More with fatal foetal diagnoses go for terminations

An increasing number of pregnant women who receive a diagnosis of a fatal foetal anomaly are travelling for abortion, a leading expert on foetal medicine has said.

Dr Peter McParland, director of foetal medicine at the National Maternity Hospital, said over the past eight to 10 years the stigma associated with abortion had reduced and "for some it is the right choice and for others it is not".

He said data was not gathered as to how many women chose termination and how many proceeded with their pregnancy, but it was clear, he said, that “we are seeing an increase in the number of patients [having been diagnosed with a fatal foetal anomaly] availing of termination of pregnancy”.

At a conference in Dublin, New developments in Perinatal Genetics, hosted by the Rotunda Hospital, he also presented data showing just half of pregnant women were offered screening for foetal anomalies such as Down syndrome, or Edward's and Patau's syndrome, which can both be fatal for the baby after birth.

“Wide disparities”

In addition there were “wide disparities” across maternity services in the type of testing offered, when in the pregnancy and by whom.

This was partly due to the influence of “religious and cultural beliefs” and was in contrast to other jurisdictions such as Britain where pre-diagnostic screening was offered to all pregnant women as standard and free of charge.

Such pre-diagnostic testing was not funded by the HSE, Dr McParland added. In most instances it must be paid for by the patient and could cost several hundred euros.

Dr McParland’s data was gathered in 2012 and he stressed things “have almost certainly improved” since.

“These tests are about information,” he said. “None of these women is setting out to have an abortion. If the news is good it allows them to enjoy the pregnancy and stop worrying. If it is less good, it can be about preparing for the birth, being counselled about what to expect, or it can be about exploring other options.

“The counselling can be very complex. I think patients are cared for very well. The counselling is non-directive and all of the options are discussed, and there can be a whole menu of options depending on a myriad different factors.

“However for equity, there should be greater uniformity of across services, certainly.”

First-trimester scan

The study, drawing on data gathered from all 20 maternity units in the State at the time – there are now 19 since the closure of Mount Carmel Hospital in Dublin earlier this year – found first-trimester scans were offered to all patients in 13 units, offered to some in six and offered to no women in one of them.

First-trimester screening – which involves a scan and a blood test to identify a pregnant woman’s risk of foetal anomaly – was only offered to all women in three units. It was offered to some in another three while in 14 units, no woman was offered screening.

If the screening indicated that a woman was a “positive risk” for an anomaly, she would usually go on to have a diagnostic test, which could be an amniocentesis or a CVS (chorionic villus sampling), both of which can determine definitively whether there is a foetal anomaly.