Indeterminate Prenatal Ultrasounds and Maternal Anxiety: A Prospective Cohort Study

Abstract

Introduction: Prenatal ultrasounds often yield indeterminate (incomplete or minor abnormality) findings with limited clinical utility. We evaluate impact of indeterminate findings on maternal anxiety. Methods: A single-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 maternal characteristics. Linear regression adjusted for confounders. Results: 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<.001), and obesity (48.8% vs. 37.0%; p=.031). Pretest anxiety was highest in second/third trimesters (p=.029), and in subjects aged age ≤24 or younger(p<.001), with a history of anxiety (p<.001),) or with prior pregnancy loss (p=.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=.026) and posttest 16.9 vs. 12.2 (p=.009; adjusted-p=.01). Versus normal ultrasounds, incomplete findings were associated with higher post-ultrasound anxiety (p=.007; adjusted-p=.01) and smaller decreases from pre-to-posttest (adjusted-p=.03), whereas minor abnormalities had higher pretest anxiety (p=.029) with larger pre-to-posttest decreases (adjusted-p=.010). Discussion: 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.