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1.
Lakartidningen ; 1162019 Sep 27.
Artigo em Sueco | MEDLINE | ID: mdl-31573669

RESUMO

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.


Assuntos
Mortalidade Materna , Adolescente , Adulto , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Morte Materna , Transtornos Mentais/mortalidade , Transtornos Mentais/prevenção & controle , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Pré-Eclâmpsia/mortalidade , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Neoplásicas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde , Sociedades Médicas , Suicídio/prevenção & controle , Suécia/epidemiologia , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
2.
J Perinat Med ; 46(2): 139-149, 2018 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-28343177

RESUMO

A multifaceted intervention at all six obstetric units in the Stockholm Health Region was performed in 2008-2011 in order to increase safety for the newborn infants. Case-controlled criterion-based reviews of care processes during labor and delivery have been used to assess factors associated with suboptimal care during labor and delivery. Categories of increased risk of adverse outcome during labor and delivery were defined. Cases with low Apgar scores and healthy controls were scrutinized and compared to data from a study with an identical design performed before the intervention. The risk of suboptimal care increased twice among controls and three times among cases when reviewing specific criteria after a multifaceted intervention. There are still gaps in care processes that need attention. Improving guidelines is important but not enough alone, and the management of fetal surveillance needs further improvement. The complexity of reviewing care processes using criterion-based research methodology is highlighted.


Assuntos
Parto Obstétrico , Monitorização Fetal , Doenças do Recém-Nascido , Complicações do Trabalho de Parto/epidemiologia , Índice de Apgar , Estudos de Casos e Controles , Cesárea/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/normas , Feminino , Monitorização Fetal/métodos , Monitorização Fetal/estatística & dados numéricos , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/etiologia , Determinação de Necessidades de Cuidados de Saúde , Gravidez , Cuidado Pré-Natal/normas , Melhoria de Qualidade , Medição de Risco/métodos , Fatores de Risco , Suécia/epidemiologia
4.
Acta Obstet Gynecol Scand ; 95(5): 596-603, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26873144

RESUMO

INTRODUCTION: We studied the effects of the national Perinatal Patient Safety Program in Sweden, addressing local improvement measures, changes in the proportion of low Apgar score and the number of settled injury claims due to asphyxia. MATERIAL AND METHODS: Final reports on achieved improvements from all Swedish obstetric units were analyzed and categories of the improvement measures taken in perinatal risk areas were established. Data on all term newborns during 2006-12 were obtained from the Medical Birth Registry. Incidence of 5-min Apgar score <7 was analyzed before, during and after the intervention. The odds ratio for low Apgar score in period ÍII vs. period I was calculated. Patient injury claims from The Swedish National Patient Insurance Company (LÖF) were analyzed. RESULTS: Numerous local improvement initiatives were reported. The incidence of 5-min Apgar score <7 on a national level remained unchanged during the study periods. The units with the highest rate of Apgar score <7 showed a significant decrease in Apgar score of 4-6 after the intervention, whereas units with the lowest rate of Apgar score <7 showed a significant increase in Apgar score <7 after the intervention. A decline in settled claims due to substandard care was observed (7.5%, 2012-14; p for trend 0.049). CONCLUSION: The national incidence of low Apgar score remained unchanged but a reduction of settled claims of severely asphyxiated neonates was observed. The study highlights the need for robust designs when evaluating large-scale initiatives for improving patient safety at delivery, along with the difficulties in performing them.


