The use of routine ultrasound in pregnancy : with special reference to normal and abnormal foetal growth, information and informed choice and the womens' experiences of the prenatal diagnostic aspects

Sammanfattning: The development of real-time ultrasound in the 1970's made indelible inpact on antenatal care. Assessing foetal growth and detecting deviations from normal in both growth and foetal anatomy became fesible. Expectant parents could also 'see' their foetus. Normal foetal growth parameters at term were consituted and selected parameters from the second trimester were evaluated in the detection of chromosome abnormalities. It became necessary to study the level of apprehension caused by an ultrasound examination, information recalled about option and that deviations from normal could found. This in turn led to more parental involvement in the choice of method for prenatal diagnosis. The results show that foetal size increased at the same rate in the post-term period and that BDD/FL graphs in the second trimester did not help in the detecting Down Syndrome. Information about option and malformations was difficult to recall. When informed choice was made an ultrasound investigation was not refused, but 1%(p=0.0003) of women < 35 years of age chose an early examination without anatomical assessment. Requests for amniocentesis increased by 6%(P=<0.0001) in this age group. Decision making about prenatal diagnosis was generally very easy. Difficulty was mainly felt concerning aspects of amniocentesis. Satisfaction with choice was high (98.8%). Higher education and work within the health proffesiona/occupations influenced requests for amniocentesis. Maternal serum screening for Down Syndrome was cosidered an acceptable addition to ultrasound but not a first alternative to amniocentesis. Given objective information about methods for prenatal diagnosis women can handle choice but can need support in difficult situations.