and demographic factors that might independently influence anxiety and health attitudes in pregnant women.

State anxiety is a transitory emotional state and refers to a palpable reaction or process taking place at a given time and level of intensity. State anxiety, unlike trait anxiety, is affected by situational circumstances e.g. undergoing a diagnostic test as an ultrasound scan. It must be noted that the individual differences in reactions (called trait anxiety) (Endler 2001) may have a more profound impact on state anxiety than the timing or nature of the feedback itself (Zlotogorski 1995).

The tools used to assess anxiety include Spielberger State-Trait Anxiety Inventory (STAI) (Spielberger 1983) and Beck Anxiety Investory (Beck 1988). The STAI differentiates between temporary or emotional state anxiety versus longstanding personality trait anxiety in adults. The STAI contains four-point Likert items. The instrument is divided into two sections, each having 20 questions. The first sub scale measures state anxiety, the second measures trait anxiety. The range of scores is 20-80, the higher score indicating greater anxiety. Approximately 10 minutes are required for adults to complete the STAI.

High feedback during a prenatal ultrasound might reduce pregnancy anxiety, particularly for the primigravida women (Field 1985). High feedback might also increase maternal-fetal attachment and promote positive attitudes toward health during pregnancy (Boukydis 2006; Reading 1982). But it can impact both ways, not only adding excessive stress on the pregnant women and their partners, but also on the physicians, especially when there are fetal anomalies (Gotzmann 2001). Needless to say the amount of information given to the pregnant woman in case of detecting an ultrasonographic soft marker is very important in light of the relatively high false-positive rates of ultrasonographic soft markers. In a recent study including 215 women, it was found that women with a possible soft ultrasound findings who were referred for further tests had significantly higher state anxiety than women who were referred because of their advanced age (Hoskovec 2008). Therefore, it seems very important to know what to say and how to say it and It should be acknowledged that a number of factors contribute to successful detection of anomalies, including the type of anomaly, gestational age at scanning, the skill of the sonographer and the ultrasound machine used (Bricker 2000).

Whereas, low feedback with a less detailed approach may be preferable for a routine screening program for low-risk pregnancy, as extensive provision of information about possible abnormal finding can cause unnecessary anxiety until further scans or tests resolve the issue (Lalor 2006). The clinical situation of 'absence of reassuring findings' during a scan might make some obstetricians provide a low level of feedback to avoid unnecessary anxiety. A recent study has shown that, contrary to their expectation of reassurance, most antenatal care attendees are warned about possible abnormalities, which often lead to further investigations and cause considerable anxiety. Two-thirds (67.2%) of antenatal care attendees reported suspicious or abnormal findings, almost half of which (45.1%) resulted from routine ultrasound scans. More than half (53.2%) of those with suspicious findings had higher state anxiety scores. The suspected problem often did not materialize: 13 of 16 suspected malformations and 34 of 42 suspected growth-retarded babies were in the normal range (Petersen 2008).

Obstetricians should be careful not to give a false reassurance while providing a detailed high feedback. This false reassurance may be due to women's lack of knowledge about what ultrasound can and cannot test for. One more issue is whether informing the parents of the fetal sex is part of the “high feedback”. The effect this information has on the parents may colour the rest of the results. The effect would also be influenced by whether the sex is the desired sex for this baby.

 

Why it is important to do this review

A systematic review is needed to identify whether to provide high feedback or low feedback during prenatal ultrasound examinations; and whether high or low feedback improves maternal positive health attitudes during pregnancy and reduces maternal state anxiety.

 

Objectives

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

To compare high feedback versus low feedback during prenatal ultrasound for reducing maternal anxiety and improving maternal health behavior and pregnancy outcomes.

 

Methods

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms
 

Criteria for considering studies for this review

 

Types of studies

Randomized controlled trials (RCTs). We did not include quasi-randomized trials.

 

Types of participants

Pregnant women undergoing routine ultrasound during pregnancy.

 

Types of interventions

High feedback versus low feedback during ultrasound during routine antenatal care.

