Midwives' attitudes to and knowledge about a newly introduced foetal screening method.

A number of screening procedures are offered by midwives during pregnancy and the number is increasing rapidly. The measurement of nuchal translucency is a fairly new ultrasound method for antenatal screening, primarily for Down syndrome. The results give a better risk calculation than maternal age alone and can mean a decrease in the number of invasive procedures needed to identify this syndrome prenatally. The aim of this study was to gain insight into the midwives' point of view concerning the introduction of the method in two different hospitals. In one hospital it had been introduced as part of a research project while in the other it had been integrated as an offer in the antenatal care programme. A questionnaire was sent to the 80 midwives working in the antenatal clinics serving these two hospitals. A total of 79% of the questionnaires were answered. The results indicate that in both districts, the similarities are greater than the differences with regard to the midwives' education, knowledge and their own opinions of their ability to inform pregnant women about the method. Although most of the respondents were positive to it, a number of midwives felt that, in general, information about foetal diagnosis was a difficult part of their work, mentioning both ethical and practical aspects. This highlights the need for continuing education, standardized policy and an ongoing ethical debate

A qualitative study of mothers' and fathers' experiences of routine ultrasound examination in Sweden.

Objective: to conceptualise mothers’ and fathers’ thoughts and feelings before, during and after the routine ultrasound examination during the second trimester of pregnancy. Design, setting and participants: a grounded theory study. Two to four weeks after their ultrasound examination, 22 Swedish mothers and 22 fathers were interviewed in their homes. Findings: the basic social process was confirmation of a new life. The four categories, visualising—the evident option, overwhelming to see life; becoming a family and reassuring, all represent a time span in the parents’ process towards confirmation of a new life. The caregivers’ way of assisting and supporting the process by information and treatment was very important to parents. Key conclusions and implications for practice: as the ultrasound examination is perceived as a confirmation of a new life it is an extremely important milestone for both parents so the father should be encouraged to participate. It is an important and unique event for both women and men in their process towards becoming parents. This process was largely dependent on the treatment the parents had received during the examination and the information given. The findings of this study are of interest to midwives and others who perform ultrasound examinations as it explains why adequate time must be allowed for the examination and the importance of the information given before hand. When introducing new forms of fetal diagnosis in the future it should be kept in mind that this might irrevocably be accepted by parents who long for confirmation of a new life

Parents' experiences of an abnormal ultrasound examination - vacillating between emotional confusion and sense of reality

<p>Abstract</p> <p>Background</p> <p>An ultrasound examination is an important confirmation of the pregnancy and is accepted without reflection to any prenatal diagnostic aspects. An abnormal finding often comes unexpectedly and is a shock for the parents. The aim was to generate a theoretical understanding of parents' experiences of the situation when their fetus is found to have an abnormality at a routine ultrasound examination.</p> <p>Methods</p> <p>Sixteen parents, mothers and fathers, whose fetus had been diagnosed with an abnormality during an ultrasound scan in the second or third trimester, were interviewed. The study employed a grounded theory approach.</p> <p>Results</p> <p>The core category <it>vacillating between the emotional confusion and sense of reality </it>is related to the main concern <it>assessment of the diagnosis impact on the well-being of the fetus</it>. Two other categories <it>Entering uncertainty </it>and <it>Involved in an ongoing change and adaptation </it>have each five sub-categories.</p> <p>Conclusions</p> <p>Parents are aware of that ultrasound examination is a tool for identifying abnormalities prenatally. The information about the abnormality initially results in broken expectations and anxiety. Parents become involved in ongoing change and adaptation. They need information about the ultrasound findings and the treatment without prolonged delay and in a suitable environment. The examiner who performs the ultrasound examination must be aware of how anxiety can be intensified by environmental factors. All parents should to be offered a professional person to give them <it>s</it>upport as a part of the routine management of this situation.</p

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

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

Applying the Case Method for Teaching within the Health Professions - Teaching the Students.

Context: When using the Case Method in teaching situations, problem-solving is emphasized and taught, in order to acquire the skills and later be able to apply them in new situations. The basis of the learning process is the students’ own activity in the situation and is built on critical appraisal and discussion. Objectives: To explain what the Case Method is, what it is not and to describe when and where to use the Case Method. The objective is also to describe how to write a ‘case’, how to lead a ‘case’ discussion and how to deal with problems. Why one should use the Case Method is also highlighted. Application The case used should be founded on a real life situation, containing a problem that must be handled. The structure and use of the white board plays a central part. It is important that the setting allows the teacher to interact with all the students. Groups of up to 30 students can be handled with ease, though larger groups are feasible in the right physical setting. Within the health professions, the Case Method can be used at all levels of training and to a certain extent the same case can be used - the depth with which it is addressed depends on the student’s prior knowledge. Different professions and specialists can take part. A whole curriculum can be built up around the Case Method, but more often it is used together with other pedagogic methods. Conclusion: The Case Method is a well-structured, student-activating way of teaching, well-suited to hone problem-solving skills within health education programmes

Normal ultrasonic fetal growth ratios evaluated in cases of fetal disproportion

During a 2-year period, 5476 normal routine obstetrical ultrasound investigations were performed in the 2nd trimester (16th to 20th week). Data on biparietal diameter (BPD), abdominal diameter (AD) and femur length (FL) have been obtained from this material. Ratios between BPD/AD and BPD/FL have been calculated, and from these ratios, graphs were constructed. Only nine normal fetuses (0.2%) were found to be outside mean +/- 3 SD, and none of the normal cases were +/- 4 SD, so this is perhaps a better guideline for those warranting further investigation. To evaluate if these ratios could better reflect disproportional fetal growth, three cases of triploidy and four cases of dwarfism were tested against these ratios. Triploidy was obvious on the BPD/AD graph and dwarfism on the BPD/FL graph. The ratios were not found to be conclusive in the intrauterine diagnosis of trisomy 21 or of trisomy 18, as only 4 of 17 cases were obvious on the graphs

Problem based learning and the case method--medical students change preferences during clerkship.

BACKGROUND: The Case Method (Case) and Problem Based Learning (PBL) are two student active methods, increasingly used in medical education. AIM: The aim of this study was to compare medical student satisfaction with the two different active methods of learning and to see if there was any variation in preference between two stages in medical training. METHODS: A short questionnaire was given out to 254 students during the eighth and eleventh term of medical training. Answers were obtained from 221 students. The results were computer analysed. RESULTS: Students in the eighth term rated both methods high, while students in the eleventh term rated Case even higher while PBL decreased in popularity. Traditional lectures were given constant neutral rating. Case was rated better for problem solving. CONCLUSIONS: It seems that Case is more suitable than PBL for the later stages of medical training when clinical problem-solving skills need to be honed