Women's responses to ultrasound examinations during routine screens in an obstetric clinic.

OBJECTIVE: The primary purpose of this research was to evaluate the impact of prenatal ultrasound consultation on maternal-fetal attachment, knowledge of fetal behavior, and development and reduction of anxiety in pregnant women scheduled for routine ultrasound screens. A standard depression screen was also used to evaluate depression levels of women undergoing these screens in the sonography clinic. METHODS: To evaluate the impact of an ultrasound consultation, the following were undertaken: (1) a preliminary observational study of routine screens in the sonography clinic was performed; (2) an ultrasound consultation manual was developed and established as reliable; and (3) women undergoing evaluations between 16 and 26 weeks' gestational age were randomly assigned to a standard care group (n = 24; the standard clinical ultrasound screen) or an ultrasound consultation group (n = 28; the ultrasound consultation was done, including the standard screen with extended consultation on fetal development, maternal and familial responses, and maternal-fetal interaction). RESULTS: The ultrasound consultation group had a significant positive change in maternal-fetal attachment scores, lower state anxiety scores, and more favorable responses to the sonographic examination (P .05). Women's depression scores did not differ between the ultrasound consultation and standard care groups and were similar to maternal prenatal depression levels in other studies. CONCLUSIONS: Ultrasound consultation was responsible for increasing maternal-fetal attachment and reducing maternal anxiety. It may be an important component of more comprehensive prevention/intervention strategies. The implications for ultrasound consultation in clinical research and practice are discussed.     

Two-dimensional vs. two- plus four-dimensional ultrasound in pregnancy and the effect on maternal emotional status: a randomized study.

OBJECTIVE: To assess whether the addition of four-dimensional (4D) ultrasound to a conventional two-dimensional (2D) scan in the second/third trimester of pregnancy facilitates maternal recognition of specific fetal structures and movements and causes an emotional impact, as subjectively perceived by the woman. METHODS: Fifty-two women were randomly assigned to 2D ultrasound only (Group 1), while 48 women underwent 2D plus 4D ultrasound (Group 2). All the women completed two questionnaires. One questionnaire listed the fetal structures and movements that the women had recognized during the 2D scan or, for those women who also underwent a 4D scan, during the combination of the two; the other questionnaire required the women to score on an analog scale whether they had seen all the fetal parts and movements that they wished to see, whether they were satisfied with the scan, and if the scan had changed for the better their perception of the fetus. A subgroup of 46 women completed the Maternal Antenatal Attachment Scale (MAAS) designed to measure antenatal emotional attachment. RESULTS: Similar percentages of women in the two groups visualized fetal structures and movements, but facial expressions and hand-to-mouth movements were twice as likely to be seen with 4D ultrasound, although this difference did not reach statistical significance. The percentage of women who reported that they had seen all the fetal parts and movements that they wished to see, and of those who were satisfied overall with the scan, were similar in the two groups. There was no difference in the percentage of women who felt that the scan had changed for the better their perception of the fetus. Although the MAAS scores were similar in the two groups, there were more women with positive quality, intensity and global attachment among those who had undergone a 4D scan. Women who had seen all the fetal parts and movements they wished to see (whether with 2D or 2D plus 4D) answered more frequently that the scan had changed for the better their perception of the fetus. CONCLUSION: This randomized study indicates that the addition of 4D ultrasound does not change significantly the perception that women have of their baby nor their antenatal emotional attachment compared with conventional 2D ultrasound.     

Preexamination and postexamination assessment of parental-fetal bonding in patients undergoing 3-/4-dimensional obstetric ultrasonography.

OBJECTIVE: The purpose of this study was to determine whether there is a change in parental bonding and couples' attitudes toward their fetus after undergoing 3-/4-dimensional ultrasonography (3D/4DUS). METHODS: Sixty-five fathers and 124 mothers were asked to fill out a maternal-fetal attachment questionnaire relating to how they felt about their fetus before and after 3D/4DUS and to mark on a line indicating their feelings about the ultrasonography experience. In addition, 135 parents filled out a positive feelings questionnaire consisting of 5 sections assessing their feelings about the fetus. The 3D/4DUS examination included rendering of the fetal face, limbs, and thorax. RESULTS: One hundred forty-two patients filled out all questions and were analyzed for the total attachment score. The difference of the total score for the maternal-fetal attachment questionnaire before and after 3D/4DUS had a z value of 5.6 for all patients and was statistically significant (P < .0001). In analyzing each question, 5 were found to have a statistically significantly different score for women, but only 2 were found so for men. The scores for the line, before and after 3D/4DUS, showed a significant difference for men but not women. The women studied did not show a change using this instrument because their median response was at the maximum measurement before their sonograms. The positive feelings questionnaire showed a statistically significant change for women in all sections but for men in only 2. CONCLUSIONS: Parents have a change in attitude regarding their fetus after undergoing 3D/4DUS. Mothers showed an increase in bonding to their fetus after 3D/4DUS in more categories than fathers.     