 

Types of outcome measures

 

Primary outcomes

  1. Maternal anxiety measured by State Trait Anxiety Inventory as defined by the investigators of each included study.

 

Secondary outcomes

  1. Cessation of alcohol
  2. Cessation of smoking
  3. Women's views of level of feedback

 

Search methods for identification of studies

 

Electronic searches

We contacted the Trials Search Co-ordinator to search the Cochrane Pregnancy and Childbirth Group’s Trials Register (March 2010). 

The Cochrane Pregnancy and Childbirth Group’s Trials Register is maintained by the Trials Search Co-ordinator and contains trials identified from:

  1. quarterly searches of the Cochrane Central Register of Controlled Trials (CENTRAL);
  2. weekly searches of MEDLINE;
  3. handsearches of 30 journals and the proceedings of major conferences;
  4. weekly current awareness alerts for a further 44 journals plus monthly BioMed Central email alerts.

Details of the search strategies for CENTRAL and MEDLINE, the list of handsearched journals and conference proceedings, and the list of journals reviewed via the current awareness service can be found in the ‘Specialized Register’ section within the editorial information about the Cochrane Pregnancy and Childbirth Group.

Trials identified through the searching activities described above are each assigned to a review topic (or topics). The Trials Search Co-ordinator searches the register for each review using the topic list rather than keywords. 

In addition, we searched CENTRAL (The Cochrane Library 2010 Issue 1), MEDLINE (January 1966 to 1 March 2010) and the metaRegister of Controlled Trials (mRCT) (March 2010) using the search strategies detailed in Appendix 1

 

Searching other resources

We handsearched citation lists of relevant publications.

We did not apply any language restrictions.

 

Data collection and analysis

The methodology for data collection and analysis followed the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2008).

 

Selection of studies

Both review authors assessed all potential studies identified as a result of the search strategy. We resolved any disagreement through discussion.

 

Data extraction and management

We designed a form to extract data. Both review authors extracted the data using the agreed form. If the study was presented only as abstract, we tried to contact the researchers. We summarized the details of the intervention in the review. We resolved discrepancies through discussion. We used the Review Manager software (RevMan 2008) to double enter all the data or a sub sample.

 

Assessment of risk of bias in included studies

Two review authors (A Nabhan and M Faris) independently assessed risk of bias for each study using the criteria outlined in the Cochrane Handbook for Systematic Reviews of Interventions (Higgins 2008). There were no disagreements on the assessment of risk of bias in the included study.

 

(1) Sequence generation (selection bias)

We described for each included study the methods used to generate the allocation sequence in sufficient detail to allow an assessment of whether it should produce comparable groups. We assessed the methods as:

  • adequate (any truly random process, e.g. random number table; computer random number generator);
  • inadequate (any non-random process, e.g. odd or even date of birth; hospital or clinic record number); or
  • unclear.

 

(2) Allocation concealment (selection bias)

We described for each included study the method used to conceal the allocation sequence in sufficient detail and determined whether intervention allocation could have been foreseen in advance of, or during recruitment, or changed after assignment. We assessed the methods as:

  • adequate (e.g. telephone or central randomisation; consecutively numbered sealed opaque envelopes);
  • inadequate (open random allocation; unsealed or non-opaque envelopes);
  • unclear.

 

(3) Blinding (performance bias)

We described for each included study all the methods used, if any, to blind study participants and personnel from knowledge of which intervention a participant received. We also provided information on whether the intended blinding was effective. Where blinding was not possible, we assessed whether the lack of blinding was likely to have introduced bias. We assessed blinding separately for different outcomes or classes of outcomes. With an intervention such as allocation to high feedback rather than low feedback during ultrasound scan, it is not practically feasible to blind women and clinical staff to treatment allocation, but it may be possible to blind outcome assessors

We assessed the methods as:

  • adequate, inadequate or unclear for outcome assessors.

