Decision-making after Ultrasound Diagnosis of Fetal Abnormality

Abstract

Congenital abnormalities are the main cause of infant death in industrialised countriesY Furthermore, these form the main diagnosis in end-of-life decisions in infants.3 Congenital abnormalities are frequently diagnosed before birth, as most major congenital abnormalities can be detected by routine prenatal examination, including ultrasound. Table 1 gives a general picture of the nature and severity of congenital abnormalities as well as the possibilities and limits of prenatal diagnosis. This table is based on data derived from an unselected British population, which is comparable to the Dutch population? Ultrasound scanning is considered the most important tool for prenatal diagnosis of structural congenital abnormalities. It detects the majority but certainly not all of the congenital abnormalities. 7 In centres for prenatal diagnosis for example, detection rates are 80-95%. However, these vary with the nature of congenital abnormalities. For example, the detection rate of neural tube defects is 98% while congenital heart defects are prenatally identified by ultrasound in 38%? Furthermore, maternal obesity results in considerably lower detection rates. When severe congenital abnormalities are detected prenatally, couples may request for termination of pregnancy? In the majority of end-of-life decisions, suspicion of fetal abnormality was first aroused after ultrasound scan. Hence, the practice of ultrasound scanning is closely related to that of end-of-life-decisions.