孕晚期孕妇母胎依恋现状及影响因素分析

目的: 分析孕晚期孕妇母胎依恋现状及其影响因素。方法: 便利取样法,选取2019年8月至12月于天津市某三级甲等医院产科门诊就医的210例孕晚期孕妇为研究对象。采用一般资料调查表、母胎依恋关系量表（MAAS）等研究工具进行调查。采用多重线性逐步回归分析法进行多因素分析。结果: 孕晚期孕妇MAAS得分（75.93±6.03）分。多重线性逐步回归分析结果显示,家庭人均月收入、抑郁、消极应对及领悟社会支持是孕晚期孕妇母胎依恋的影响因素（P<0.01）,解释总变异量的43.3%。结论: 孕晚期孕妇母胎依恋水平处于较高水平,受多种因素影响。医护人员可通过提高其积极应对能力和社会支持水平,改善其母胎依恋质量,从而促进母婴健康。     

Effect of fetal movement, ultrasound scans, and amniocentesis on maternal-fetal attachment

The effects of fetal movement, ultrasound scans, and amniocentesis on maternal-fetal attachment and perception of fetal development in normal pregnancy were examined in 91 women during the second trimester. Women who reported feeling fetal movement early in pregnancy had higher maternal-fetal attachment scores and higher perception of fetal development scores. Ultrasound scans had no effect on either variable. Women who had genetic amniocentesis had lower attachment scores before the procedure, but one month later the attachment scores were not significantly different from those of other women. Both maternal-fetal attachment and perceptions of fetal development increased significantly from 16 to 20 weeks of gestation. There was a small but significant correlation between attachment scores and perception of fetal development.     

The Relationship of Maternal-Fetal Attachment and Postpartum Depression: A Longitudinal Study

Aim

To determine the relationship between maternal-fetal attachment and postpartum depression.

Patterns of normal change in cervical length and width during pregnancy in nulliparous women: a prospective, longitudinal ultrasound study.

OBJECTIVES: To determine what constitutes normal changes in the uterine cervix visible at transvaginal ultrasound examination from 24 gestational weeks until delivery in nulliparous women delivering at term. DESIGN: Cervical length and width were measured using transvaginal ultrasound, and the inner cervical os was assessed as being closed or open every 2 weeks from gestational week 24 until delivery in 19 healthy nulliparae delivering at term. RESULTS: In all but one woman cervical length decreased, and in all but one woman cervical width increased, with advancing gestation. Three patterns of change in cervical length were observed: a continuous decrease ( n = 10), an accelerated shortening rate after approximately 30 gestational weeks ( n = 5), or a sudden drop in length between the last two examinations ( n = 3). The median rate of decrease in cervical length was 1 (range, 0.6-1.9) mm/week for women with continuous shortening of the cervix. For women with accelerated shortening the corresponding figure was 2.2 (range, 1.8-2.7) mm/week after the start of accelerated shortening. Two patterns of increase in cervical width (cervical broadening) were noted: a continuous increase ( n = 12), or an accelerated broadening rate from around 32 weeks ( n = 6). The median rate of increase in cervical width was 0.8 (range, 0.3-2.0) mm/week for women with continuous broadening of the cervix. For women with accelerated broadening rate the corresponding figure was 1.7 (range, 1.0-6.4) mm/week after the start of increased broadening rate. Opening of the internal cervical os was observed at least once in eight of the 19 women (42%) and was first observed at 30 gestational weeks. Dynamic changes (i.e. opening and closing of the inner cervical os during examination) were seen in six women (32%) and were first detected at 31 gestational weeks. CONCLUSIONS: There are different patterns of normal change in cervical length and width during pregnancy in nulliparous women. This must be taken into account if repeated ultrasound examinations of the cervix during pregnancy are used to identify nulliparae at increased risk of preterm delivery.     