 

(4) Incomplete outcome data (attrition bias)

We described for each included study, and for each outcome or class of outcomes, the completeness of data including attrition and exclusions from the analysis. We stated whether attrition and exclusions were reported, the numbers included in the analysis at each stage (compared with the total randomized participants), reasons for attrition or exclusion where reported, and whether missing data were balanced across groups or were related to outcomes. Where sufficient information was reported, or could be supplied by the trial authors, we re-included missing data in the analyses which we undertook. We assessed methods as:

  • adequate;
  • inadequate (missing data greater than 20% of the sample);
  • unclear.

 

(5) Selective reporting bias

We described for each included study how we examined the possibility of selective outcome reporting bias and what we found.

We assessed the methods as:

  • adequate (where it is clear that all of the study's pre-specified outcomes and all expected outcomes of interest to the review have been reported);
  • inadequate (where not all the study's pre-specified outcomes have been reported; one or more reported primary outcomes were not pre-specified; outcomes of interest are reported incompletely and so cannot be used; study fails to include results of a key outcome that would have been expected to have been reported);
  • unclear.

 

(6) Other sources of bias

We described for each included study any important concerns we have about other possible sources of bias.

We assessed whether each study was free of other problems that could put it at risk of bias:

  • yes;
  • no;
  • unclear.

 

(7) Overall risk of bias

We made explicit judgements about whether studies were at high risk of bias, according to the criteria given in the Handbook (Higgins 2008). With reference to (1) to (6) above, we assessed the likely magnitude and direction of the bias and whether we considered it is likely to impact on the findings. We explored the impact of the level of bias through undertaking sensitivity analyses.

 

Measures of treatment effect

We carried out statistical analysis using the Review Manager software (RevMan 2008).

 

Dichotomous data

For dichotomous data, we presented results as summary risk ratio with 95% confidence intervals.

 

Continuous data

For continuous data, we used the mean difference if outcomes are measured in the same way between trials. We used the standardized mean difference to combine trials that measure the same outcome, but use different methods.

 

Unit of analysis issues

 

Cluster-randomized trials

We did not include any cluster-randomized trials in the analyses in addition to individually randomized trials.

 

Dealing with missing data

We analyzed data on all participants with available data in the group to which they were allocated, regardless of whether or not they received the allocated intervention.

 

Assessment of heterogeneity

We applied tests of heterogeneity between trials, if appropriate, using the I2 statistic. If we identified high levels of heterogeneity among the trials (exceeding 50%), we explored it by prespecified subgroup analysis and perform sensitivity analysis. We used a random-effects meta-analysis as an overall summary if we considered this appropriate.

 

Assessment of reporting biases

Where we suspected reporting bias (see 'Selective reporting bias' above), we planned to contact study authors asking them to provide missing outcome data.

 

Data synthesis

We used fixed-effect meta-analysis for combining data in the absence of significant heterogeneity if trials were sufficiently similar. If we found heterogeneity, we explored this by sensitivity analysis followed by random-effects if required.

 

Subgroup analysis and investigation of heterogeneity

We conducted planned subgroup analyses classifying whole trials by interaction tests as described by Deeks 2001.

We carried out subgroup analysis by timing of intervention, as it is plausible that the level of feedback might be of greater impact on maternal anxiety and her health attitude if provided early in pregnancy.

 

Sensitivity analysis

We carried out sensitivity analysis to explore the effect of trial quality assessed by concealment of allocation, by excluding studies with clearly inadequate allocation of concealment.

 

Results

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms
 

Description of studies

See: Characteristics of included studies; Characteristics of excluded studies.

We have provided descriptions of studies in the 'Characteristics of included studies' and 'Characteristics of excluded studies' tables.

 

Results of the search

We identified seven potentially eligible studies (Boukydis 2006; Cox 1987; Field 1985; Reading 1985; Reading 1982; Salkovskis 2001; Zlotogorski 1996). (We identified one additional trial report in an updated search after the analysis had been carried out (Stotts 2009). This will be assessed when the review is updated.)

 

Included studies

We included four studies (365 participants) (Field 1985; Reading 1985; Reading 1982; Zlotogorski 1996). All included studies compared low feedback and high feedback during ultrasound scan in pregnancy.

