Antenatal Women’s Knowledge and Attitudes Respecting the practice of Ultrasonography in Saudi Arabia

INTRODUCTION

Prof. Donald brought ultrasound technology to the obstetrics department for the first time in 1958. Worldwide results for antenatal follow-up and pregnancy outcomes have shown that routine use of ultrasonography during pregnancy is significantly beneficial.¹ In the last several years, antenatal follow-up ultrasound has been regarded as a standard technique or approach for evaluating the pregnant mother and foetus. According to a previous study, all expectant mothers viewed ultrasound as a useful diagnostic radiological tool that might aid in the early detection of difficulties.² However, ultrasound is a very valuable diagnostic tool for pregnant women. This tool is frequently used to assess various anatomical characteristics of the foetus, including gestational age, femur length, head circumference, abdominal circumference, and transverse length of the cerebellum.³ Several countries provide prenatal screening for foetal structural abnormalities and aneuploidies like Down syndrome as part of standard prenatal care.⁴ In order to determine gestational age (GA), assess placental placement, identify single or multiple pregnancies, increase foetal abnormality detection, and improve pregnancy outcomes, the World Health Organization (WHO) recommends that all pregnant women have one ultrasound scan before 24 weeks of pregnancy.⁵ While all expectant women should undergo two US scans in the first and second trimesters, according to the International Federation of Gynaecology and Obstetrics (FIGO), to lower the risk of adverse perinatal outcomes.⁶ Proper antenatal care (ANC), in which the US plays a significant role, can prevent the pregnancy-related complications that plague women in underdeveloped nations.^7,8 Considering that women's decisions to undertake obstetric ultrasound tests are influenced by their attitude and amount of knowledge regarding pregnancy procedures. Pregnancy problems, however, might arise from a lack of knowledge of and understanding of the role of ultrasonography during pregnancy, Ultrasonography, on the other hand, can determine the date of delivery and discover foetal problems, health, and gestational weeks early. As a result, it's critical that all expectant mothers understand the benefits of using ultrasound. Numerous studies have demonstrated the significance of women's attitudes toward prenatal ultrasound and how it impacts their mental health; therefore, more research in this area is necessary. Besides, determined that pregnant women undergoing antenatal ultrasounds have a variety of expectations, the majority of which centre around learning the sex of the pregnancy, viability, anticipated due date, and assurance that the baby is healthy.⁹ Nevertheless, research findings on the safe use of ultrasound during pregnancy were scant in Saudi Arabia, and no studies were conducted to assess attitudes and understanding in this Aljouf area. Therefore, the purpose of this study was to evaluate pregnant women's attitudes and knowledge regarding the safe use of ultrasonography.

MATERIAL AND METHODS

Design, Area and duration of study

This cross-sectional study was carried out from January 2023 to September 2023 at the Obstetrics department of the Maternity and Children Hospital (MCH) who were referred to the Radiology department for their ultrasonography follow-up. The MCH located at the Sakaka, Aljouf Saudi Arabia. The Sakaka has one Maternity and Children Hospital. At the Maternity and Children hospital (MCH), the pregnant women referred from surrounding cities and primary health care services including antenatal care (ANC) follow-up, delivery facilities and as well as postpartum care. This research approved by IRB of research with project No 2023-89. We have selected the pregnant women who came at OPD for antenatal care. A convenient and randomly method for collecting the participants who were came for ANC and consultants referred them to ultrasonography for routing follow-up. All recruited individuals were gathered from the Radiology department as well as the Obstetrics OPD.

Participants of study

The source of participants for this research study was the attendance at MCH for antenatal care follow-up of all pregnant mothers. We included the three hundred four pregnant women by convenience sampling who were available during data collection for this study from January 2023 to September 2023.

Method of Sampling and Estimating Sample Size

The Cochran formula was used to determine a minimum sample size of 304, giving this study a power of 80% at a 95% level of significance and an alpha level of 0.05. For events such as non-response or recording error, an attrition value of 10% was permitted.

Sampling methods

Convenience sampling method applied for collection of participants who came in this hospital for their ANC between our research period.

Gathering of data

Face-to-face interviews were conducted using semi-structured, pretested questionnaires and posttest that recorded interviewee information or data. The questionnaires were initially written in English, then translated into Arabic as a native language before being distributed to the participants. The questionnaires were designed with the participants' demographics, obstetrical history, awareness of and use of ultrasound for ANC, and mother attitudes and knowledge about ultrasonography.

Data quality

Five percent (n = 15) of the 304 participants took the pretest at the MCH. During the pretest period, the interview questions were evaluated for their readability, comprehensiveness, and simplicity. Based on the pretest results, adjustments and modifications were made.

