Maternal anxiety and its correlation with pain experience during chorion villus sampling and amniocentesis.
OBJECTIVE
Invasive prenatal diagnostic procedures, such as chorion villus sampling (CVS) and amniocentesis (AC), are routinely performed to exclude or diagnose fetal chromosomal abnormalities. The aim of this study was to investigate anxiety-dependent pain experience during CVS and AC and the potential factors that increase anxiety and pain levels.


METHODS
During a 2-year period, women undergoing invasive procedures in three specialist centers were asked to participate in the study. Anxiety was evaluated before the procedure using the Spielberger State-Trait-Anxiety-Inventory, and pain was evaluated directly after the procedure using a verbal rating scale.


RESULTS
Among the women, 348/480 (73%) underwent AC, while 131/480 (27%) underwent CVS. There was a significant correlation between state and trait anxiety (p<0.0001). A positive correlation existed between the degree of anxiety and the level of pain experienced (p=0.01). There was a positive correlation for trait anxiety (p=0.0283) as well as for state anxiety (p=0.0001) and pain perception (p=0.0061) when invasive procedure was performed owing to abnormal ultrasound finding or to a history of fetal aneuploidy. Maternal age was found to be another influencing factor for the experienced pain (p=0.0016). Furthermore, the analysis showed a significant negative correlation between maternal age and anxiety. That applies for trait anxiety (p=0.0001) as well as for state anxiety (p=0.0001). The older the woman, the less anxious the reported feeling was in both groups. The main indication for undergoing CVS was abnormal ultrasound results (45%), and the main reason for undergoing AC was maternal age (58%).


CONCLUSIONS
Procedure-related pain intensity is highly dependent on the degree of anxiety before the invasive procedure. In addition, the indication has a significant impact on the emerging anxiety and consequential pain experiences. These influencing factors should therefore be considered during counseling and performance.
Department of Gynecology and Obstetrics, Hanover Medical School, Hanover; Department of Gynecology and Obstetrics, Diakovere Friederikenstift Hanover, Hanover.
Katharina
K
Klages
Department of Gynecology and Obstetrics, Hanover Medical School, Hanover.
Sudip
S
Kundu
Department of Anesthesiology, University of Goettingen, Pain Clinic, Goettingen.
Joachim
J
Erlenwein
Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
Michael
M
Elsaesser
Department of Gynecology and Obstetrics, Hanover Medical School, Hanover.
Peter
P
Hillemanns
Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
Alexander
A
Scharf
Department of Gynecology and Obstetrics, Hanover Medical School, Hanover.
Ismini
I
Staboulidou
amniocentesis; anxiety; chorion villus sampling; invasive prenatal procedure; procedure-related pain