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 authors said.

The main reason for this seems to be funding, the authors say.

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 study said.

"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 said.

*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.

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