Assuntos
Segurança do Paciente , Assistência Perinatal , Gestão da Segurança/organização & administração , Índice de Apgar , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/prevenção & controle , Eficiência Organizacional , Feminino , Humanos , Recém-Nascido , Segurança do Paciente/normas , Segurança do Paciente/estatística & dados numéricos , Assistência Perinatal/métodos , Assistência Perinatal/normas , Gravidez , Melhoria de Qualidade , Suécia/epidemiologia
5.
Sex Reprod Healthc ; 5(4): 195-8, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25433831

RESUMO

OBJECTIVE: The aim of the study was to evaluate whether interpreting CTG pairwise brings about a higher level of correctly classified CTG recordings in a non-selected population of midwives and physicians. STUDY DESIGN: A comparative study. SETTING: Five delivery units in Stockholm and one delivery unit in Uppsala, with 1589, 3740, 3908, 4539, 6438, and 7331 deliveries in 2011, respectively. SUBJECTS: 536 midwives and physicians classified one randomly selected CTG recording individually followed by a pairwise classification. The pairs consisted of two midwives (119 pairs) or one midwife and one physician (149 pairs), a total of 268 pairs. MAIN OUTCOME MEASURE: The proportion of individually correctly classified CTG recordings versus the proportion of pairwise correctly classified CTG recordings. RESULTS: The proportion of individually correctly classified CTG's was 75% and the proportion of pairwise correctly classified CTG's was 80% (difference 5%, p = 0.12). CONCLUSIONS: There was no statistically significant difference when CTG's were classified pairwise compared to individual classifications. The proportion of individually correctly classified CTG's was high (75%). There were differences in the proportion of correctly classified CTG recordings between the delivery units, indicating potential areas of improvement.


Assuntos
Cardiotocografia/métodos , Parto Obstétrico , Tocologia , Obstetrícia/métodos , Médicos , Salas de Parto/normas , Feminino , Serviços de Saúde , Humanos , Gravidez , Suécia
6.
J Perinat Med ; 40(5): 533-8, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23104796

RESUMO

AIM: To determine infant survival and neonatal outcome after fetoscopic laser treatment of twin-to-twin transfusion syndrome (TTTS). RESULTS: In 53/71(75%) laser-treated TTTS cases, at least one twin was liveborn and in 42/71(59%) cases at least one twin survived infancy. Fetal survival did not differ between donors [41/71(58%)] and recipients [46/71(65%), P=0.36]. Among liveborns, infant survival was 29/41(71%) in donors and 36/46(78%) in recipients (P=0.12). Infant survival did not correlate to maternal characteristics (age, BMI, smoking or parity), gestational age at treatment or severity of TTTS (Quintero stage). No TTTS infant born before 25 weeks of gestation survived the first week. Among the 87 infant survivors, 26 (30%) had an Apgar score <7 at 5 min, 47 (54%) developed respiratory distress syndrome, 10 (11%) showed signs of severe brain damage, nine (10%) renal failure, eight (9%) bronchopulmonary dysplasia, and five (6%) infants developed retinopathy of prematurity ≥stage 3. There was no significant difference in neonatal morbidity between recipients and donors. CONCLUSIONS: Fetal survival after laser treatment was comparable to that reported by other international centers. There was no significant difference in survival or neonatal morbidity between donors and recipients. Major neonatal morbidity was common, and combined with extremely preterm delivery the prognosis of TTTS is poor.


Assuntos
Transfusão Feto-Fetal/cirurgia , Fetoscopia , Terapia a Laser , Adulto , Antropometria , Estudos de Coortes , Feminino , Transfusão Feto-Fetal/mortalidade , Idade Gestacional , Humanos , Gravidez , Fatores de Risco , Suécia/epidemiologia , Resultado do Tratamento , Adulto Jovem
7.
BMC Health Serv Res ; 12: 274, 2012 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-22920327