 

Excluded studies

We excluded three studies: Boukydis 2006 and Salkovskis 2001 did not compare high feed back and low feedback during ultrasound scan. Cox 1987 was a quasi-randomized trial.

 

Risk of bias in included studies

We have provided detailed descriptions of the risk of bias in the included studies in the risk of bias tables.

 

Allocation

In the four included studies (Field 1985; Reading 1985; Reading 1982; Zlotogorski 1996), there was neither a description of the method of sequence generation nor the method used for allocation concealment.

 

Blinding

None of the four included trials included any description of blinding for any of the outcomes and whether the outcome assessors were blind to the group allocation.

 

Incomplete outcome data

In the Zlotogorski 1996 study, 211 women were the subjects recruited (three subjects with findings of congenital fetal malformations or other pathological findings were excluded, 10 subjects dropped out at different stages of the study and 15 subjects failed to complete the questionnaires). One participant was never accounted for in the trial. Therefore, only 182 women were available for analysis. For the state anxiety scores, data from 177 participants were recorded. The trial did not account for the missing five participants.

 

Selective reporting

There is no evidence that there was selective reporting of outcomes.

 

Other potential sources of bias

There is no evidence that there were other potential sources of bias.

 

Effects of interventions

 

Maternal anxiety

All included trials used the same tool, the State Trait Anxiety Inventory which is a valid tool for use in pregnant adults to assess the effect of intervention on maternal anxiety. Three trials including 346 women (Field 1985; Reading 1982; Zlotogorski 1996) provided data that allowed quantitative analysis with a mean difference 0.92, 95% CI -0.58 to 2.43 ( Analysis 1.1). We carried out the subgroup analysis: high feedback versus low feedback in second trimester pregnancy ultrasound. Only one trial (Field 1985), including 40 women, reported data on the effect of level of feedback during second trimester routine ultrasound scan on maternal anxiety and showed no difference between high and low feedback (mean difference 2.00, 95% CI -3.40 to 7.40).

 

Secondary outcomes

 

Health behaviour

 

Alcohol consumption

One trial (Reading 1982; 129 participants) reported the effect of the level of feedback on alcohol consumption during pregnancy. Women who had a high feedback during ultrasound were more likely to avoid alcohol during pregnancy (RR 2.96; 95% CI 1.15 to 7.60) see  Analysis 1.2.

 

Smoking

One trial (Reading 1982; 129 participants) reported the effect of the level of feedback on smoking during pregnancy. Women who had a high feedback during ultrasound were more likely to stop smoking during pregnancy (RR 2.93; 95% confidence interval (CI) 1.25 to 6.86), see  Analysis 1.3.

 

Women's views of level of feedback

Two trials (Reading 1982; Reading 1985; 148 participants) reported women's views of the level of feedback. Women in the high feedback groups were not more likely to choose very positive adjectives to describe their feelings after the scan (RR (random effects) 3.30; 95% CI 0.73 to 14.85; see  Analysis 1.4). It has to be noted that there was substantial heterogeneity among studies (I² = 88%) that could not be explained and therefore we used a random-effects meta-analysis.

 

Discussion

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

We conducted this systematic review to compare high feedback versus low feedback during prenatal ultrasound for reducing maternal state anxiety and improving maternal health behaviour. Receiving information promotes knowledge and understanding, but it may also increase state anxiety (Yee 2007).

 

Summary of main results

Four RCTs (365 women) reported the impact of level of feedback during ultrasound examination on maternal (pregnancy) state anxiety and prenatal health attitudes. There is insufficient evidence regarding what amount of feedback works better to reduce state anxiety. There was no difference between high and low feedback regarding women's views of the level of feedback. Only one small trial reported the impact of feedback level on the health attitudes of women, namely smoking cessation and alcohol consumption. Women who had high level feedback during ultrasound were more likely to stop smoking and avoid alcohol during pregnancy.

