Pre-natal screening is only for the few
By Olivia Fens
More than seven in 10 GPs believe there are ethical difficulties
with pre-natal screening in Ireland.
A new study carried out by doctors based at Dublin's Rotunda
Hospital gives the figure in an assessment of attitudes and needs for screening
of babies before birth.
The study attacks the lack of an Irish national policy
on prenatal screening, and calls for ultra-sonographic screening (eg, ultrasound)
to be routine for all pregnant women.
The study, reported in the Irish Medical Journal (IMJ),
found that only 26% of consultants had access to prenatal screening for
high-risk patients, and limited access for other patients.
Its authors, Dr Caoimhe Lynch and Professor Fergal Malone,
who work at the Rotunda Hospital in Dublin, said the ban on abortion here
is a factor (because prenatal screening could be seen as superfluous in
circumstances where termination was not available).
"Major foetal malformations occur in 2%-3% of fetuses
and account for 20-30% of perinatal mortality in developed countries. The
majority of malformations occur in pregnancies without obvious risk factors," say
the study authors.
"It is for this reason that routine ultrasonographic
screening, as distinct from that which is indication-based, has been recommended
for all women for the detection of fetal abnormalities."
As well as the low figure for consultants, their research
showed that 59% of specialist registrars and 35% of GPs could easily obtain
prenatal screening. This is for patients who meet certain risk factor criteria,
and the screening is harder to obtain for other patients.
The study finds Ireland needs to develop prenatal screening
guidelines, and says this will have major implications for the delivery
of obstetric care.
Only one study has been done of antenatal patients' attitudes
towards prenatal diagnostic tests and detailed foetal ultrasound screening.
The result was 75% of respondents said they would have a detailed foetal
anomaly scan if the service were available.
"Not only is there a disparity between international
best practices and actual practice in Ireland, there is also a significant
gap between patient expectations and actual services provided by physicians," the
The main reason for this seems to be funding, the authors
The Republic of Ireland is unusual in Europe because of
its restrictive laws on termination of pregnancy.
"In Ireland, many would argue that prenatal diagnosis
is not of benefit because termination of pregnancy is not available in
this jurisdiction. However, prenatal diagnosis should not be equated simply
with a decision on whether or not to undergo pregnancy termination," the
"Efficient prenatal diagnostic services provide reassurance
to the vast majority of couples when investigations are normal, allows
time for preparation and education for the couple if an abnormality is
found, and allows for the provision of subspeciality paediatric consultation,
in-utero therapy if feasible, and optimising the delivery setting. Prenatal
diagnosis also allows for the preparation for the delivery of an infant
with special needs as safely and sensitively as possible."
But more than 70% of GPs felt that there are ethical difficulties
for patients undergoing prenatal screening and diagnosis. The figure for
consultants was 38% and 52% of specialist registrars.
"A selection bias likely exists between those patients
seen by GPs and those who successfully make their way to obstetricians
to ask for further information regarding screening," the study report
*A nutrition conference in Dublin was told recently that a national
register of birth defects will soon be established. Ireland has one of
the highest rates of neural tube defects (NTDs) in Europe. NTDs are severe
birth defects such as spina bifida.
Between 50 and 90 babies born each year here are affected by NTDs.