Effects of Ultrasound on maternal-fetal bonding: 2D vs. 3D

Objectives: To compare the effects of 2D ultrasound vs. 3D ultrasound imaging on the maternal-fetal bonding process.

Results: A randomized sampling of data was preformed to equalize cells for some study questions. Mothers who received 3D ultrasound shared their ultrasound photographs with significantly more number of people (mean, 31.72) than did mother receiving 2D ultrasound (mean, 16.02). Subjects screened with 3D ultrasound had a greater tendency to form a mental image of the baby post-screening (82%) than 2D ultrasound subjects (39%). The 3D ultrasound parents were more likely to receive comments on similarities/differences with the actual baby than parents having 2D ultrasound studies. Further, 70% of the mothers receiving 3D ultrasound felt they knew the baby right after birth because of the images they saw compared to only 56% of 2D ultrasound moms.

Conclusion: The 3D ultrasound images appears to have a more positive influence on the perception of mothers compared to 2D ultrasound images. Specifically, mother who had 3D ultrasound showed their images to twice as many people as those having 2D ultrasound studies. 3D ultrasound may have the potential benefit to strengthen the support system for families expecting their newborns.

D.H. Pretorius, K.M. Uyan, R. Neton A. Hull, G. James & T. Nelson. 11th World Congress on Ultrasound in Obstetrics and Gynecology. 12-28 October 2001. Melbourne, Australia.

Maternal Smoking Habit Modification Via Fetal Visualization

The objective of this work is to reduce rates of maternal smoking, leading to consequent improvement in fetal well-being, neonatal development and maternal health. The consequences of maternal smoking pose long-term as well as immediate hazards to the developing fetus. Fortunately, most pregnant women have some degree of interaction with the health-care system during their pregnancy which offers the opportunity to incorporate smoking cessation assistance in their care.

In our study, we are evaluating the elect of fetal viewing from conventional 2D ultrasound imaging and new 3D imaging combined with smoking cessation assistance and comparing them to a control group of patients who do not undergo ultrasound examinations.

We are assessing the maternal smoking cessation motivational levels as well as actual decreases in smoking in women who have an opportunity for increased fetal-maternal bonding resulting from viewing their developing fetuses. To date, we have observed that mothers are very interested in ultrasound studies of their fetuses be it 2D or 3D imaging studies. Patients who undergo ultrasound studies have been given a videotape showing their fetus inside the uterus. Typically, images of the fetal face, heart, spine, stomach hands, feet and genitals are recorded for the mother. We have patients enrolled in all three study groups identified in our original proposal but due to the length of pregnancy and follow up time we are unable to make any conclusions regarding our data to date.

The implications of this work is significant in attempting to improve fetal neonatal and maternal health. The economic costs to society, both human and medical, for both the child and the mother are immense. Fetal complications of maternal smoking include increased mortality, prematurity, placental previa and abruption, 1ow birth weight, spontaneous abortion, learning deficits, impaired cognitive development and congenital abnormalities. Pregnancy offers a great opportunity to influence women to stop smoking for their own benefit as well as their child's.

Dolores H. Pretorius, Maternal smoking habit modification via fetal visualization. University of California tobacco related disease research program. Annual report to the California State Legislature. 1996: 76

Psychological effects of ultrasound examinations: changes of body perception and child image in pregnancy

Ultrasound scanning is known to have psychological effects due to its vivid imagery. In a prospective study on 60 healthy gravidae in midtrimester pregnancy, the impact of a single scan upon child image and body perception was evaluated. Seven-point numerical scales were filled in by the women before and after ultrasound and high feedback of the screen image was given during the scan. Medical and socio-economic information was collected in an interview.

Child image changed considerably towards a brisker, more active and more familiar view; for body image, an increase in reassurance could be observed. Parity and partner status had an influence on the experience of the scan. Primiparae without partners and women with pregnancy complaints could benefit by the scan in certain aspects of their body perception.

Implications of these finding for early mother-infant bonding, abortion and daily clinical practice are discussed.

Langer M, Ringler M. & Reinold E. Psychological effect's of ultrasound examinations: Changes on body perception and child image in pregnancy. J. Psychosom Obstet Gynaecol, 1988, 199-208.

