Duke University School of Medicine, Durham, USA.
Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA.
Matern Child Health J. 2023 Jan;27(1):101-110. doi: 10.1007/s10995-022-03515-1. Epub 2022 Nov 9.
Routine prenatal screening ultrasounds primarily serve to diagnose major fetal anomalies which may prompt further testing and inform clinical decision-making, including possible pregnancy termination. Meanwhile, expectant parents may view the ultrasound experience and information gained differently from their clinicians. In this setting, how to best counsel patients, especially regarding the increasing findings of indeterminant clinical significance, is unclear. Greater understanding of women's views before undergoing their ultrasound may help to guide anticipatory counseling about the purpose of screening and interpretation of results.
We surveyed 289 patients presenting for scheduled prenatal ultrasounds at an academic tertiary care center. Discrete and open-ended questions assessed views surrounding the receipt of abnormal results and management of the pregnancy once fetal anomalies are detected. Qualitative responses were analyzed using thematic analysis.
Most (95%) desired information about abnormal sonographic findings, although only half would consider pregnancy termination for anomalies. Reasons for wanting return of abnormal results included preparedness, valuing knowledge, and to a lesser extent, informing decision-making. When considering potential termination as a result of ultrasound findings, participants' rationales demonstrated deontological (seeing termination as inherently impermissible or permissible), relational (duties arising from the role of being a mother), and consequentialist (weighing harms and benefits) reasoning.
This study highlights women's perceptions of prenatal ultrasounds as an inherently valuable source of information and preparedness, beyond their role in informing clinical decision-making. Identifying the ethical constructs underpinning patients' perspectives may help direct development of counseling tools responsive to individual needs and values regarding prenatal ultrasound findings.
常规产前超声筛查主要用于诊断可能导致进一步检查和临床决策的重大胎儿异常，包括可能终止妊娠。与此同时，期待成为父母的人可能会从与临床医生不同的角度看待超声体验和获得的信息。在这种情况下，如何最好地为患者提供咨询，特别是关于越来越多的不确定临床意义的发现，尚不清楚。在接受超声检查之前，更多地了解女性的观点可能有助于指导关于筛查目的和结果解释的预期咨询。
我们调查了在学术三级保健中心进行定期产前超声检查的 289 名患者。离散和开放式问题评估了围绕接受异常结果和一旦检测到胎儿异常时管理妊娠的看法。使用主题分析对定性反应进行分析。
大多数（95%）希望了解异常超声检查结果的信息，但只有一半会考虑因异常而终止妊娠。希望返回异常结果的原因包括准备、重视知识，以及在较小程度上，为决策提供信息。当考虑因超声检查结果而潜在终止妊娠时，参与者的推理表现出道义论（将终止视为内在不允许或允许）、关系论（从母亲角色中产生的职责）和后果论（权衡危害和利益）推理。
本研究强调了女性对产前超声检查的看法，认为其是一种有价值的信息和准备来源，而不仅仅是为临床决策提供信息的作用。确定患者观点背后的伦理结构可能有助于指导制定针对个体对产前超声检查结果的需求和价值观的咨询工具。