RESUMO

BACKGROUND: Patient safety is fundamental in high quality healthcare systems but despite an excellent record of perinatal care in Sweden some children still suffer from substandard care and unnecessary birth injuries. Sustainable patient safety improvements assume changes in key actors' mental models, norms and culture as well as in the tools, design and organisation of work. Interventions positively affecting team mental models on safety issues are a first step to enhancing change. Our purpose was to study a national intervention programme for the prevention of birth injuries with the aim to elucidate how the main interventions of self-assessment, peer review, feedback and written agreement for change affected the teams and their mental model of patient safety, and thereby their readiness for change. Knowledge of relevant considerations before implementing this type of patient safety intervention series could thereby be increased. METHODS: Eighty participants in twenty-seven maternity units were interviewed after the first intervention sequence of the programme. A content analysis using a priori coding was performed in order to relate results to the anticipated outcomes of three basic interventions: self-assessment, peer review and written feedback, and agreement for change. RESULTS: The self-assessment procedure was valuable and served as a useful tool for elucidating strengths and weaknesses and identifying areas for improvement for a safer delivery in maternity units. The peer-review intervention was appreciated, despite it being of less value when considering the contribution to explicit outcome effects (i.e. new input to team mental models and new suggestions for actions). The feedback report and the mutual agreement on measures for improvements reached when signing the contract seemed exert positive pressures for change. CONCLUSIONS: Our findings are in line with several studies stressing the importance of self-evaluation by encouraging a thorough review of objectives, practices and outcomes for the continuous improvement of an organisation. Even though effects of the peer review were limited, feedback from peers, or other change agents involved, and the support that a clear and well-structured action plan can provide are considered to be two important complements to future self-assessment procedures related to patient safety improvement.


Assuntos
Traumatismos do Nascimento/prevenção & controle , Retroalimentação , Inovação Organizacional , Revisão por Pares , Autoavaliação , Auditoria Clínica/normas , Competência Clínica , Comportamento Cooperativo , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/normas , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Maternidades/normas , Humanos , Entrevistas como Assunto , Masculino , Equipe de Assistência ao Paciente/normas , Avaliação de Programas e Projetos de Saúde , Suécia , Recursos Humanos
9.
Obstet Gynecol ; 119(4): 801-9, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22433344

RESUMO

OBJECTIVE: To identify factors related to retained placenta in the context of contemporary obstetric practice. METHODS: This was a case-control study comparing 408 cases of retained placenta and an equivalent number of control individuals. Epidemiological and delivery-related variables were registered in computerized prenatal and in-hospital medical records. Univariable and multivariable logistic regressions were used for estimation of risk ratios and statistical significance. RESULTS: Independent risk factors for retained placenta were: previous retained placenta (odds ratio [OR] 12.61, 95% confidence interval [CI] 3.61-44.08); preterm delivery (OR 3.28, 95% CI 1.60-6.70); oxytocin use for 195-415 minutes (OR 2.00, 95% CI 1.20-3.34); oxytocin use more than 415 minutes (OR 6.55, 95% CI 3.42-12.54, number needed to harm 2.3); preeclampsia (OR 2.85, 95% CI 1.20-6.78); two or more previous miscarriages (OR 2.62, 95% CI 1.31-5.20); and one or more previous abortion (OR 1.58, 95% CI 1.09-2.28). Parity of two or more had a seemingly protective effect (OR 0.40, 95% CI 0.24-0.70), as did smoking at the start of pregnancy (OR 0.28, 95% CI 0.09-0.88). Retained placenta was significantly associated with an increased risk of postpartum hemorrhage. The OR related to blood loss exceeding 500 mL, 1,000 mL, and 2,000 mL and the need for blood transfusion was 33.07 (95% CI 20.57-53.16), 43.44 (95% CI 26.57-71.02), 111.24 (95% CI 27.26-454.00), and 37.48 (95% CI 13.63-103.03), respectively. Diabetes was numerically overrepresented in the case group, but the power of the study to detect a significant difference in risk outcome was insufficient. CONCLUSION: Identifying risk factors for retained placenta is important in the assessment of women after delivery. The increased risk associated with duration of oxytocin use is of interest, considering its widespread use. LEVEL OF EVIDENCE: II.