The Psychological Impact of Diagnostic Ultrasound

The psychological impact of ultrasound scanning in pregnancy was examined in low- and high-risk pregnancies. Women in each category were assigned consecutively to a condition of either 1ow or high feedback. For high feedback, the women received extensive verbal and visual feedback, whereas in the low feedback, subjects were denied visual access to the monitor. Psychological changes were measured using the State Anxiety Inventory and the Subjective Stress Scale. When a male partner attended, he was included in the assessment. The emotional impact of ultrasound was influenced by the level of feedback provided, with those in the high-feedback condition indicating significantly less anxiety and more positive emotional experiences during the scan, compared with those who received less feedback.

DN Cox, BK Wittmann, M Hess, AG Ross, J Lind, and S Lindahl. The psychological impact of Diagnostic Ultrasound. Obstet Gynecol 1987; Vo1 70 (5): 673-676.

Psychological Reactions to Ultrasound Examinations during Pregnancy

Twenty women underwent ultrasound examination three times during low-risk pregnancy. Before and after the ultrasonography, the Symptom Questionnaire was applied to evaluate changes in psychological distress. Anxiety, depression, somatic symptoms, and hostility significantly decreased after patients received video and verbal feedback during the first ultrasound examination. Such changes were consistently observed also during the subsequent two examinations.

Michelacci L et al. Psychological Reactions to Ultrasound Examination during Pregnancy. Psychother Psychosom 1998, Vo1 50, pp. 1-4.

The Impact of Fetus Visualization on Parents' Psychological Reactions

The intention of this study was to examine the short-term psychological effects on parents fetal visualization, if any, from ultrasound scanning. The starting hypothesis was that after visualizing the fetus, parents experience a lower level of stress and anxiety. To test that hypothesis, a quasiexperimental/control type of study was conducted. The subjects, all parents (N=296) were divided into two groups: an experimental high-feedback group that watched the ultrasound screen, and a low-feedback control group that could not see a screen. Each group had two subgroups; risk pregnancy and no-risk pregnancy. To test the level of anxiety and stress, a number of scales were administered. The results confirm the positive effect of screening. Stress and anxiety levels were reduced. Statistically significant differences between the groups are found. Additional analysis in this area should be pursued.

Kovacevic, Melita. Impact of Fetus Visualization on Parents' Psychological Reactions. Per- and Perinatal Psychology Journal, Vol. 8 (2), 1993, 83-94.

The importance of ultrasound to first-time mothers thoughts about their unborn child.

The aim of this study was to evaluate the importance of ultrasound to women's thoughts about their unborn child. Ten primigravidae were interviewed approximately 1 week before and 1 week after their first ultrasound screening. Analysis of the interviews was conducted using the techniques of grounded theory. The results showed that ultrasound was of great importance for increasing the women's awareness of bearing a child. This realization process was expressed in various categories of thoughts about the unborn child: (1) the existing fetus, (2) the coming child, (3) the woman's life situation, (4) parenthood and (5) delivery. The paper examines the way in which ultrasound influences these categories of thought.

K. Dykes, K. Stjernqvist. The importance of ultrasound to first-time mothers thoughts about their unborn child. Journal of Reproductive and Infant Psychology, Vol. 19 (2), 95-104.

Maternal Stress and Fetal Motor Behavior: A Preliminary Report

Fetal motility was observed by ultrasound scan in 15 pregnant women awaiting amniocentesis in order to assess the effects of maternal stress on fetal motor behavior. Amniocentesis was considered a stress situation giving rise to maternal anxiety not artificially induced. The control group consisted of 15 pregnant women undergoing routine ultrasound examination. Fetal motor activity was assessed in terms of quantity and quality. Anxiety was measured using the State-Trait Anxiety Inventory (STAI). Fetuses showed a significantly higher motor activity, although qualitative differences did not appear in the experimental group. Anxiety score was also higher than in the controls.

Nicola Rossi, Paola Avveduti, Nicola Rizzo and Raffaele Lorusso. Maternal Stress and Fetal Motor Behavior: A Preliminary Report. Per and Peri-Natal Psychology Joumal Vol. 3 (4), 1989, 311-318.

