Paper

Fetal Diagnosis - Obligations of the Clinician
Case Studies in the Prenatal Diagnosis of Major Heart Abnormality
Samuel Menahem^a, Lynn Gillam<sup>b

a</sup>Paediatric Cardiology and Fetal Diagnostic Unit, Monash Medical Centre, and
^bCentre for Health and Society, University of Melbourne, Melbourne and Clinical Ethicist, Royal Children's Hospital, Melbourne, Australia

Address of Corresponding Author

Fetal Diagn Ther 2007;22:233-237 (DOI: 10.1159/000098725)

  Key Words

• Heart abnormality
• Counselling
• Ethics

  Abstract

Fetal echocardiography allows for accurate diagnosis of major heart abnormalities by 16-18 weeks. The parents have up to 22 weeks to consider possible termination. What are the obligations of the clinician once an abnormality is found? Should only information be provided or is there a role in influencing the parents' decision? Two diverse examples are provided to discuss these questions. Mrs A., aged 40 years was noted at the 18-week and then the 20-week scan to have a fetus with a complete atrio-ventricular septal defect. In addition, the fetus had a Danny-Walker cyst. There was thickened nuchal folds and echogenic bowel all suggestive of a chromosomal abnormality. Amniocentesis was refused and the pregnancy continued. Mrs B., aged 34 years was noted at 19 weeks and again at 20 weeks to have a fetus with mild thickening of the walls of both the right and left ventricles. The flow patterns appeared normal. Despite a probable good outlook, the parents asked for a repeat scan at 22 weeks to allow them to consider possible termination. Despite a probable chromosomal abnormality, definite major cardiac and neurological abnormalities, Mrs A. refused karotyping and planned to proceed with the pregnancy. Mrs B., despite a probable good outcome for the fetus asserted pressure for us to prognosticate by 22 weeks. While non-directive counselling is the accepted norm, is that appropriate for all situations? Should one strongly influence Mrs A. to have an amniocentesis to confirm a probable Trisomy thereby allowing her to make a more informed decision? How reassuring can the clinician be to Mrs B. and if termination is sought should one counsel against that? Arguments for these positions are described, highlighting the difficulties faced by clinicians as they counsel parents often with incomplete information and in a setting of acute emotional distress.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Prof. S. Menahem, Monash University Heart and Chest Research Institute
Department of Psychological Medicine, Monash University, Monash Medical Centre
246 Clayton Road, Clayton 3168, Victoria (Australia)
Tel. +61 3 9594 2242, Fax +61 3 9594 6239 E-Mail samuel.menahem@southernhealth.org.au

  Article Information

Received: September 14, 2004
Accepted after revision: May 2, 2005
Published online: January 17, 2007
Number of Print Pages : 5
Number of Figures : 0, Number of Tables : 0, Number of References : 26