 

Overall completeness and applicability of evidence

The four included trials are not sufficient to address an important issue in our daily practice. Currently, there are no practice guidelines or consensus on the amount of information given to pregnant women and their families and who should do that, particularly in low-risk pregnancy.

 

Quality of the evidence

The results from this systematic review do not allow a robust conclusion regarding the impact of the level of feedback on maternal state anxiety. In all the included RCTs, it is unclear how randomization (both sequence generation and allocation concealment) was implemented. The sample size in all four included trials was not sufficient to address the outcomes sought. This very small number of participants in all included studies is a limitation to information.

 

Potential biases in the review process

We identified all relevant studies pertinent to the review question. However, not all outcomes of interest were reported in all included trials.

 

Agreements and disagreements with other studies or reviews

One prior report has systematically reviewed trials regarding the level of feedback during an ultrasound scan as part of a large work on women’s views of pregnancy ultrasound (Bricker 2000; Garcia 2002). This earlier review claimed that women in the high feedback groups are more likely to choose very positive adjectives to describe their feelings after the scan. We could not find evidence from the included RCTs to show an impact of the amount of information provided on maternal state anxiety and women's views of the scan.

On the other hand, we have shown that women in the high feedback group were more likely to act positively towards cessation of smoking and alcohol consumption during pregnancy. Others have not found that high feedback has an influence on smoking and other aspects of health behaviour (Bricker 2000; Garcia 2002).

 

Authors' conclusions

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

 

Implications for practice

There is insufficient evidence to support either high or low feedback during an ultrasound scan in pregnancy to have a favourable influence on maternal anxiety or health behaviour during pregnancy.

 
Implications for research

The question of the amount of information delivered to women and their families needs to be properly addressed in large, well designed and conducted RCTs. It might not be possible to conduct such studies in the majority of developed countries where there is the expectation that women are provided with high feedback during their ultrasound examinations.

Further trials are required:

  • to examine clinical and demographic factors that might independently influence anxiety in a low-risk population;
  • to examine the effect of level of feedback on positive health attitude during pregnancy.

 

Acknowledgements

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

MS Ahmed-Tawfik, who assisted AF Nabhan in developing the first draft of the protocol.

As part of the pre-publication editorial process, this review has been commented on by three peers (an editor and two referees who are external to the editorial team), a member of the Pregnancy and Childbirth Group's international panel of consumers and the Group's Statistical Adviser.

 

Data and analyses

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms
Download statistical data

 
Comparison 1. High feedback versus low feedback of routine prenatal ultrasound

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 Maternal anxiety3Mean Difference (IV, Fixed, 95% CI)Subtotals only

    1.1 Throughout pregnancy
3346Mean Difference (IV, Fixed, 95% CI)0.92 [-0.58, 2.43]

    1.2 In the second trimester
140Mean Difference (IV, Fixed, 95% CI)2.0 [-3.40, 7.40]

 2 Cessation of alcohol1129Risk Ratio (M-H, Fixed, 95% CI)2.96 [1.15, 7.60]

 3 Cessation of smoking1129Risk Ratio (M-H, Fixed, 95% CI)2.93 [1.25, 6.86]

 4 Women's views of level of feedback2148Risk Ratio (M-H, Random, 95% CI)3.30 [0.73, 14.85]

 

Appendices

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms
 

Appendix 1. Search strategies for CENTRAL, MEDLINE and mRCT

 

CENTRAL

#1 MeSH descriptor Ultrasonography, Prenatal explode all trees
#2 ultraso*
#3 pregnan* or antenatal* or prenatal* or antepart*
#4 (#2 AND #3)
#5 (#1 OR #4)
#6 feedback or anxiety or attitude* or psychol*
#7 MeSH descriptor Maternal Behavior explode all trees
#8 MeSH descriptor Mothers explode all trees with qualifier: PX
#9 (#6 OR #7 OR #8)
#10 (#5 AND #9)

 

MEDLINE

1 exp Ultrasonography, Prenatal/
2 exp Ultrasonography/
3 (pregnan$ or prenatal$ or antenatal$ or antepart$)
4 2 and 3
5 1 or 4
6 feedback.tw. or exp Feedback/ or exp Feedback, Psychological/
7 exp Mothers/px [Psychology]
8 exp Attitude/
9 6 or 7 or 8
10 9 and 5

