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Breaking Bad News to a Pregnant Woman With a Fetal Abnormality on Ultrasound

Greiner, Andrea L. MD*; Conklin, Jona MD

Obstetrical & Gynecological Survey: January 2015 - Volume 70 - Issue 1 - p 39–44
doi: 10.1097/OGX.0000000000000149

Ultrasound is a common procedure performed in pregnancy. Most obstetric patients have an ultrasound between 18 and 20 weeks’ gestation. While there is debate regarding the utility of this ultrasound, it has become a routine part of prenatal care. Discovery of a fetal anomaly on ultrasound is most commonly an unexpected, emotionally devastating event for pregnant women. Counseling these women about the ultrasound findings requires empathy and sensitivity. This task falls on the physicians caring for pregnant women: maternal-fetal medicine specialists, radiologists, generalist obstetricians, and family medicine physicians. Their training regarding breaking bad news is varied. Therefore, the purpose of this article is to provide a framework to break bad news of an anomalous fetus for physicians caring for pregnant women using the SPIKES protocol. The SPIKES acronym stands for setting, perception, invitation, knowledge, empathize, summary, and strategy.

Target Audience Obstetricians and gynecologists, family physicians

Learning Objectives After completing this CME activity, physicians should be better able to discuss the importance of “pretest” counseling prior to an obstetric ultrasound, use the SPIKES protocol in clinical practice to break bad news, and sensitively counsel women who are not native English speakers, are adolescents, or are intellectually impaired.

*Clinical Assistant Professor, Department of Obstetrics & Gynecology, University of Iowa Carver College of Medicine, Iowa City; and †Staff Physician, Perinatal Center of Iowa, Des Moines, IA

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

Correspondence requests to: Andrea L. Greiner, MD, Department of Obstetrics & Gynecology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242. E-mail:

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