Prenatal three-dimensional ultrasound: perception of sonographers, sonologists and undergraduate students.

OBJECTIVE: To assess the perception of non-pregnant sonographers, sonologists and undergraduate students on the use of three-dimensional (3D) ultrasound technology in fetal medicine. METHODS: This was a study of two groups of non-pregnant subjects. Group I included 520 (305 female, 215 male) medical professionals who completed a questionnaire after attending a lecture on 3D imaging. Factors such as gender, career and having children were analyzed with respect to the attendee's responses about use of 3D ultrasound for medical purposes and for reassurance. Group II included 137 (75 female, 60 male, two unknown) undergraduate students from bioengineering, psychology and physiology classes who completed a questionnaire after attending a brief presentation on two-dimensional and 3D fetal imaging. Factors such as gender and area of educational interest were analyzed with respect to the students' responses about the use of 3D ultrasound for medical purposes and for parental-fetal attachment. RESULTS: In Group I, 63% said that they would like to have a 3D ultrasound examination in the future, while 14% said that they would not. Common reasons given for wanting a 3D ultrasound exam in the future were for medical purposes (39%) or reassurance (18%). The main differences perceived between two-dimensional (2D) and 3D ultrasound were medical advantages (65%) and parental reassurance (28%). 62.4% of Group I thought 3D technology should be in wide use in obstetric ultrasound and 73.6% thought that 3D ultrasound would reassure parents carrying normal fetuses. Gender, age and career did not have a significant influence on perception of 3D ultrasound. In Group II, the majority (91%) said they could see a remarkable difference between 2D and 3D ultrasound. 83% responded that they would like to have a 3D ultrasound examination of their own baby in the future for the following reasons: 34% for the detailed picture, 31% for increased abnormality detection, 13% for reassurance or curiosity; 8% thought it would be unnecessary or a negative experience. Concerning parental-fetal attachment, 72% thought 3D ultrasound would have a positive effect. The majority of Group II (93%) thought 3D ultrasound would be valuable and 56% thought 3D ultrasound would assist in diagnosing fetal abnormalities. There was no significant relationship between gender, age or area of interest and the perception of 3D ultrasound. CONCLUSIONS: Responses by sonographers and physicians suggest that 3D ultrasound will have a role in the future for medical indications and in reassuring patients carrying normal fetuses. Our results also suggest that undergraduate students believe that 3D ultrasound will be a valuable technique in obstetrics and that it will have a positive effect on parental-fetal attachment.     

抑郁在妊娠晚期孕妇身体不满与母胎依恋间的中介效应

目的 探讨妊娠晚期孕妇抑郁在身体不满及母胎依恋间的中介效应。方法 便利选取2022年7—8月在郑州市某三级甲等医院产科门诊做产前常规检查的246例妊娠晚期的孕妇为研究对象。使用母胎依恋关系量表、孕期身体感受测评量表及爱丁堡产后抑郁量表对其进行调查。结果 妊娠晚期孕妇母胎依恋得分为（73.89±7.31）分、身体不满得分为（47.91±7.47）分、抑郁得分为（8.09±3.25）分。身体不满与抑郁呈正相关（P<0.001）,与母胎依恋呈负相关（P<0.001）;母胎依恋与抑郁呈负相关（P<0.001）。抑郁在身体不满与母胎依恋起部分中介作用,中介效应占总效应的60.25%。结论 妊娠晚期孕妇抑郁、身体不满和母胎依恋关系密切,身体不满可通过抑郁间接影响母胎依恋。医护人员可通过降低孕妇的身体不满程度,改善抑郁状况,增强母胎依恋水平。     

Cranial Ultrasound Screening Protocols for Very Preterm Infants

Cranial ultrasound examinations are routinely performed in very preterm neonates. There is no widespread agreement on the optimal timing of these examinations. This review examines screening protocols and recommendations available for the timing of cranial ultrasound examinations in preterm neonates born before 32 wk of gestation. A systematic search was performed to find published screening protocols, and 18 articles were included in the final review. The protocols varied in their recommendations on timing, although at least one examination in the first week of life was universally recommended. The recommended timing for a “late” or final ultrasound examination was variable, and included at 6 wks of postnatal age, term-equivalent age or hospital discharge. There was no agreement as to whether weekly or fortnightly sequential ultrasound imaging should be performed after the first week of life. Further studies are required to establish an optimal protocol for these very preterm neonates to improve detection and monitoring of brain injuries.     

