Academic journal article Issues in Law & Medicine

Diagnosis of Fetal Anomaly and the Increased Maternal Psychological Toll Associated with Pregnancy Termination

Academic journal article Issues in Law & Medicine

Diagnosis of Fetal Anomaly and the Increased Maternal Psychological Toll Associated with Pregnancy Termination

Article excerpt

Life isn't fair and perhaps one of the most profound inequities is experienced by a small percentage of couples, who are eagerly awaiting the birth of a child and their worst fears are realized with the news of a significant fetal anomaly. Back in 1987 when I was pregnant with my first son, prenatal screening procedures were not offered frequently and they lacked the accuracy of contemporary assessment tools. My pregnancy progressed uneventfully, as did my friend Beth's. Our due dates were just two weeks apart and we shared each stage as well as our excitement, fears, and dreams related to our babies. Beth's daughter, Eliza Rose predictably entered the world a short time before my son Joe was born. Not so predictably, almost immediately after giving birth, Beth was shockingly informed that Eliza Rose suffered from Trisomy 13 (or Patau Syndrome).

Trisomy 13 is a chromosomal condition involving severe intellectual disability and physical abnormalities, including heart defects, brain or spinal cord problems, poorly developed eyes, and weak muscle tone, among other impairments. Many infants with Trisomy 13 die within weeks of birth and only a small minority live past a year. Today Beth would likely have learned of Eliza Rose's condition early in the second trimester and she would have been presented with the option to terminate her pregnancy. Beth, like so many other parents who are faced with the birth and death of a child within an obscenely short time frame, welcomed her daughter, learned to care for her, and cherished a few very special months with her. Was Beth at a disadvantage by not having the choice to terminate her pregnancy and spare herself, her husband, and little Eliza Rose a great deal of suffering? Or would her anguish have been amplified by choosing to terminate Eliza Rose's life before it ended naturally? Would Beth even have been truly able to make her own decision regarding her pregnancy in a medical context that typically involves recommendations and sometimes pressure to terminate? How do women today make choices between two difficult options in a social environment wherein a diversity of opinions abound? What do we know about the mental health trajectories of women who choose to terminate a pregnancy due to fetal anomaly versus that of women who opt to carry to term despite a grim prognosis? Are current practices in line with data that has accrued in the professional literature? What are the unmet needs of parents confronted with a prenatal diagnosis of fetal anomaly? These are the primary questions to be addressed in this review after providing basic background information on the incidence and detection of fetal anomalies, as well as statistics on the frequency of termination.

Detection of Fetal Anomaly: An Uncommon Occurrence of Mid to Late Pregnancy

Ultrasound imaging and biochemical testing innovations occurring in recent years, coupled with more advanced maternal age, have increased the detection rate of fetal anomalies. Today the majority of diagnoses for fetal anomalies occur in the prenatal period (Irving et ah, 2011; Parker et ah, 2010). Routine ultrasound examination typically includes a dating scan in the first trimester of pregnancy and a fetal abnormality scan at approximately 18 to 20 weeks gestation (Bijma, van der Heide, & Wildschut, 2008). By 18-20 weeks gestation, most anatomical structures are sufficiently formed and the size of the fetus is conducive to comprehensive examination with the aid of conventional trans-abdominal ultrasound (Lim, Whittle, Lee, Ryan, Sr Van Mieghem, 2013). High frequency trans-vaginal ultrasound probes and sophisticated software have enabled more detailed visualization at earlier points in pregnancy (Lim et al., 2013). Lim and colleagues (2013) recently reported an accuracy rate of 72% with early ultrasound at 12-17 weeks gestation for detection of fetal anomalies in a high-risk population. The false positive rate detected by this research team was 4%. …

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