Data analysis

All information was initially gathered on a data collection sheet, which was subsequently moved to an Excel spreadsheet in 2014 for statistical analysis using IBM SPSS 22.0. The quantitative variable's percentage, frequency, and standard deviation calculations. The crude relationship between the utilization of prenatal ultrasounds and explanatory variables was found using logistic regression. An odds ratio with a 95% confidence interval was used to assess the strength of the link. The test of significance for proportions was the Chi-square test. Less than 0.05 for the two-tailed P value was deemed significant.

RESULTS

Three hundred four pregnant women were part of the current study, having attended MCH for antenatal follow-up. For their ultrasonography, all participants were referred to the Radiology department. Our study used questionnaires to collect data and present them. The demographic parameters include age, which is broken down into three categories: under 25 years old (41.1%), 26 to 30 years old (33.5%), and above 30 years old (77%). The mother's educational background is primary, secondary, and upper secondary school. 21.7%, 35.8%, and 42.4%, in that order. Whereas Table 1 showed occupation, financial situation, and place of residence.

Of all individuals, 21.3% and 78.6%, respectively, were found to be primigravida and multigravida. In the current study, there were 5.5% and 15.4% of birth defects and abortion histories, respectively. In this study, all antenatal pregnant women in variable trimesters—40.7% in the first, 43.7% in the second, and 15.4% in the third—participated. While 7.2% of minor issues were discovered, Table 2 displays all of the facts.

Table 3 asked participants a series of questions about safety ultrasound procedures during pregnancy, to which all participants provided answers. At a value of p < 0.05, the majority of participants demonstrated good knowledge that was statistically significant. "Are you aware that US can decide on the delivery date?" is one such query. possess no discernible differences.

Factors related to obstetrical ultrasound knowledge of pregnant women

Among the study participants, the mother's age, educational background, occupation, and place of residence were appropriate for both bivariate and multivariate analysis. Multivariate logistic regression in the current study revealed statistically significant relationships between age between 26 and 30 and over 30 years (AOR 0.94, 95% CI, (0.44–1.66), (AOR 1.35, 95% CI, (0.78–1.77), educational background such as secondary and above seconder school (AOR 0.54,95% CI, 0.11-2.17), (AOR 0.44,95% CI, 0.021-2.46), occupation as Government job (AOR 0.181, 95% CI, 0.049-0.66), school teacher (AOR 1.201, 95% CI, .678- 2.177) and location of residence in cities (AOR 0.151 95% CI, 0.033-0.44) all data represented in Table 4.

Attitude towards Ultrasonography

Every participant in the current study demonstrated a positive attitude toward the safe and other important aspects of using ultrasonography while pregnant. Although there were some negative statements, 37.2% and 21.3% of respondents thought that the ultrasonography process was painful and that it was a cause of cancer, respectively (Table 5).

Factors related to obstetrical ultrasound attitude of pregnant women

The Bivariate and multivariate assessment were performed and significant positive responded comparatively more than negative. Their noteworthy attitude toward age, educational background, and location was revealed by the logistic regression as far as (AOR 0.63 95% CI, 0.78-2.68), (AOR 1.02,95% CI, 0.86–3.25), educational background (AOR 0.54 95% CI, 0.11-2.17), (AOR 0.44 ,95% CI, 0. .021-2.46), occupation (AOR 0.181,95% CI, 0.049-0.66), (AOR 1.201,95% CI, 0.678- 2.177), and location of residence in cities (AOR 0.153, 95% CI, 0.036-0.55) respectively (Table 6).

DISCUSSION

As far as we are aware, the Aljouf area was the site of our initial investigation; there are no published statistics on this field there. Three hundred four pregnant women in total voluntarily participated in this study, and all of them answered the questionnaire. For their antenatal imaging follow-up, we enrolled pregnant women who were referred by the obstetrics department to the Radiology department. The chosen questions were designed so short and easy to answer that pregnant women with any kind of educational level may do so. Nonetheless, the majority of respondents in this study were between the ages of 26 and 30, which is the right age to become pregnant, according to earlier research that revealed similar data.^10-12 According to earlier research, the majority of pregnancy-related issues, including chromosomal defects, preterm or premature birth, and foetal abnormalities, develop after the age of 35.¹³ In addition, the study's multigravida individuals had a response rate that was significantly higher than that of primiparous. In the current study, about 60.8% of the pregnant women are from cities; as a result, they have access to more information than those who live outside of cities and have similar reports regarding their place of residence.¹⁴ The purposes, indications, and limitations of ultrasound were far better understood by patients with college degrees. As to the recommendations of the American Institute of Ultrasound in Medicine, ultrasonography is a safe and appropriate diagnostic tool during pregnancy.¹⁵

