The effects on maternal anxiety of two‐dimensional versus two‐ plus three‐/four‐dimensional ultrasound in pregnancies at risk of fetal abnormalities: a randomized study

Abstract

To test the hypothesis that the use of two-dimensional (2D) ultrasonography with three-dimensional/four-dimensional (3D/4D) ultrasonography can reduce anxiety to a greater extent in women at risk of having a fetus with congenital abnormalities than the use of 2D ultrasonography alone. A total of 124 women attending the prenatal diagnostic clinic of a teaching hospital were randomized into the intervention group (2D ultrasonography followed by 3D/4D ultrasonography) or control group (2D ultrasonography alone). The primary outcome was maternal anxiety levels, which were assessed by the Spielberger state-trait anxiety inventory. We measured the anxiety levels in all women at the first visit, at around 18 weeks' gestation (immediately after ultrasound examinations) and at 28 weeks' gestation. A short-term reduction of the state-anxiety score (by around 2 points) from the first visit to after ultrasound examinations was observed in both the intervention group and the control group. Unexpectedly, a small increase in the state-anxiety score from the first visit to 28 weeks' gestation was observed in the intervention group but not in the control group, though there was no significant difference in the changes between the two groups. Repeated measures ANOVA (analysis of variance) also showed that there was no significant interaction effect between groups and time of assessment on the state-anxiety scores (F = 1.072 and P = 0.344). About 80% of women reported a better understanding that their baby was normal after viewing 3D rather than 2D images. This randomized study indicates that the addition of 3D/4D ultrasound does not cause a significant reduction in maternal anxiety in pregnancies at risk of fetal abnormalities compared with conventional 2D ultrasound alone.