Johns Hopkins Berman Institute of Bioethics, 1809 Ashland Ave, Baltimore, MD, 21205, USA.
Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Women's Mood Disorders Center, 550 N. Broadway, Suite 305, Baltimore, MD, 21205, USA.
Matern Child Health J. 2021 May;25(5):802-812. doi: 10.1007/s10995-020-03042-x. Epub 2021 Jan 3.
Prenatal ultrasounds often yield indeterminate (incomplete or minor abnormality) findings with limited clinical utility. We evaluate impact of indeterminate findings on maternal anxiety.
A single-U.S.-center prospective cohort study administered the Perinatal Anxiety Screening Scale (PASS; control mean = 13.4; > 20 denotes clinically significant anxiety) before and after prenatal ultrasounds in February-May 2017. Ultrasound reports were coded as: normal; indeterminate; or major abnormality. Primary outcome was anxiety after indeterminate vs. normal ultrasounds. Secondary outcomes included anxiety change from pre-to-post-ultrasound and relative to women's characteristics. Linear regression adjusted for confounders.
Of 286 ultrasounds, 51.0% were normal, 40.5% indeterminate (22.0% incomplete; 18.5% minor abnormality), and 8.0% major abnormalities. Indeterminate findings were unrelated to age, race, parity, infertility, or psychiatric history, but associated with gestational age (26.6%/45.0%/52.5% for first/second/third trimesters; p < 0.001), and obesity (48.8 vs. 37.0%; p = 0.031). Pretest anxiety was highest in second/third trimesters (p = 0.029), and in subjects aged age ≤ 24 or younger(p < 0.001), with a history of anxiety (p < 0.001),) or with prior pregnancy loss (p = 0.011). Mean anxiety score decreased pre-to-posttest across all groups. Indeterminate findings were associated with higher PASS scores than normal findings: pretest 20.1 vs. 16.4 (p = 0.026) and posttest 16.9 vs. 12.2 (p = 0.009; adjusted-p = 0.01). Versus normal ultrasounds, incomplete findings were associated with higher post-ultrasound anxiety (p = 0.007; adjusted-p = 0.01) and smaller decreases from pre-to-posttest (adjusted-p = 0.03), whereas minor abnormalities had higher pretest anxiety (p = 0.029) with larger pre-to-posttest decreases (adjusted-p =0.010).
Indeterminate ultrasounds, especially incomplete findings, are associated with significantly higher anxiety than normal findings, suggesting need for evidence-based counseling, management and strategies for decreasing number of indeterminate results.
产前超声检查常出现不确定（不完整或轻微异常）的结果，临床应用价值有限。本研究评估了不确定发现对产妇焦虑的影响。
这是一项在美国进行的单中心前瞻性队列研究，在 2017 年 2 月至 5 月期间，在产前超声检查前后使用围产期焦虑筛查量表（PASS；对照均值=13.4；>20 表示临床显著焦虑）进行评估。超声报告编码为：正常；不确定；或主要异常。主要结局为不确定与正常超声检查后的焦虑。次要结局包括超声检查前后的焦虑变化，以及与女性特征的关系。线性回归调整混杂因素。
在 286 次超声检查中，51.0%为正常，40.5%为不确定（22.0%不完整；18.5%轻微异常），8.0%为主要异常。不确定的发现与年龄、种族、产次、不孕或精神病史无关，但与孕龄（第 1、2、3 孕期分别为 26.6%/45.0%/52.5%；p<0.001）和肥胖（48.8%/37.0%；p=0.031）有关。第 2 和第 3 孕期的术前焦虑最高（p=0.029），年龄≤24 岁或更年轻（p<0.001）、有焦虑史（p<0.001）或有妊娠丢失史（p=0.011）的患者焦虑程度更高。所有组的术前和术后平均焦虑评分均呈下降趋势。与正常发现相比，不确定的发现与更高的 PASS 评分相关：术前 20.1 比 16.4（p=0.026），术后 16.9 比 12.2（p=0.009；调整后 p=0.01）。与正常超声检查相比，不完整的发现与更高的超声检查后焦虑相关（p=0.007；调整后 p=0.01），且从术前到术后的焦虑下降幅度更小（调整后 p=0.03），而轻微异常的患者术前焦虑更高（p=0.029），但从术前到术后的焦虑下降幅度更大（调整后 p=0.01）。
不确定的超声检查，尤其是不完整的发现，与明显更高的焦虑相关，这表明需要基于证据的咨询、管理和减少不确定结果数量的策略。
