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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)

 
Characteristics of included studies [ordered by study ID]
Field 1985

MethodsWomen were randomly assigned to either a feedback or no feedback group.


Participants40 pregnant women who were referred for ultrasound assessment of gestational age. They did not differ in background characteristics including age, education, socioeconomic status or ethnicity. Half of the sample was primiparous.


InterventionsWomen assigned to feedback group could see the monitor and were given a running description of the fetal anatomy, measurements and movements. In the no feedback group, women could not see the monitor and they were given only a summary statement of the scan.


OutcomesMaternal anxiety using the Spielberger STAI, fetal movement, maternal sleep behavior, neonatal behavior, neonatal activity level and birthweight.


NotesUSA.


Risk of bias

ItemAuthors' judgementDescription

Adequate sequence generation?UnclearThe study does not include any description of sequence generation.

Allocation concealment?UnclearThe study does not include any description of allocation concealment.

Blinding?
All outcomes
UnclearThe study does not indicate if outcome assessors were blind to allocation

Incomplete outcome data addressed?
All outcomes
Yes

Free of selective reporting?Yes

Free of other bias?Yes

Reading 1982

MethodsWomen were randomly assigned at their first clinical visit (10-14 weeks) to either a high feedback (number = 67) or low feedback (number = 62) groups. Women were asked to complete the STAI before and after the scan. They were also asked to rate their attitude toward receiving a scan and to describe the emotional state at the time by selecting the most appropriate word from the Subjective Stress Scale.


ParticipantsA consecutive series of primiparous Caucasian women fulfilling the selection criteria of obstetrically "low risk" and attending King's College hospital antenatal booking clinics, were studied. Mothers with a history of previous miscarriages or having undergone extended (more than 2 months) infertility treatment were excluded, along with those identified by accredited criteria as being at risk of congenital malformation.


InterventionsWomen assigned to high feedback group could see the monitor and were given standardized visual and verbal feedback as to fetal size, shape and movement. In the low feedback group, women could not see the monitor and were not given specific visual or verbal feedback. They only received a global evaluation of the form "all is well". The examination was of comparable duration and the operator interacted in a similarly reassuring pattern as with high feedback women.


OutcomesSTAI score

Maternal rating of feelings towards being pregnant and towards the fetus

Attitude toward receiving a scan and the emotional state at the time

Cessation of alcohol

Cessation of smoking


NotesUK


Risk of bias

ItemAuthors' judgementDescription

Adequate sequence generation?UnclearThe study does not include any description of sequence generation.

Allocation concealment?UnclearThe study does not include any description of allocation concealment.

Blinding?
All outcomes
UnclearThe study does not indicate if outcome assessors were blind to allocation.

Incomplete outcome data addressed?
All outcomes
Yes

Free of selective reporting?Yes

Free of other bias?Yes

Reading 1985

MethodsThe women were assigned at random to one of four conditions: (1) high-feedback ultrasonography (number = 11), (2) low-feedback ultrasonography (number = 8), fetal monitoring (number = 11), and video control (number = 7). All women were informed that they would be taking part in a study of attitudes towards ultrasonography. None of the women approached refused to participate, and all signed informed consent forms. Before and after the procedure the women completed the state scale of the STAI. Immediately following the procedure the women were asked to select the word best describing their emotional state then from the Subjective Stress Scale, which consists of a series of adjectives describing such states.


ParticipantsA consecutive series of women attending the USC/LAC Women's hospital prenatal clinic for ultrasonography was studied.


InterventionsWomen assigned to high feedback group (number = 11) could see the monitor during their real time examination and a nurse pointed out the features visualized. In the low feedback group (number = 8), women could not see the monitor and so received only global feedback, in the form of "all appears to be well".


Outcomes1. STAI scores

2. Emotional state following the procedure


NotesUK


Risk of bias

ItemAuthors' judgementDescription

Adequate sequence generation?UnclearThe study does not include any description of sequence generation.

Allocation concealment?UnclearThe study does not include any description of allocation concealment.

Blinding?
All outcomes
UnclearThe study does not indicate if outcome assessors were blind to allocation.

Incomplete outcome data addressed?
All outcomes
Yes

Free of selective reporting?Yes

Free of other bias?Yes

Zlotogorski 1996

MethodsSubjects were randomly assigned to one of two feedback conditions, high feedback and low feedback during an ultrasound examination. All subjects completed the STAI before and after the ultrasound examination.


ParticipantsThe subjects for the study were 211 pregnant women (4 to 41 weeks' gestation) who underwent an ultrasound examination. Three subjects with findings of congenital fetal malformations or other pathological findings were excluded. In addition, 10 subjects who dropped out at different stages of the study and 15 subjects who failed to complete the questionnaires were also excluded. The final sample of 182 women was reported in the results.


InterventionsWomen assigned to high feedback group were shown the monitor screen and were given a standardized visual and verbal feedback of fetal heart, head and limbs. Finally printed pictures of what was seen on the monitor were handed to the subjects by the staff. In the low feedback group, women were not able to see the monitor and the doctor limited himself to providing standardized verbal feedback: "head ... normal, heart ... normal, limbs ... normal, everything ... normal". Printed pictures were not handed to the subjects.


OutcomesMaternal STAI scores.


NotesIsrael


Risk of bias

ItemAuthors' judgementDescription

Adequate sequence generation?UnclearThe study does not include any description of sequence generation.

Allocation concealment?UnclearThe study does not include any description of allocation concealment.

Blinding?
All outcomes
UnclearThe study does not indicate if outcome assessors were blind to allocation.

Incomplete outcome data addressed?
All outcomes
Unclear211 women were the subjects recruited (3 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 reported in the results. For the state anxiety scores, data from 177 participants were recorded. The trial did not account for the missing 5 participants.

Free of selective reporting?Yes

Free of other bias?Yes

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Boukydis 2006This RCT did not compare high and low feedback during an ultrasound scan.

Cox 1987Women were consecutively assigned to either a low feedback or a high feedback during ultrasound scan.

Salkovskis 2001This RCT did not compare high and low feedback during a routine ultrasound scan.

 
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]