Do Pregnant Women Realise What Their Scan Could Tell Them?

September 11, 1998

(First trimester ultrasound screening carries ethical and psychological implications)

Pregnant women may be offered the option of having an ultrasound scan when their fetus is at the 10-14 week stage. This scan is used to accurately date the pregnancy and determine the presence of one or more fetuses. In some centres, high resolution scans are used to diagnose major fetal abnormalities and assess the likelihood of high risk chromosomal abnormalities. In the majority of cases the fetus is normal (98 per cent), but what if it isn't - would you be prepared for the worst?

In this week's BMJ authors of an editorial and a cluster of letters discuss the fact that the high resolution ultrasound scanning that is now possible during the first trimester of pregnancy raises ethical and psychological issues. In an editorial Anne McFadyen and colleagues ask whether women are fully informed about the level of information that a scan could reveal - it is not simply a means of discovering the gestational age. They are concerned that if the full implications of the technology are not fully explained, this may leave parents unprepared for bad news, which in turn could mean that a difficult decision may need to be made about whether to proceed with the pregnancy.

In a letter Katherine Hampton says that "...most women are enthusiastic about having an ultrasound scan, perhaps because they do not associate scans with screening". Guy Nash, a consultant obstetrician and gynaecologist from East Sussex, argues that, on the contrary, the majority of mothers understand that scanning is done to detect abnormalities and that they would expect to be informed if any are identified. "If information was not given, she [the mother] would probably sue her obstetrician when it became known that the abnormality had been detected earlier."

Stephen Carroll from the Fetal Medicine Unit at St Michael's Hospital in Bristol argues that the identification of an abnormality is not solely to provide a basis for the decision to terminate the pregnancy or not. He explains that if a disorder is identified then provision can be made for a "...planned delivery in a centre with appropriate neonatal intensive care facilities [which] will optimise neonatal outcome".

In their editorial McFadyen et al stress that psychological support is an important part of the ultrasound scanning process and that counselling services should be offered more actively following termination for fetal abnormality. This view is shared by Johanna Layng from the Division of Primary Care and Population Health Sciences, based at the Chelsea and Westminster Hospital in London, who believes that health professionals should be trained to provide counselling - especially, she says, as there is likely to be an increasing demand for this type of service.

McFadyen and colleagues conclude that all women should receive a clear explanation of the purposes of all antenatal testing, the information that may be discovered and the degree of certainty about the information that is gleaned, in order that they are able to make an informed decision about whether to undertake tests such as an ultrasound scan.

Anne McFadyen, Senior Lecturer or Julia Gledhill, Honorary Research Fellow, Leopold Muller Department of Child and Family Mental Health, Royal Free and University College Medical School, London

Demetrios Economides, Senior Lecturer and Consultant in Obstetrics and Gynaecology, Royal Free and University College Medical School, London

Katherine Hampton, Tunbridge Wells, Kent

Guy Nash, Consultant Obstetrician and Gynaecologist, Conquest Hospital, Leonards-on-Sea, East Sussex

Stephen Carroll, Subspecialty Trainee in Maternal and Fetal Medicine, Fetal Medicine Unit, St Michael's Hospital, Bristol

Johanna Layng, The Surgery, 18 New Wokingham Road, Crowthorne Berks

Kypros Nicolaides, Professor of Fetal Medicine, Harris Birthright Research Centre for Fetal Medicine, Department of Obstetrics and Gynaecology, Kings College School of Medicine and Dentistry, London


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