TY - ABST

T1 - Disrupted pregnancies? How doctors, sonographers and pregnant couples negotiate high risk for Down’s syndrome

T2 - a qualitative study

AU - Lou, Stina

AU - Hvidman, Lone

AU - Petersen, Olav Bjørn

N1 - Special Issue: 38TH NORDIC CONGRESS OF OBSTETRICS AND GYNECOLOGY 17–19 JUNE 2012, BERGEN, NORWAY. Abstract 99 Poster position PoOb20

PY - 2012/6

Y1 - 2012/6

N2 - Background: In Denmark, first-trimester screening for Down's syndrome is widely perceived as a routine pregnancy examination. For app. 5% of all pregnant couples, this routine takes a disruptive or unexpected turn when screening results show ‘high-risk’. They are subsequently offered invasive diagnostic testing (CVS) which involves a miscarriage risk of 0.5–1%. The majority decides to take the CVS and for 90–95% of the couples, the CVS will show normal chromosomes (a false positive screening result). Research shows that pregnant women are often not knowledgeable about the potential consequences of a high-risk screening result; the multi-faceted information and the complex choices they may face. However, we lack knowledge of how the high-risk pregnant couples experience and deal with this disruption. In order to fully understand this, we also need to include and investigate the daily practises of the doctors and the sonographers with whom the high-risk couples interact. The area of interest calls for an exploratory, qualitative approach. Objective: A qualitative, anthropological investigation of how professionals and couples communicate, interact and make decisions following a high-risk screening result. Or, framing it in anthropological terms: How couples, doctors and sonographers negotiate the high-risk result? Method & Materials: An anthropological research strategy is used. Materials include 4 months of anthropological fieldwork at an obstetric ultrasound clinic: – Observing first trimester ultrasound examinations – Observing high-risk couples in their subsequent diagnostic testing – Participating in everyday life at the ultrasound clinic Materials also include semi-structured, in-dept interviews with high-risk pregnant couples, with doctors and with sonographers. Preliminary results: Being categorized as high-risk calls into question the expected normal pregnancy and the imagined future parenthood. It generates anxiety, uncertainty and sadness. Doctors and sonographers work to frame the high-risk category and the CVS as a serious and uncertain situation, but also one of hope. Through their interaction they communicate and negotiate, tone down and elaborate on information in order to make the situation manageable for the couples. Couples use medical information and personal experience to negotiate and make sense of a process characterised by waiting and hoping. Discussion: CVS results will show that 90–95% of the high-risk couples carry a foetus with normal chromosomes. How do these couples frame the disruption caused by the high risk category? Are they able to return to a ‘normal’ pregnancy or does the disruption cause subsequent worry? In the presentation, we will reflect on this important issue. We will discuss how the quality of the communication between professionals and high-risk couples may influence the couples’ abilities to negotiate the situation in a meaningful way.

AB - Background: In Denmark, first-trimester screening for Down's syndrome is widely perceived as a routine pregnancy examination. For app. 5% of all pregnant couples, this routine takes a disruptive or unexpected turn when screening results show ‘high-risk’. They are subsequently offered invasive diagnostic testing (CVS) which involves a miscarriage risk of 0.5–1%. The majority decides to take the CVS and for 90–95% of the couples, the CVS will show normal chromosomes (a false positive screening result). Research shows that pregnant women are often not knowledgeable about the potential consequences of a high-risk screening result; the multi-faceted information and the complex choices they may face. However, we lack knowledge of how the high-risk pregnant couples experience and deal with this disruption. In order to fully understand this, we also need to include and investigate the daily practises of the doctors and the sonographers with whom the high-risk couples interact. The area of interest calls for an exploratory, qualitative approach. Objective: A qualitative, anthropological investigation of how professionals and couples communicate, interact and make decisions following a high-risk screening result. Or, framing it in anthropological terms: How couples, doctors and sonographers negotiate the high-risk result? Method & Materials: An anthropological research strategy is used. Materials include 4 months of anthropological fieldwork at an obstetric ultrasound clinic: – Observing first trimester ultrasound examinations – Observing high-risk couples in their subsequent diagnostic testing – Participating in everyday life at the ultrasound clinic Materials also include semi-structured, in-dept interviews with high-risk pregnant couples, with doctors and with sonographers. Preliminary results: Being categorized as high-risk calls into question the expected normal pregnancy and the imagined future parenthood. It generates anxiety, uncertainty and sadness. Doctors and sonographers work to frame the high-risk category and the CVS as a serious and uncertain situation, but also one of hope. Through their interaction they communicate and negotiate, tone down and elaborate on information in order to make the situation manageable for the couples. Couples use medical information and personal experience to negotiate and make sense of a process characterised by waiting and hoping. Discussion: CVS results will show that 90–95% of the high-risk couples carry a foetus with normal chromosomes. How do these couples frame the disruption caused by the high risk category? Are they able to return to a ‘normal’ pregnancy or does the disruption cause subsequent worry? In the presentation, we will reflect on this important issue. We will discuss how the quality of the communication between professionals and high-risk couples may influence the couples’ abilities to negotiate the situation in a meaningful way.

U2 - 10.1111/j.1600-0412.2012.01435_2.x

DO - 10.1111/j.1600-0412.2012.01435_2.x

M3 - Conference abstract in journal

VL - 91

SP - 50

EP - 51

JO - Acta Obstetricia et Gynecologica Scandinavica

JF - Acta Obstetricia et Gynecologica Scandinavica

SN - 0001-6349

IS - Suppl. 159

ER -