Impact of the availability of sonography in the acute gynecology unit.

OBJECTIVE: The initial assessment of acute gynecology patients is usually based on history and clinical examination and does not involve ultrasound. The aim of this study was to investigate the impact of the availability of transvaginal sonography at the time of initial assessment of the emergency gynecology patient. METHODS: This was a prospective observational study carried out over a 5-month period in the acute gynecology unit of an inner London teaching hospital. Women were assessed in the routine manner by history-taking and clinical examination and questionnaires were completed by the doctors, including details of the intention to treat. Transvaginal ultrasound examinations were then performed and a second diagnosis and management plan were made utilizing the extra information from the scan. The plans for clinical management before and after the ultrasound examination were compared. RESULTS: We originally recruited 1000 consecutive women to the study. The mean age was 31.1 (SD, 9.81) years. Complete data were available for 920 (92%). 84 (9.1%) women did not require a scan. Of the 521 women with a positive pregnancy test, 75.6% were reassured immediately that their pregnancy was intrauterine. 143 women (27.4%) were given the diagnosis of a suspected ectopic pregnancy before sonography, compared with 29 (5.6%) after. Following the ultrasound examination there was a change in clinical management in 54.1% of the women with a positive pregnancy test and a reduction in admissions (including inpatient theater admissions) (from 40.3% to 17.1%) and outpatient follow-up examinations (from 41.1% to 35.5%). In 90 (23.8%) non-pregnant women a significant ovarian cyst (> 5 cm) was suspected clinically; 28/90 (31.1%) were confirmed on sonography. Following the ultrasound examination there was a change in clinical management for 38.1% of non-pregnant women and a reduction in admissions (from 37.1% to 19.4%) and outpatient follow-up examinations (from 25.7% to 18.1%). CONCLUSION: It appears that the availability of transvaginal sonography at the time of initial assessment of emergency gynecology patients improves diagnostic accuracy and reduces unnecessary admissions and follow-up examinations.     

Effects of ultrasound on maternal-fetal bonding: a comparison of two- and three-dimensional imaging.

OBJECTIVES: The purpose of this study was to evaluate the effect of two-dimensional (2DUS) compared to three-dimensional ultrasound (3DUS) imaging on the maternal-fetal bonding process. METHODS: Fifty mothers who had 2DUS and 50 who had 2DUS and 3DUS were included in the study. A postpartum survey by telephone interview was carried out to assess maternal-fetal bonding. Bonding was evaluated by analysis of extent of prenatal image sharing, maternal ability to form a mental picture of the baby and mother's comments about their ultrasound images. Data were analyzed using the independent t-test, Chi-square and Mann-Whitney U-tests. RESULTS: Mothers who received 3DUS showed their ultrasound images to more people (median, 27.5; interquartile range, 14.5-40.0) than mothers receiving 2DUS alone (median, 11.0; interquartile range, 5.0-25.5) (P < 0.001, Z = -3.539). Eighty-two percent of the subjects screened with 3DUS had a greater tendency to form a mental picture of the baby postexamination compared to 39% of the 2DUS subjects (P < 0.001, Z = -3.614). Mothers receiving a 3DUS study were more likely to receive comments on the similarities/differences of the neonate compared to those having 2DUS studies. Furthermore, 70% of the mothers receiving 3DUS felt they 'knew' the baby immediately after birth vs. 56% of the mothers receiving 2DUS (P = 0.009, Z = -2.613). Both 2DUS and 3DUS experiences were positive, however, the comments made by the mothers undergoing 3DUS (n = 18) were more exclamatory (amazed, wonderful, fabulous) than those undergoing 2DUS (n = 4). Patients having a 3DUS examination consistently scored higher than those having a 2DUS examination alone for all categories of maternal-fetal bonding. CONCLUSION: 3DUS appears to more positively influence the perceptions of mothers to their babies postbirth compared to 2DUS. Specifically, mothers who had 3DUS showed their ultrasound images to a greater number of people compared to mothers who had 2DUS alone and this may represent mother's social support system. 3DUS may have a greater impact on the maternal-fetal bonding process.     

