How to care for fetuses with prenatally diagnosed severe abnormalities
Article Sidebar
Main Article Content
Abstract
Ultrasound in pregnancy has become standard of care, resulting in an increased number of antenatally diagnosed fetal anomalies. It is
important to have a consistent approach to the management of these abnormalities. This may include offering termination of pregnancy,
standard care or non-aggressive/palliative care. A categorisation of anomalies and management options is proposed to assist with these
decisions, underpinned by an ethical framework.
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJOG is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
Oladapo OT. Amniocentesis and chorionic villus sampling for prenatal diagnosis: RHL commentary (last revised 1 April 2009). The WHO Reproductive Health Library. Geneva: World Health Organization. https://srhr.org/rhl/article/amniocentesis-and-chorionic-villus-sampling- for-prenatal-diagnosis (accessed 1 November 2022).
National Institute for Health and Care Excellence (NICE). Antenatal care: NICE guideline (NG201). 19 August 2021. www.nice.org.uk/guidance/ng201 (accessed 20 March 2022).
Nicolaides KH. Screening for fetal aneuploidies at 11 to 13 weeks. Prenat Diagn 2011;31(1):7-15.
https://doi.org/10.1002/pd.2637
Evans MI, O’Brien JE, Dvorin E, Harrison H, Bui TH. Second-trimester biochemical screening. Clin Perinatol 2001;28(2):289-301. https://doi.org/10.1016/s0095-5108(05)70084-1
Hill M, Wright D, Daley R, et al. Evaluation of non-invasive prenatal testing (NIPT) in an NHS setting: A reliable, accurate non-invasive prenatal diagnosis (RAPID) protocol. BMC Pregnancy Childbirth 2014;14:229. https://doi.org/10.1186/1471-2393-14-229
Chen M, Leung TY, Sahota DS. Ultrasound screening for fetal structural abnormalities performed by trained midwives in the second trimester in a low-risk population – an appraisal. Acta Obstet Gynecol Scand 2009;88(6):713-719. https://doi.org/10.1080/00016340902934688
Gallot D, Boda C, Ughetto S, et al. Prenatal detection and outcome of congenital diaphragmatic hernia: A French registry-based study. Ultrasound Obstet Gynecol 2007;29(3):276-283. https://doi. org/10.1002/uog.3863
Colvin J, Bower C, Dickinson JE, Sokol J. Outcomes of congenital diaphragmatic hernia: A population-based study in Western Australia. Pediatrics 2005;116(3):e356-e363. https://doi. org/10.1542/peds.2004-2845
Wilkinson D, de Crespigny L, Xafis V. Ethical language and decision-making for prenatally diagnosed lethal malformations. Semin Fetal Neonat Med 2014;19(5):306-311. https://doi. org/10.1016/j.siny.2014.08.007
Republic of South Africa. Choice on Termination of Pregnancy Act 92 of 1996. https:// www.parliament.gov.za/storage/app/media/ProjectsAndEvents/womensmonth_2015/docs/ Act92of1996.pdf (accessed 1 November 2022).
South African Society for Ultrasound in Obstetrics and Gynaecology (SASUOG). SASUOG position statement on the late termination of pregnancy for fetal anomalies (TOPFA). https://www. sasuog.org.za/MemberPanel/downloads/SASUOG%20Position%20statement%20on%20late%20 TOP%20for%20fetal%20anomalies.pdf (accessed 5 June 2022).
Jaquier M, Klein A, Boltshauser E. Spontaneous pregnancy outcome after prenatal diagnosis of anencephaly. Int J Obstet Gynaecol 2006;113(8):951-953. https://doi.org/10.1111/j.1471- 0528.2006.01014.x
Bruns D, Campbell E. Twenty-two survivors over the age of 1 year with full trisomy 18: Presenting and current medical conditions. Am J Med Genet A 2013;164A(3):610-619. https://doi. org/10.1002/ajmg.a.36318.
Subramaniam A, Jacobs AP, Tang Y, et al. Trisomy 18: A single center evaluation of management trends and experience with aggressive obstetric and neonatal intervention. Am J Med Genet A 2016;170A(4):838-846. https://doi.org/10.1002/ajmg.a.37529
Kato E, Kitase Y, Tachibana T, et al. Factors related to survival discharge in trisomy 18: A retrospective multicenter study. Am J Med Genet A 2019;179A(7):1253-1259. https://doi. org/10.1002/ajmg.a.61146
Kosiv KA, Long J, Lee HC, Collins RT 2nd. A validated model for prediction of survival to 6 months in patients with trisomy 13 and 18. Am J Med Genet A 2021;185A(3):806-813. https://doi. org/10.1002/ajmg.a.62044
Chervenak FA, McCullough LB, Levene I. An ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies. Obstet Gynaecol 1990;75(3 Part 1):311-316.
Chervenak FA, McCullough LB. Nonaggressive obstetric management: An option for some anomalies during the third trimester. JAMA 1989;261(23):3439-3440. https://doi.org/10.1001/ jama.261.23.3439
Van Roosmalen J, van den Akker T. Safety concerns for caesarean section. BJOG 2014;121(7):909- 910. https://doi.org/10.1111/1471-0528.12747
Perinatal Palliative Care: ACOG Committee Opinion, Number 786. Obstet Gynecol 2019;134(3):e84-e89. https://doi.org/10.1097/AOG.0000000000003425
Bijma HH, Wildschut HI, van der Heide A, van der Maas PJ, Wladimiroff JW. Obstetricians’ agreement on fetal prognosis after ultrasound diagnosis of fetal anomalies. Prenat Diagn 2004;24(9):713-718. https://doi.org/10.1002/pd.972
Lakovschek IC, Streubel B, Ulm B. Natural history of trisomy 13, trisomy 18 and triploidy after prenatal diagnosis. Am J Med Genet A 2011;155A(11):2626-2633. https://doi.org/10.1002/ ajmg.a.34284
Roach JW, Short BF, Saltzman HM. Adult consequences of spina bifida: A cohort study. Clin Orthop Relat Res 2011;469(5):1246-1252. https://doi.org/10.1007/s11999-010-1594-z
Appasamy M, Roberts D, Piling D, Buxton N. Antenatal ultrasound and magnetic resonance imaging in localising the level of the lesion in spina bifida and correlation with postnatal outcome. Ultrasound Obstet Gynecol 2005;27(5):530-536. https://doi.org/10.1002/uog.2755
Peralta CB, Bunduki V, Plese JP, et al. Association between prenatal sonographic findings and postnatal outcome in 30 cases of spina bifida aperta. Prenat Diagn 2003;23(4):311-314. https:// doi.org/10.1002/pd.584