Assuntos
Ocitocina/efeitos adversos , Placenta Retida/epidemiologia , Aborto Induzido , Aborto Espontâneo , Adolescente , Adulto , Estudos de Casos e Controles , Distocia/epidemiologia , Feminino , Humanos , Placenta Retida/etiologia , Gravidez , Nascimento Prematuro , Suécia/epidemiologia , Adulto Jovem
10.
Birth ; 39(2): 106-14, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23281858

RESUMO

BACKGROUND: For safety reasons an in-hospital birth center was replaced by a modified form of birth center care with the same medical guidelines and equipment as in standard care. The aim of this study was to investigate women's and men's satisfaction with modified care compared with standard care. METHODS: Women in both groups gave birth from July 2007 to July 2008. The same medical low-risk criteria during pregnancy applied to both groups. Of those invited to the study, 547 (82.7%) women in modified birth center care and 445 (66.7%) men returned a questionnaire posted 2 months after the birth, and 786 (71.6%) women and 639 (58.2%) men in standard care. Odds ratios (ORs) for being satisfied were calculated with 95 percent confidence intervals (CIs) and adjusted for possible confounders. We also explored the effects of different components of care on overall satisfaction. RESULTS: Adjusted ORs for being satisfied overall were approximately doubled in the modified birth center group compared with the standard care group: antenatal care-OR: 2.1 (95% CI: 1.6-2.7) in women and OR: 2.2 (95% CI: 1.5-2.8) in men; intrapartum care-OR: 2.2 (95% CI: 1.7-2.9) in women and OR: 1.7 (95% CI: 1.3-2.4) in men; and postpartum care-OR: 1.7 in women (95% CI: 1.4-2.2) and OR: 2.1 (95% CI: 1.6-2.8) in men. Important explanations of these differences included perception of the midwife as being more supportive, the presence of a calmer environment and atmosphere (intrapartum), and the option for fathers to stay overnight (postpartum). CONCLUSION: In-hospital birth center with medical equipment on site increased overall satisfaction with all episodes of care compared with standard care. (BIRTH 39:2 June 2012).


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Salas de Parto/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Saúde da Mulher , Adulto , Intervalos de Confiança , Feminino , Humanos , Recém-Nascido , Razão de Chances , Gravidez , Inquéritos e Questionários , Suécia/epidemiologia , Adulto Jovem
13.
Birth ; 38(2): 120-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21599734

RESUMO

BACKGROUND: A challenge of obstetric care is to optimize maternal and infant health outcomes and the mother's experience of childbirth with the least possible intervention in the normal process. The aim of this study was to investigate the effects of modified birth center care on obstetric procedures during delivery and on maternal and neonatal outcomes. METHODS: In a cohort study 2,555 women who signed in for birth center care during pregnancy were compared with all 9,382 low-risk women who gave birth in the standard delivery ward in the same hospital from March 2004 to July 2008. Odds ratios (OR) were calculated with 95% confidence interval (CI) and adjusted for maternal background characteristics, elective cesarean section, and gestational age. RESULTS: The modified birth center group included fewer emergency cesarean sections (primiparas: OR: 0.69, 95% CI: 0.58-0.83; multiparas: OR: 0.34, 95% CI: 0.23-0.51), and in multiparas the vacuum extraction rate was reduced (OR: 0.42, 95% CI: 0.26-0.67). In addition, epidural analgesia was used less frequently (primiparas: OR: 0.47, 95% CI: 0.41-0.53; multiparas: OR: 0.25, 95% CI: 0.20-0.32). Fetal distress was less frequently diagnosed in the modified birth center group (primiparas: OR: 0.72, 95% CI: 0.59-0.87; multiparas: OR: 0.45, 95% CI: 0.29-0.69), but no statistically significant differences were found in neonatal hypoxia, low Apgar score less than 7 at 5 minutes, or proportion of perinatal deaths (OR: 0.40, 95% CI: 0.14-1.13). Anal sphincter tears were reduced (primiparas: OR: 0.73, 95% CI: 0.55-0.98; multiparas: OR: 0.41, 95% CI: 0.20-0.83). CONCLUSION: Midwife-led comprehensive care with the same medical guidelines as in standard care reduced medical interventions without jeopardizing maternal and infant health.


