Acute maternal social dysfunction, health perception and psychological distress after ultrasonographic detection of a fetal structural anomaly

Authors


A Kaasen, Department of Obstetrics, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway. Email a.kaasen@online.no

Abstract

Please cite this paper as: Kaasen A, Helbig A, Malt U, Næs T, Skari H, Haugen G. Acute maternal social dysfunction, health perception and psychological distress after ultrasonographic detection of a fetal structural anomaly. BJOG 2010;117:1127–1138.

Objectives  To predict acute psychological distress in pregnant women following detection of a fetal structural anomaly by ultrasonography, and to relate these findings to a comparison group.

Design  A prospective, observational study.

Setting  Tertiary referral centre for fetal medicine.

Population  One hundred and eighty pregnant women with a fetal structural anomaly detected by ultrasound (study group) and 111 with normal ultrasound findings (comparison group) were included within a week following sonographic examination after gestational age 12 weeks (inclusion period: May 2006 to February 2009).

Methods  Social dysfunction and health perception were assessed by the corresponding subscales of the General Health Questionnaire (GHQ-28). Psychological distress was assessed using the Impact of Events Scale (IES-22), Edinburgh Postnatal Depression Scale (EPDS) and the anxiety and depression subscales of the GHQ-28. Fetal anomalies were classified according to severity and diagnostic or prognostic ambiguity at the time of assessment.

Main outcome measures  Social dysfunction, health perception and psychological distress (intrusion, avoidance, arousal, anxiety, depression).

Results  The least severe anomalies with no diagnostic or prognostic ambiguity induced the lowest levels of IES intrusive distress (P = 0.025). Women included after 22 weeks of gestation (24%) reported significantly higher GHQ distress than women included earlier in pregnancy (P = 0.003). The study group had significantly higher levels of psychosocial distress than the comparison group on all psychometric endpoints.

Conclusions  Psychological distress was predicted by gestational age at the time of assessment, severity of the fetal anomaly, and ambiguity concerning diagnosis or prognosis.

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