Short-Term Impact of Fetal Imaging on Paternal Stress and Anxiety

This study compared the stress and anxiety responses of expectant fathers attending a routine visit with their partners who saw ultrasound imaging of their unborn child with those of fathers also attending a routine office visit with their partners who did not view ultrasound imaging of the fetus. Fathers were given the State-Trait Anxiety Inventory and the Subjective Stress Scale in addition to a demographic questionnaire and the Paternal Attitudes towards Pregnancy Inventory prior to the examination. The anxiety and stress measures were readministered after the examination. Anxiety measures showed no significant differences between experimental and control groups, but fathers who saw fetal imaging did experience significant reductions in stress.

Gary F. Brown. Short-Term Impact of Fetal Imaging on Paternal Stress and Anxiety. Per and Peri-Natal Psychology Joumal, 1988, Vol. 3, pp. 24-40.

The Influence of Maternal Emotions during Pregnancy on Fetal and Neonatal Behavior

This study was designed to examine: 1) whether the influence of maternal emotions on fetal behavior could be established using real-time ultrasound echography and cardiography; and 2) whether the prenatal influence was reflected in neonatal behavior. In a longitudinal study of 30 women out of a larger group of 70 nulliparous women revealed that maternal state anxiety during echographic recording was significantly correlated with fetal behavior. Moreover, fetal behavior was sensitive to the influence of material chronic anxiety during pregnancy. Results on the subgroup of 30 women and their babies suggest a certain degree of continuity between fetal and neonatal movement patterns, and further indicate that the prenatal influence is reflected in neonatal behavior.

B. R. H. Van den Bergh. The Influence of Maternal Emotions during Pregnancy on Fetal and Neonatal Behavior. Per and Peri-Natal Psychology Journal, Vol. 5 (2), 1990, 119-130.

Three-Dimensional Ultrasound Experience in Obstetrics

PURPOSE OF REVIEW: Three-dimensional (3D) ultrasound is a natural development of the imaging technology. Fast computers are essential to enable 3D and four-dimensional (4D) ultrasound pictures. A short review of the technical points and clinical aspects is presented. Our purpose is to acquaint the reader with the possibilities of this new technology and to increase awareness of its present clinical usefulness. A short review of technical information is provided. RECENT FINDINGS: The advantages of 3D and 4D ultrasound in certain areas are unequivocal. Its use in the workup of fetal anomalies involving the face, limbs, thorax, spine and the central nervous system are already applied by most centers. The use of this technology in applying color Doppler, in guiding needles for different puncture procedures as well in evaluating the fetal heart are under close research scrutiny. The bonding effect between the parents and their future offspring is becoming evident as 3D ultrasound is used. Consulting specialists understand fetal pathology better and can better plan postnatal interventions. 4D or real time 3D ultrasound was developed and is expected to achieve new meaning with the planned introduction of electronic transducer multilinear arrays. SUMMARY: 3D ultrasound is an extremely promising imaging tool to image the fetus. In spite of the scant outcome studies the potential of 3D ultrasound is understood by a large number of obstetricians, maternal fetal specialists and imaging specialists.

IE Timor-Tritsch and LD Platt. Three-Dimensional Ultrasound Experience in Obstetrics. Department of Obstetrics and Gynecology, New York University School of Medicine.

An interview study of pregnant women's attitudes to ultrasound scanning

404 pregnant women were interviewed, in the ante-natal clinics of two hospitals, concerning their attitudes to ultrasound scanning, which is routine at one of these hospitals, selective at the other. It was found at the hospital where scanning is selective, that women who had not been examined by ultrasound were less likely to regard a scan as an additional source of reassurance, and to approve of routine scanning, than were those who had yet to be scanned at the other hospital, or any of those who had experienced the procedure. A majority of the women interviewed were enthusiastic about the method, but an important source of dissatisfaction was failure of the operator to reveal and/or explain the foetal image.

B. Hyde. An interview study of pregnant women's attitudes to ultrasound scanning. Soc Sci Med. 1986,.22(5):587-592

Psychological Aspects of Ultrasound Imaging During Pregnancy

The psychological impact of ultrasound examination on expectant parents is assessed through direct observation, interviews and the administration of a questionnaire to a large group of parents. The examination was a positive and reassuring experience for most parents. Among a wide array of variables that could account for the effects of the exam, the results were the most important. Women viewing their first ultrasound, especially primiparae were more moved. The results did not confirm that there is a traumatic effect when viewing precedes quickening. Contrary to previous reports, fathers were as emotionally involved as the mothers. The presence of the father seemed also to have a beneficial effect on the mother. One-half of parents wanted to know the sex of the fetus before birth. These findings are discussed, along with implications for problems arising from introduction of new technologies during pregnancy.