Assuntos
Salas de Parto , Parto Obstétrico , Guias de Prática Clínica como Assunto , Resultado da Gravidez , Adulto , Feminino , Humanos , Cuidado Pós-Natal , Gravidez , Fatores de Risco
14.
Acta Obstet Gynecol Scand ; 90(6): 654-8, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-21370996

RESUMO

OBJECTIVE: To generate a regression equation for the nuchal translucency (NT) median for the Swedish population and compare this with other median values. SETTING: Eight Swedish hospitals. SAMPLE: The data set included 20 887 unaffected fetuses. METHODS: Calculation and generation of an NT centile chart for the Swedish population. RESULTS: The NT centiles for crown-rump length (CRL) from 45 to 84 mm were calculated and compared with the medians from Glasgow, from the Fetal Medicine Foundation (FMF, London, UK; FMF-original) and those published recently (FMF-new). The NT medians cease to increase at CRLs between 70 and 75 mm. The Swedish, FMF-new and Glasgow medians followed the same pattern, but the Glasgow NT median curve was systematically lower by around 20%. Swedish, FMF-new and Glasgow medians differed in shape from the FMF-original medians, which continuously increase throughout the whole range of CRLs. CONCLUSIONS: Our results demonstrate that there are substantial differences in the NT medians and centiles between countries.


Assuntos
Estatura Cabeça-Cóccix , Idade Gestacional , Medição da Translucência Nucal , Complicações na Gravidez/diagnóstico por imagem , Adulto , Feminino , Humanos , Computação Matemática , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Análise de Regressão , Amostragem , Suécia/epidemiologia , Incerteza , Reino Unido/epidemiologia
15.
Acta Obstet Gynecol Scand ; 90(1): 26-32, 2011 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-21275912

RESUMO

OBJECTIVE: To evaluate the effects on neonatal morbidity of a regional change in induction policy for post-term pregnancy from 43(+0) to 42(+0) gestational weeks (GWs). DESIGN AND SETTING: Nationwide retrospective register study between 2000 and 2007. POPULATION: All singleton pregnancies with a gestational age of >41(+2) GW (n= 119,198). METHODS: All Swedish counties were divided into three groups where study group allocation was designated by the proportion of pregnancies >42(+2) GW among all pregnancies of >41(+2) GW. Stockholm county formed a separate group. MAIN OUTCOME MEASURES: Perinatal morbidity. RESULTS: In counties with the most active management, 19% of pregnancies >41(+2) GW were delivered at >42(+2) GW during 2000-2004 compared to 7.1% in 2005-2007. In the least active counties, corresponding figures were 21.0% compared to 19.4%. During 2005-2007, the odds ratios for meconium aspiration and 5-minute Apgar score of ≤6 in the least compared to most active counties, were 1.55 (95% CI: 1.03-2.33) and 1.26 (95% CI: 1.06-1.51). In Stockholm >42(+2) GW seen among pregnancies of >41(+2) decreased from 21.0% in 2000-2004 to 5.9% in 2005-2007. Reduced perinatal death risks by 48%, meconium aspiration of 51% and low Apgar scores by 31% in 2005-2007 compared with 2000-2004 were observed. Rates of operative deliveries at >41(+2) GW in Stockholm were unaltered. CONCLUSION: A significant reduction in perinatal morbidity was found, with no influence on operative delivery rates for post-term pregnancy in Stockholm. We advocate a nationwide change toward more active management of post-term pregnancies.


Assuntos
Protocolos Clínicos , Parto Obstétrico , Gravidez Prolongada/mortalidade , Gravidez Prolongada/terapia , Programas Médicos Regionais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Mortalidade Perinatal , Gravidez , Sistema de Registros , Estudos Retrospectivos , Suécia/epidemiologia
16.
Acta Obstet Gynecol Scand ; 89(1): 39-48, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-19961278

