Parents' expectations, experiences and reactions to a routine ultrasound examination during pregnancy

Abstract: The overall aim of this thesis was to describe parents’ expectations, experiences and reactions to a routine ultrasound examination during the second trimester of pregnancy and to develop, test and use a questionnaire. The aim was also to conceptualize the parents’ experiences and ways of handling the situation when the diagnosis was a non-viable fetus. The data for this thesis was collected between 2001 and 2007. The work started qualitatively and inductively with interviews using the Grounded Theory method for data collection and analysis of 22 women’s and 22 men’s expectations experiences and reactions to routine ultrasound examination with normal findings. The results were used during the instrument development of the PEER-U questionnaire. The procedure included a pilot study where 126 parents answered both parts of the questionnaire. Factor analysis and statistical tests for validity and reliability were performed. The PEER-U questionnaire was then used for deductive testing of the results of the qualitative study with a one year cohort in which 2183 parents (1258 women and 925 men) answered both parts of a two-part (before and after ultrasound) questionnaire. The questionnaire included the PEER-U scale with an ultrasound specific state of mind index and the scales state and trait anxiety (STAI) and sense of coherence (SOC) as well as demographics. A follow-up Grounded Theory interview study was performed with 15 parents from the cohort who had been given a diagnosis of a non-viable fetus. The results from the qualitative parts showed that the parents expected to get a confirmation of a normal and apparently healthy child during the ultrasound. For parents with normal results, the ultrasound was experienced as very positive and they started to feel like a family. Afterwards these parents were left with a feeling of relief. Parents who received the diagnosis of a non-viable fetus experienced a collision between hopes and facts. They felt deceived by a false sense of security as the condition was unexpectedly discovered during a routine examination. These parents required clear information and focused on what would happen next. The need for a general and individual care plan was evident as was the need for a follow-up initiated by the care-givers. The development of the PEER-U questionnaire resulted in 30 items to measure parents’ expectations and 23 items to measure their experiences and reactions. Internal consistency, calculated by Cronbach’s coefficient alpha, was 0.77 for the “before ultrasound” part of the PEER-U questionnaire and 0.75 for the “after ultrasound” part. The results from the cohort study showed that both parents’ degree of worried state of mind decreased after the ultrasound but their sense of coherence remained stable. In a gender comparison the women’s state anxiety decreased significantly while the men showed no significant change. Before the examination the women showed a significantly higher degree of worried state of mind in relation to ultrasound than the men while afterwards the situation was reversed. The findings show that parents easily accept fetal diagnosis that gives them a visual evidence of the fetus. This should be remembered when new forms of fetal diagnosis are introduced in the future. Their state of mind in relation to ultrasound can be measured with the ultrasound specific state of mind index. Further research might improve the questionnaire and make it better adapted for use when the parents have experienced adverse findings during a routine ultrasound examination.