Maternal Obesity Limits the Ultrasound Evaluation of Fetal Anatomy

Objective. The purpose of this study was to evaluate the effect of maternal habitus on adequate visualization of fetal anatomy during a standard second‐trimester ultrasound examination. Methods. This was a retrospective cohort study of singleton pregnancies at 18 to 24 weeks that underwent sonography over a 5‐year period. Pregnancies complicated by an indication for targeted sonography were excluded. Standard ultrasound examinations were performed according to American Institute of Ultrasound in Medicine criteria. Ten anatomic components were evaluated for adequacy of visualization: atria of the cerebral ventricles, posterior fossa, midline face, 4‐chamber view of the heart, spine, ventral wall, umbilical cord vessels, stomach, kidneys, and bladder. The body mass index (BMI) was based on the patient's weight at the first prenatal visit. Results. Of 10,112 women who underwent a standard ultrasound examination, 2% were underweight; 38% were of normal weight; 34% were overweight; and 26% were obese. Visualization of fetal anatomy decreased significantly with increasing maternal BMI for the complete survey as well as for each individual component with the exception of the fetal bladder (all P < .001). Among those with a normal or underweight BMI, an overweight BMI, and class 1, 2, and 3 obesity, all 10 anatomic components were adequately visualized at the initial examination in 72%, 68%, 57%, 41%, and 30% of cases, respectively (P < .001). Conclusions. Increasing maternal BMI limits visualization of fetal anatomy during a standard ultrasound examination at 18 to 24 weeks. In obese women, the fetal anatomy survey could be completed during the initial examination in only 50% of cases. Counseling may need to be modified to reflect the limitations of sonography in obese women.     

Binding-in: still a relevant concept?

Development of the maternal-fetal relationship was described by Rubin as an intimate "binding-in process." Recent technological advances enabled health care providers to observe, study, diagnose, and treat unborn children and led some to reconsider the relevance of the binding-in concept. Research has focused on prenatal attachment or bonding, maternal characteristics that influence prenatal attachment/bonding, and interventions to promote it. Before binding-in is dismissed as irrelevant, assessment of the prenatal attachment research, consideration of the impact of these ideas on pregnant women and their families, and the implications for maternity nurses must be examined.     

Reference data representative of normal findings at two-dimensional and three-dimensional gray-scale ultrasound examination of the cervix from 17 to 41 weeks' gestation.

OBJECTIVES: To create reference values representative of normal findings on two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVS) examination of the cervix from 17 to 41 weeks' gestation and to determine the agreement between cervical measurements taken by 2D and 3D TVS. METHODS: Cross-sectional study covering 17 to 41 weeks in 419 nulliparous and 360 parous women who delivered at term and who underwent 2D and 3D TVS examination of the uterine cervix. We examined approximately 25 women in each gestational week. The length, anteroposterior (AP) diameter and width of the cervix (and of any cervical funnel) and AP diameter of the cervical canal were measured. Results were plotted against gestational age. The agreement between 2D and 3D ultrasound results was expressed as the mean (+/- 2 SDs) difference between the results of the two methods and as the interclass correlation coefficient (inter-CC). RESULTS: There was excellent agreement between measurements taken by 2D and 3D ultrasound (inter-CC values, 0.80-0.98) but measurements of cervical length taken using 3D ultrasound were greater than measurements taken by 2D ultrasound (mean difference, -0.04 +/- 0.36 cm). Cervical length did not change substantially between 17 and 32 gestational weeks but decreased progressively thereafter. Cervical length was similar in nulliparous and parous women at 17-32 weeks, but from 33 weeks the cervix tended to be longer in parous women. In nulliparae, cervical length decreased from a median of 3.8 (range, 0.7-6.1) cm at 17-32 weeks to 2.3 (range, 0.4-6.0) cm at 33-40 weeks and to 0.7 (range, 0.2-1.5) cm at 41 weeks. In parous women, the corresponding figures were 3.9 (range, 1.0-6.1) cm, 3.0 (range, 0.4-5.7) cm and 0.8 (range, 0.4-3.4) cm (results obtained by 3D ultrasound). Cervical AP diameter and width did not differ between nulliparous and parous women. Median AP diameter increased from 3.0 (range, 2.0-4.6) cm at 17-30 weeks to 3.5 (range, 1.8-5.5) cm at 31-40 weeks and to 4.0 (range, 2.8-5.9) cm at 41 weeks. Cervical width was 3.7 (range, 2.3-6.0) cm at 17-30 weeks and 4.5 (range, 2.3-6.1) cm at 31-41 weeks. The percentage of women with funneling increased from 4% (3/84) at 17-18 weeks to 63% (12/19) at 41 weeks and the percentage of women with an open cervical canal increased from 19% (15/84) to 72% (13/19). Funneling and opening of the cervical canal were equally common in nulliparous and parous women. CONCLUSIONS: Reference data provide the basis for studies of pathological conditions. Common reference values for nulliparous and parous women can be used for cervical AP diameter and width from 17 to 41 weeks and for cervical length from 17 to 32 weeks. Separate reference values for cervical length for nulliparous and parous women should be used from 33 to 41 weeks.     