 

mRCT

ultraso% AND pregnan%

 

History

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

Protocol first published: Issue 3, 2008
Review first published: Issue 4, 2010

 

Contributions of authors

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

AF Nabhan proposed the topic and developed the first draft of the protocol. AF Nabhan edited all the revised drafts of the protocol. Mohamed Faris reviewed and commented on the final draft protocol. Both authors contributed to analysis and interpretation of data; drafting the review and revising it critically for important intellectual content; and final approval of the version to be published.

 

Declarations of interest

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

None known.

 

Sources of support

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms
 

Internal sources

  • No sources of support supplied

 

External sources

  • Department of Obstetrics and Gynecology, Ain Shams University, Egypt.

 

Differences between protocol and review

  1. Top of page
  2. Background
  3. Objectives
  4. Methods
  5. Results
  6. Discussion
  7. Authors' conclusions
  8. Acknowledgements
  9. Data and analyses
  10. Appendices
  11. History
  12. Contributions of authors
  13. Declarations of interest
  14. Sources of support
  15. Differences between protocol and review
  16. Index terms

None.

* Indicates the major publication for the study

References

References to studies included in this review

  1. Top of page
  2. AbstractRésumé scientifiqueアブストラクト
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to studies awaiting assessment
  21. Additional references
Field 1985 {published data only}
  • Field TM, Sandberg D, Quetel TA, Garcia R, Rosario M. Effects of ultrasound feedback on pregnancy anxiety, fetal activity, and neonatal outcome. Obstetrics & Gynecology 1985;66(4):525-8.
Reading 1982 {published data only}
  • Campbell S, Reading AE, Cox DN, Sledmere CM, Mooney R, Chudleigh P, et al. Ultrasound scanning in pregnancy: the short-term psychological effects of early real-time scans. Journal of Psychosomatic Obstetrics and Gynaecology 1982;1:57-61.
  • Reading AE, Campbell S, Cox DN, Sledmere CM. Health beliefs and health care behaviour in pregnancy. Psychological Medicine 1982;12:379-83.
  • Reading AE, Cox DN. The effects of ultrasound examination on maternal anxiety levels. Journal of Behavioral Medicine 1982;5:237-47.
  • Reading AE, Cox DN, Campbell S. A controlled, prospective evaluation of the acceptability of ultrasound in prenatal care. Journal of Psychosomatic Obstetrics and Gynaecology 1988;8:191-8.
  • Reading AE, Cox DN, Sledmere CM, Campbell S. Psychological changes over the course of pregnancy: a study of attitudes towards the fetus/neonate. Health Psychology 1984;3:211-21.
  • Reading AE, Sledmere CM, Campbell S, Mooney R, Cox D, Chudleigh P, et al. The psychological effects on the mother of real-time ultrasound in antenatal clinics [abstract]. British Journal of Radiology 1981;54(642):546.
Reading 1985 {published data only}
Zlotogorski 1996 {published data only}

References to studies excluded from this review

  1. Top of page
  2. AbstractRésumé scientifiqueアブストラクト
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to studies awaiting assessment
  21. Additional references
Boukydis 2006 {published data only}
  • Boukydis CF, Treadwell MC, Delaney-Black V, Boyes K, King M, Robinson T, et al. Women's responses to ultrasound examinations during routine screens in an obstetric clinic. Journal of Ultrasound in Medicine 2006;25(6):721-8.
Cox 1987 {published data only}
Salkovskis 2001 {published data only}
  • Salkovskis P. Reactions to prenatal screening. Current Controlled Trials (www.controlled-trials.com) (accessed 12 June 2002).

