Preexamination and Postexamination Assessment of Parental-Fetal Bonding in Patients Undergoing 3-/4-Dimensional Obstetric Ultrasonography

Abstract

Supplementing two-dimensional ultrasonography (2DUS) with three- and four-dimensional US (3D/4DUS) aids the detection of fetal anomalies and also provides images that are more readily recognized by parents. There is evidence that 2DUS images contribute to positive attitudes on the part of expectant parents and enhance parental-fetal bonding, but similar data regarding 3D/4DUS is lacking. This study therefore assessed parental attitudes and bonding by asking parents to fill out three questionnaires before and after 3D/4DUS depicting the fetal face, limbs, and thorax. The first series of questions came from Cranley’s maternal-fetal attachment questionnaire or a modified version that functioned as a paternal-fetal questionnaire. This was followed by a line instrument that queried the parents experience with 3D/4DUS. Finally they answered questions from the Positive Feelings Questionnaire, that assessed levels of positive feelings using a Likert scale. The entire survey was completed before and after ultrasonography by 142 parents, including 89 mothers and 53 fathers. These parents constituted a mainly middle- and upper-class population. The maternal- or paternal-fetal attachment questionnaire included three types of questions. Type 1 questions pertained to the parent’s curiosity and imagination about the fetus (for example, “I picture myself feeding the baby”). Type 2 questions regarded the parents own health practices (“I do things to stay healthy that I would not do if I were not pregnant”), and Type 3 questions regarded the parent’s behavior toward the fetus (“I talk to my unborn baby”). The total score indicated a statistically significant positive change in both father’s and mother’s attitudes toward the pregnancy after 3D/4DUS. The answers to five questions indicated a significant positive change in women, while the answers to two of these indicated a significant change for men. All five questions were Type 1 questions and indicated increased bonding. On the second questionnaire, men expressed an increase in excitement after the ultrasound exam was performed, while women were already maximally excited before the exam. The Positive Feelings Questionnaire demonstrated significant change in a positive direction during the examination and, at the same time, a lessening of anxiety. Women changed positively and significantly in their feelings about the baby, degree of happiness, reduced anxiety, freedom from fear, and hopefulness. Men changed significantly in experiencing less anxiety and less fear. These findings suggest that 3D/4DUS favorably affects prospective mothers and fathers through strengthening bonding with, and inducing more positive feelings toward, their fetus. Further studies comparing the impact of ultrasound study in the second and third trimesters would be of interest.