Three-dimensional ultrasound: a novel technique for investigating the urethral sphincter in the third trimester of pregnancy.

OBJECTIVES: To measure urethral sphincter volume by three-dimensional (3D) ultrasound. To assess the reproducibility of this measurement technique and to compare volumes obtained using 3D ultrasound with volumes calculated from a formula based on 2D ultrasound measurements. METHODS: Women were recruited as part of an ongoing study of changes to the pelvis resulting from pregnancy and childbirth. One hundred and eleven women in the third trimester of pregnancy (between 32 and 41 completed weeks' gestation) underwent a 3D transvaginal ultrasound scan of the urethra. In 10 cases the scan was analyzed twice by different observers to assess the reproducibility of the measurements from the scans and the results were analyzed using limits of agreement. RESULTS: The interobserver error was consistent between all the linear, 2D and 3D measurements obtained from the area scanned. There was a significant difference between volumes calculated directly by 3D ultrasound and the approximated volumes from conventional 2D measurements. CONCLUSIONS: Three-dimensional ultrasound appears to be a useful tool in measuring urethral sphincter volume. The error is consistent with that of linear and 2D imaging. However, the increase in normal range generated by biological variation in all three planes makes 3D ultrasound a more sensitive method of evaluating change to the urethral sphincter.     

Identifying predictors of breastfeeding self-efficacy in the immediate postpartum period

Researchers have found evidence that breastfeeding self-efficacy is an important variable that significantly influences initiation and duration rates. The purpose of this study was to develop a multi-factorial predictive model of breastfeeding self-efficacy in the first week postpartum. As part of a longitudinal study, a population-based sample of 522 breastfeeding mothers in a health region near Vancouver, British Columbia completed mailed questionnaires at 1-week postpartum. Bivariate correlations were used to select variables for the multiple regression analysis. The best-fit regression model revealed eight variables that explained 54% of the variance in Breastfeeding Self Efficacy Scale (BSES) scores at 1-week postpartum: maternal education, support from other women with children, type of delivery, satisfaction with labor pain relief, satisfaction with postpartum care, perceptions of breastfeeding progress, infant feeding method as planned, and maternal anxiety. The BSES may be used to identify risk factors, enabling health professionals to improve quality of care for new breastfeeding mothers.     

Relationships between nausea and vomiting, perceived stress, social support, pregnancy planning, and psychosocial adaptation in a sample of mothers: a questionnaire survey

BACKGROUND: Women worldwide experience pregnancy-related nausea and vomiting yet tolerate this significant prenatal stressor. The physical and emotional stress caused by pregnancy-related nausea and vomiting may influence maternal psychosocial adaptation yet few studies have examined these relationships. OBJECTIVES: The purpose of the study was to examine the relationships between nausea and vomiting, perceived stress, social support and their ability to predict maternal psychosocial adaptation among Taiwanese women during early pregnancy. DESIGN: A correlational, cross-sectional research design. SETTING: Four prenatal clinics in Taiwan. PARTICIPANTS: Women (n=243) who had completed the 6-16 week of gestation consented to participate. METHODS: Subjects completed four self-report questionnaires in additional to providing demographic data: Index of Nausea, Vomiting, and Retching (INVR), Perceived Stress Scale (PSS), Interpersonal Support Evaluation List (ISEL), and the Prenatal Self-Evaluation Questionnaire (PSEQ). RESULTS: Pregnancy-related nausea and vomiting was experienced in varying degrees by 188 (77.4%) women. Stepwise multiple regression analysis revealed that 37.6% of the variance in maternal psychosocial adaptation was explained by the severity of nausea and vomiting, perceived stress, social support, and pregnancy planning. CONCLUSIONS: Women at higher risk for poor maternal psychosocial adaptation have not planned their pregnancy and experience severe pregnancy-related nausea and vomiting. Severe pregnancy-related nausea and vomiting associated with high-perceived stress levels may be mediated by social support.