title: Two sides of the same coin--an interview study of Swedish obstetricians' experiences using ultrasound in pregnancy management.
abstract: BACKGROUND
  The extended use of ultrasound that is seen in maternity care in most Western countries has not only affected obstetric care but also impacted on the conception of the fetus in relation to the pregnant woman. This situation has also raised concerns regarding the pregnant woman's reproductive freedom. The purpose of this study was to explore Swedish obstetricians' experiences and views on the role of obstetric ultrasound particularly in relation to clinical management of complicated pregnancy, and in relation to situations where the interests of maternal and fetal health conflict.
  
  
  METHODS
  A qualitative study design was applied, and data were collected in 2013 through interviews with 11 obstetricians recruited from five different obstetric clinics in Sweden. Data were analysed using qualitative content analysis.
  
  
  RESULTS
  The theme that emerged in the analysis 'Two sides of the same coin' depicts the view of obstetric ultrasound as a very important tool in obstetric care while it also was experienced as having given rise to new and challenging issues in the management of pregnancy. This theme was built on three categories: I. Ultrasound is essential and also demanding; II. A woman's health interest is prioritised in theory, but not always in practice; and III. Ultrasound is rewarding but may also cause unwarranted anxiety.
  
  
  CONCLUSIONS
  The widespread use of ultrasound in obstetric care has entailed new challenges for clinicians due to enhanced possibilities to diagnose and treat fetal conditions, which in turn might conflict with the health interests of the pregnant woman. There is a need for further ethical discussions regarding the obstetrician's position in management of situations where maternal and fetal health interests conflict. The continuing advances in the potential of ultrasound to impact on pregnancy management will also increase the need for adequate and appropriate information and counselling. Together with other health care professionals, obstetricians therefore need to develop improved ways of enabling pregnant women and their partners to make informed decisions regarding pregnancy management.
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden. annika.ahman@umu.se.
authors.forename: Annika
authors.initials: A
authors.lastname: Åhman
authors.affiliation: Department of Nursing, Umeå University, Umeå, Sweden. margareta.persson@umu.se.
authors.forename: Margareta
authors.initials: M
authors.lastname: Persson
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden. kristina.edvardsson@umu.se.|Judith Lumley Centre, La Trobe University, Melbourne, Vic, 3000, Australia. kristina.edvardsson@umu.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Edvardsson
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden. ann.lalos@obgyn.umu.se.
authors.forename: Ann
authors.initials: A
authors.lastname: Lalos
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Solna, Sweden. sofie.graner@karolinska.se.|Department of Medicine, Centre for Pharmacoepidemiology, Karolinska Institutet, Solna, Sweden. sofie.graner@karolinska.se.
authors.forename: Sophie
authors.initials: S
authors.lastname: Graner
authors.affiliation: Judith Lumley Centre, La Trobe University, Melbourne, Vic, 3000, Australia. r.small@latrobe.edu.au.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Small
authors.affiliation: Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden. ingrid.mogren@obgyn.umu.se.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Mogren
mesh_terms: D000328:Adult; D019468:Disease Management; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000941:ethics*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000000981:diagnostic imaging*; D011295:Prenatal Care / Q000592:standards*; D036301:Qualitative Research; D013548:Sweden; D016216:Ultrasonography, Prenatal / Q000941:ethics*; D016387:Women's Health; D014933:Women's Rights