Villeneuve C, Laroche C, Lippman A, Marrache M. Psychological Aspects of Ultrasound Imaging During Pregnancy. Can J Psychiatry 1988; 33:530-536.

Effects of routine one-stage ultrasound screening in pregnancy: a randomised controlled trial

4997 of 7354 pregnant women had no clinical indication for an elective ultrasound examination at 12 weeks' gestation. 2482 of these women were randomly selected for ultrasound screening at 15 weeks and the remainder received the same standard antenatal care without the scan. Labor was less often induced among screened women both for all reasons (5.9% vs. 9.1%, p less than 0.0001) and for suspected post-term pregnancy (1.7% vs. 3.7%, p less than 0.0001). Earlier detection of twins had no effect on neonatal outcome. Among babies born to screened women, fewer were of birth weight less than 2500 g (59 vs. 95, p = 0.005) and mean birth weight was 42 g higher (p 0.008). For babies born to screened women who smoked it was 75 g higher (p 0.012) and for those of non-smokers 26 g (not significant). The reason for the differences in mean birth weight could be that screened women reduced smoking in response to watching their fetus on the scan.

Waldenstrom U, Axelsson O, Nilsson S, Eklund G, Fall O, Lindeberg S, Sjodin Y. Effects of routine one-stage ultrasound screening in pregnancy: a randomized controlled trial. Lancet. 1988 Sep 10,.2(8611):585-8.

A controlled. prospective evaluation of the acceptability of ultrasound in prenatal care

The psychological reactions of primiparae to the routine use of ultrasound in prenatal care was studied. Women attending between 10 and 14 weeks menstrual age were assigned at random to 2 conditions of real time ultrasound: (a) high feedback (n=67) in which the monitor screen was visible and feedback as to fetal size, shape and movement was provided; (b) 1ow feedback (b=62) in which specific feedback via the monitor screen was denied. Assessments were completed pre and post this examination and at 16 and 32 weeks biphasic scans and following delivery. Women in the high feedback condition showed a uniformly more positive response to the initial real time scan and were more likely following the delivery to nominate this as the most important scan. The implications of providing feedback of this kind are discussed.

Reading AE, Cox DN, Campbell S. A controlled, prospective evaluation of the acceptability of ultrasound in prenatal care. J Psychosom Obstet Gynaecol 1988, 8: 191-8

Effects of ultrasound feedback on pregnancy anxiety, fetal activity, and neonatal outcome

A group of pregnant women received video and verbal feedback during three ultrasound examinations. This group was compared with a no-feedback group on measures of pregnancy anxiety, fetal activity, and neonatal outcome. The feedback appeared to reduce pregnancy anxiety and fetal activity, particularly for the primiparous women. These women also experienced fewer obstetric complications and gave birth to neonates who were greater weight, more appropriate weight-for-length, less active and irritable, and showed better performance on the Brazelton neonatal behavior assessment.

T Field, D Sandberg, TA Qudel, R Garciw and M Rosario. Effects of ultrasound feedback on pregnancy anxiety, fetal activity, and neonatal outcome. Obstetrics & Gynecology, 1985,. 4: 525-528.

Seeing the Baby: The Impact of Ultrasound Technology

This paper reports results of a study of prenatal diagnosis patients who underwent ultrasound examinations and lost their pregnancies through miscarriage or elective terminations. The majority of the women felt that viewing the ultrasound image influenced their relationship to the fetus and their coping with the pregnancy loss. The women commented on the power of ultrasound to make their pregnancies more real as well as painful, yet sometimes beneficial consequences of seeing the fetus. Clinical implications are considered for health professionals who provide prenatal diagnostic services or counseling after pregnancy loss.

Black RB. Seeing the Baby: The Impact of Ultrasound Technology. Journal of Genetic Counselling 1(1): 45-54, 1992.