Fetal anomaly

Speedie, J; Lyus, R; Robson, SC

doi:10.1017/CBO9781107338623.019

Fetal anomaly

Lookup NU author(s): Professor Steve Robson ORCiD

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Abstract

In many developed countries antenatal screening for fetal anomalies is offered to all pregnant women. As antenatal screening tests and the use of ultrasound to detect fetal anomalies improve, more women/couples are discovering in early pregnancy that their unborn child has a structural or chromosomal anomaly [1, 2]. This news is likely to be extremely distressing and is immediately followed by having to face dificult decisions regarding whether to continue with the pregnancy or not [1]. According to the British Abortion Act 1967, as amended by the Human Fertilisation and Embryology Act 1990, termination of pregnancy for fetal anomaly (TOPFA) can be legally performed either under section 1(1)(a) of the Act up to 24 weeks’ gestation, or under section 1(1)(d) at any point in the pregnancy. Section 1(1)(a) can be used if two medical practitioners believe that as a result of the fetal anomaly ‘the continuance of the pregnancy would involve risk, greater than if the pregnancy were terminated, of injury to the physical or mental health of the pregnant woman or any existing children or her family’ [1]. Section 1(1)(d) can be used if ‘there is a substantial risk that, if the child were born, it would suffer from such physical or mental abnormalities as to be severely handicapped’. At present there is no legal definition of what constitutes a ‘substantial risk’ or a ‘serious handicap’ [1]. Thus decisions around TOPFA at erffetal viability are particularly challenging for both parents and health professionals. Fetal medicine specialists acknowledge the dificulties of ensuring they work within the law and within their own ethical frameworks [3]. Practice with respect to which abnormalities meet the legal criteria is governed largely by consensus between colleagues [3].