RESUMO

OBJECTIVE: To identify maternal, pregnancy, delivery and infants characteristics related to neonatal asphyxia and associated with substandard care. DESIGN AND SETTING: A nation-wide case-control study in Sweden. POPULATION: Infants born between 1990 and 2005 with a gestational age > or = 33 weeks and a spontaneous or induced onset of labor. METHODS: Cases were 177 previously identified infants suffering from encephalopathy caused by asphyxia where there was suspected substandard care during labor, and where claims for financial compensation were filed. Controls were identified from the population-based Swedish Medical Birth Register, had an Apgar score of 10 at five minutes, and were alive at 28 days of age. MAIN OUTCOME MEASURES: Severe asphyxia associated with substandard care during childbirth. RESULTS: Maternal and delivery factors associated with asphyxia included maternal age > or = 30 years, short maternal stature (< or =159 cm), previous cesarean delivery, insulin-dependent diabetes before pregnancy and gestational diabetes, induced deliveries and delivery at night, with adjusted odds ratios (ORs) ranging from a two- to fourfold increase in risk. Compared with non-dystocic deliveries, the OR for dystocic deliveries was fivefold higher, and was further increased if epidural anesthesia or opioids were used. Small- and large-for-gestational age infants, post-term (> or =42 weeks) births, twins and breech deliveries had a three- to eightfold increase in risk of asphyxia when there was substandard care during labor. CONCLUSION: Dystocia of labor, especially if epidurals and/or opioids are used, is the strongest risk factor associated with substandard care causing severe asphyxia during labor.


Assuntos
Asfixia Neonatal/epidemiologia , Competência Clínica , Distocia/epidemiologia , Índice de Apgar , Cardiotocografia , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Gravidez , Qualidade da Assistência à Saúde , Fatores de Risco , Suécia/epidemiologia
20.
Midwifery ; 25(3): 264-76, 2009 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17920172

RESUMO

OBJECTIVE: to explore how information about being at risk of carrying a fetus with Down's syndrome was understood, and whether the actual risk and the woman's perception of risk was associated with worry or depressive symptoms during and after pregnancy. DESIGN AND SETTING: observational study. The sample was drawn from the intervention group of a Swedish randomised controlled trial of ultrasound screening for Down's syndrome by nuchal translucency measurement. MEASUREMENTS: data were collected by three questionnaires. Questions were asked about recall of the risk score and perception of risk. The Cambridge Worry Scale and the Edinburgh Postnatal Depression Scale measured worry and depressive symptoms, respectively, on all three occasions. FINDINGS: of the 796 women who provided data for this study, one in five was unaware that the risk score was noted in her case record. In total, 620 women stated that they had received a risk score, but only 64% of them recalled the figure exactly or approximately. The actual risk was associated with the perceived risk, but of the 31 women who perceived the risk to be high, only 14 were actually at high risk. A high-risk score was not associated with worry or depressive symptoms in mid-pregnancy, in contrast to a woman's own perception of being at high risk. Two months postpartum, no associations were found between maternal emotional well-being and actual or perceived risk. CONCLUSIONS: information about fetal risk is complicated and women's perception of risk does not always reflect the actual risk, at least not when presented as a numerical risk score. The possibility that the information may cause unnecessary emotional problems cannot be excluded. IMPLICATIONS FOR PRACTICE: caregivers should ascertain that information about fetal risk is interpreted correctly by pregnant women.


Assuntos
Atitude Frente a Saúde , Síndrome de Down/diagnóstico por imagem , Programas de Rastreamento/psicologia , Gestantes/psicologia , Medição de Risco , Ultrassonografia Pré-Natal/psicologia , Adolescente , Adulto , Depressão/diagnóstico , Depressão/etiologia , Depressão/psicologia , Depressão Pós-Parto/diagnóstico , Depressão Pós-Parto/etiologia , Depressão Pós-Parto/psicologia , Feminino , Seguimentos , Humanos , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/métodos , Medição da Translucência Nucal/psicologia , Pesquisa Metodológica em Enfermagem , Educação de Pacientes como Assunto , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/etiologia , Complicações na Gravidez/psicologia , Escalas de Graduação Psiquiátrica , Medição de Risco/métodos , Fatores de Risco , Inquéritos e Questionários , Suécia , Ultrassonografia Pré-Natal/efeitos adversos , Ultrassonografia Pré-Natal/métodos , Adulto Jovem
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