Knowledge of Antenatal Ultrasonography

The current study's findings showed that 61.6% of participants had strong knowledge, which was almost identical to what was observed in the other study.^6,16,8 These findings would suggest that when they visited the obstetrics department for antenatal care, they learned impotency of ultrasonography from medical professionals there. Additionally, those multigravida pregnant women who reside in Sakaka and have access to MCH frequently do so because they have a strong understanding of ultrasonography from a previous pregnancy. A total 8 question selected for knowledge and 84.9% of pregnant women agreed to know that ultrasonography (US) is important and safe investigation during pregnancy. While 76.3%, 72% and 77.3%, pregnant women believe that US detected the foetal wellbeing, foetal defect and week of gestation respectively. The primary reason for this high proportion of knowledge is because ultrasonography is now widely conducted in numerous countries and is routinely utilized as a component of antenatal (ANC) investigation in addition to other investigations. After learning the purpose of amniotic fluid in detail, 68.8% of participants in the current study were aware of it. According to a previous study, having a solid understanding of safety ultrasonography is crucial for identifying and managing pregnancy issues early on.¹⁷ Nonetheless, it is essential that medical practitioners inform pregnant women about the safety of ultrasound during ANC.

Attitudes towards Antenatal Ultrasonography

Antenatal ultrasonography scans were generally viewed positive by 65.5% of participants. This positive rate is attributable to ANC services provided by medical personnel. Therefore, the majority of participants learn about ultrasonography scans by health providers from their initial appointment with the ANC. Furthermore, in the present study, the participants exhibited 88.5% and 88.5% positive attitudes on the safety of ultrasound during pregnancy, as well as knowledge regarding foetal sex determination, which in turn influences the respect for ultrasound during pregnancy. Nevertheless, comparable studies described in a different study.^18-20 Moreover, 78.7% of pregnant women had confidence in safe ultrasonography.²¹ Although 21.3% of participants stated that ultrasonography causes cancer (Table 5), this concern was not well-represented due to low educational background. In contrast to other studies such as Nigeria, Jeddah and India, the attitude level in the current study is thought to be lower than 73.1% ,78.9% and 88%.^22-24

Factors associated with knowledge regarding used antenatal ultrasonography

The educational standing of pregnant women has a major impact on their knowledge; women who have completed secondary school or higher are more likely to have good knowledge than those who have not. Comparable results were found in research done in other nations.^23,25,26 One possible explanation for this could be that pregnant women who have higher educational statuses may also be more exposed to information. Living in a city is linked to having better ultrasound knowledge than living outside of one. This suggests that a lack of facilities stems from a lack of educational background, while comparable results were found in another study.^25,26

Factors associated with attitude regarding used antenatal ultrasonography

The status of education, age, and city of residency all had an impact on the pregnant women's attitudes of the safe use of ultrasonography in the current study. Evidence from earlier research shows that education level is crucial for obtaining knowledge about the safe use of ultrasonography in pregnant women.²² Current study, it is known that people working for the government had an upbeat attitude than others, however a similar finding was made in another study.²³ Since its inception in clinical care, obstetric ultrasound has become a major part of obstetrics, and there is no question that the benefits of this method have improved pregnancy outcomes. Therefore, in order to improve the management of pregnancy problems and ensure improved pregnancy outcomes, all pregnant women should undergo an ANC ultrasonography scan. A few limitations apply to this study: first, the research follow-up period was too short; second, because this study focused on pregnant women from a single hospital, the results could not be applied to the total community of pregnant women. We hope to conduct additional study that may involve various hospitals.

CONCLUSION

According to this study, pregnant women have a generally fairly good magnitude of knowledge 61.6% and attitude 65.5% regarding ultrasonography. Age, occupation, educational background, place of residence, and attitude toward antenatal ultrasonography were associated factors. Enhancing pregnant women's knowledge can be achieved by health workers in antenatal care facilities teaching them about the efficacy of ultrasonography. It is necessary to dispel the myth about the negative consequences of ultrasonography, particularly the cancer risk, by promoting interaction between sonographers and pregnant women and holding health discussions during ANC sessions. The author concluded by recommending that antenatal ultrasound screening be a component of antenatal care and that mothers should be informed about the benefits of obstetric ultrasonography. However, ultrasonography is widely acknowledged as a crucial study that plays a major role in antenatal care.

FUNDING: This work was funded by the Deanship of Scientific Research at Jouf University under grand No (DSR2023-01-02521).

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