Date Published: May 1, 2019
Publisher: Public Library of Science
Author(s): Charlotte A. Vollgraff Heidweiller-Schreurs, Marjon A. de Boer, Karuna R. M. van der Meij, Caroline J. Bax, Christianne J. M. de Groot, Lidewij Henneman, Manuela De Allegri.
To explore experiences among pregnant women diagnosed with a small-for-gestational age (SGA) fetus, and monitored by frequent ultrasounds.
We performed a qualitative study at the outpatient clinic of the Gynecology and Obstetrics department of a large academic hospital in Amsterdam. Semi-structured interviews were conducted with fifteen women, diagnosed with an SGA fetus during their pregnancy and having had at least two monitoring ultrasounds since. Themes were identified following analysis of the interview transcripts.
Most women experienced the frequent ultrasounds as a source of support providing comfort and a feeling of safety. It was considered necessary, in the best interest of the baby, which outweighed the discomfort caused by having to come to the hospital frequently. Women described anxiety building up prior to each ultrasound, but feeling reassured and relieved afterwards. During the ultrasound a continuous explanation was preferred, which provided confirmation and a feeling of security. Women identified the uncertainty of SGA’s cause and prognosis as one of the biggest challenges to cope with, for which they used different strategies. Many women expressed a need for more detailed information and counselling, including non-medical aspects of pregnancy and delivery as well. Lastly, many women reported that seeing different doctors negatively influenced the perceived quality of care.
In general, women in this study were satisfied with the ultrasounds for their small-for-gestational age pregnancies. However, women expressed a need for additional information to help cope with a feeling of uncertainty regarding cause and prognosis. Their medical team should preferably provide this in a consistent and continuous manner.
A fetus is generally diagnosed as ‘small-for-gestational age’ (SGA) when growing below the 10th percentile at any given gestational age, measured by ultrasound. Consequently, SGA affects approximately 10 percent of all pregnancies, making it a common prenatal problem. SGA is a complex and multifactorial condition. Placental insufficiency is the most common cause in non-anomalous fetuses, and constitutes one of the leading causes of maternal and neonatal morbidity and mortality worldwide.[2–4] However, in the non-anomalous fetus it is difficult to distinguish suboptimal fetal growth due to placental insufficiency from adequate growth of a genetically small fetus. Consequently, the cause and prognosis of SGA are often uncertain. The complexity of SGA is further exacerbated by the fact that no effective treatment exists, except iatrogenic delivery of the fetus to prevent intrauterine death or irreversible organ damage.
From the interviews, four major themes were identified and are discussed below: (1) experience of the ultrasound, (2) uncertainty and how to cope with it, (3) information need and support, and (4) continuity of care and satisfaction.
In the context of ultrasonographic monitoring of SGA pregnancies, women in this study were satisfied with the frequency of their ultrasounds, which provided a feeling of safety, despite experiencing a feeling of uncertainty regarding the causes and prognosis. From their ultrasonographists they sought continuous reassurance during the ultrasound. From their medical doctors they sought adequate counselling regarding both medical and non-medical aspects of their pregnancy complicated by SGA, which should be provided to them in a consistent and continuous manner by their medical team. Caregivers need to appreciate women’s uncertainty after SGA diagnosis and need to ensure they support and manage women’s expectations.