Additional references

  1. Top of page
  2. AbstractRésumé scientifiqueアブストラクト
  3. Background
  4. Objectives
  5. Methods
  6. Results
  7. Discussion
  8. Authors' conclusions
  9. Acknowledgements
  10. Data and analyses
  11. Appendices
  12. History
  13. Contributions of authors
  14. Declarations of interest
  15. Sources of support
  16. Differences between protocol and review
  17. Characteristics of studies
  18. References to studies included in this review
  19. References to studies excluded from this review
  20. References to studies awaiting assessment
  21. Additional references
Beck 1988
  • Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology. 1988/12/01 1988; Vol. 56, issue 6:893-7.
Bricker 2000
  • Bricker L, Garcia J, Henderson J, Mugford M, Neilson J, Roberts T, et al. Ultrasound screening in pregnancy: a systematic review of the clinical effectiveness, cost-effectiveness and women's views. Health Technology Assessment (Winchester, England) 2000;4(16):i-vi, 1-193.
Crandon 1979
  • Crandon AJ. Maternal anxiety and neonatal wellbeing. Journal of Psychosomatic Research. 1979/01/01 1979; Vol. 23, issue 2:113-5. [0022-3999: (Print)]
Deeks 2001
  • Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG editor(s). Systematic reviews in health care: meta-analysis in context. London: BMJ Books, 2001.
Endler 2001
Garcia 2002
Gotzmann 2001
  • Gotzmann L, Romann C, Schonholzer SM, Klaghofer R, Zimmermann R, Buddeberg C. Communication competence in ultrasound examination in pregnancy. Gynakologisch-Geburtshilfliche Rundschau 2001;41(4):215-22.
Gudex 2006
Harris 2004
Higgins 2008
  • Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.1 [updated September 2008]. The Cochrane Collaboration, 2008. Available from www.cochrane-handbook.org.
Hoskovec 2008
  • Hoskovec J, Mastrobattista JM, Johnston D, Kerrigan A, Robbins-Furman P, Wicklund CA. Anxiety and prenatal testing: do women with soft ultrasound findings have increased anxiety compared to women with other indications for testing?. Prenatal Diagnosis. 2008/02/01 2008; Vol. 28, issue 2:135-40. [0197-3851: (Print)]
Jahn 2002
  • Jahn A. Ultrasound screening in pregnancy: evidence and maternity care reality. Zeitschrift für ärztliche Fortbildung und Qualitätssicherung 2002;96(10):649-54.
Janus 1980
  • Janus C, Janus S. Ultrasound: patients' views. Journal of Clinical Ultrasound. 1980/02/01 1980; Vol. 8, issue 1:17-20. [0091-2751: (Print)]
Lalor 2006
Lobel 2008
  • Lobel M, Cannella DL, Graham JE, DeVincent C, Schneider J, Meyer BA. Pregnancy-specific stress, prenatal health behaviors, and birth outcomes. Health Psychology 2008;27(5):604-15.
Petersen 2008
  • Petersen J, Jahn A. Suspicious findings in antenatal care and their implications from the mothers' perspective: a prospective study in Germany. Birth. 2008/03/01 2008; Vol. 35, issue 1:41-9. [1523-536X: (Electronic)]
Reading 1982
RevMan 2008
  • The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.0.17. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
Sen 2003
  • Sen C, Yayla M, Levene M. Antalya consensus on perinatal care: the report of the 2nd World Congress of Perinatal Medicine for Developing Countries. Journal of Perinatal Medicine 2003;31(5):361-72.
Sjöström 2002
Spielberger 1983
  • Spielberger CD. Manual for the state/trait anxiety inventory (form Y): (self evaluation questionnaire). Palo Alto: Consulting Psychologists Press, 1983.
Teixeira 1999
Yee 2007
  • Yee WH, Sauve R. What information do parents want from the antenatal consultation?. Paediatrics & Child Health 2007;12(3):191-6. [PUBMED: 19030358]
Zlotogorski 1995
  • Zlotogorski Z, Tadmor O, Duniec E, Rabinowitz R, Diamant Y. Anxiety levels of pregnant women during ultrasound examination: coping styles, amount of feedback and learned resourcefulness. Ultrasound in Obstetrics & Gynecology 1995;6(6):425-9.