Susanne Georgsson Ohman, Sissel Saltvedt, Ulla Waldenström, Charlotta Grunewald, Sonja Olin-Lauritzen
Department of Nursing, Karolinska Institutet, Stockholm, Sweden.
Birth. 2006 Mar;33(1):64-73. doi: 10.1111/j.0730-7659.2006.00075.x.
Fetal screening for Down syndrome by an ultrasound examination, including measurement of fetal nuchal translucency, at 12 to14 weeks' gestation is presently being evaluated in a Swedish randomized controlled trial. Women at high risk were offered an amniocentesis to obtain a definite diagnosis. The aim of this study was to explore women's reactions and responses to information about being at high risk after the scan, with a special focus on reactions to a false positive test.
Interviews were conducted with 24 women within 1 week after the scan, in midpregnancy, and 2 months after the birth. The interviews were analyzed qualitatively. Down syndrome was confirmed in 4 women, who chose to terminate the pregnancy. The remaining 20 women had a false positive test.
For the majority, the risk information caused strong reactions of anxiety and worries about the future. A typical way for women to cope was to "withhold" the pregnancy, to take a "timeout," and try to live as if they were not pregnant any longer. Some weeks later, when the women received normal results from the chromosome analysis, they resumed being pregnant. Six women ages more than 35 years who had a risk score lower than their age-related risk did not express similarly strong reactions. Two months after the birth of a healthy baby, most stated they would undergo the same procedure in a subsequent pregnancy. One woman still suffered from the experience when interviewed at 2 months after the birth, and another said she regretted participating in the fetal screening program.
A false positive test of fetal screening for Down syndrome by ultrasound examination may cause strong reactions of anxiety and even rejection of the pregnancy. The prevalence of such reactions and possible long-term effects need further investigation.
目前瑞典一项随机对照试验正在评估在妊娠12至14周时通过超声检查（包括测量胎儿颈部透明带）进行唐氏综合征的胎儿筛查。高危女性可选择进行羊膜穿刺术以获得明确诊断。本研究的目的是探讨女性在扫描后得知处于高危状态时的反应和应对方式，特别关注对假阳性检测结果的反应。
在扫描后1周内、孕中期和产后2个月对24名女性进行访谈。对访谈进行定性分析。4名女性被确诊为唐氏综合征，她们选择终止妊娠。其余20名女性检测结果为假阳性。
对大多数人来说，风险信息引发了强烈的焦虑反应以及对未来的担忧。女性应对的典型方式是“暂停”妊娠，“暂停一下”，并试图像不再怀孕一样生活。几周后，当女性收到染色体分析的正常结果时，她们又恢复了妊娠状态。6名年龄超过35岁且风险评分低于其年龄相关风险的女性没有表现出同样强烈的反应。在健康婴儿出生2个月后，大多数人表示她们会在后续妊娠中接受相同的检查。一名女性在产后2个月接受访谈时仍受此经历困扰，另一名女性表示后悔参加胎儿筛查项目。
超声检查进行唐氏综合征胎儿筛查的假阳性结果可能会引发强烈的焦虑反应，甚至导致对妊娠的排斥。此类反应的发生率及可能的长期影响需要进一步研究。
