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J Med Ethics doi:10.1136/medethics-2011-100340
  • Reproductive ethics
  • Paper

Survey of physicians' approach to severe fetal anomalies

  1. Janice L Byrne
  1. Maternal Fetal Medicine, Intermountain Healthcare and University of Utah, Murray, Utah, USA
  1. Correspondence to Dr Cara C Heuser, Maternal Fetal Medicine, Intermountain Healthcare and University of Utah, 5121 S Cottonwood Street, Ste 100, Murray, UT 84107, USA; cara.heuser{at}imail.org
  1. Contributors All authors have participated in the work and can defend the manuscripts contents and have read the manuscript before its submission for publication and agree with its contents. No person who would meet the standards for authorship has been excluded.

  • Received 1 November 2011
  • Revised 12 December 2011
  • Accepted 19 December 2011
  • Published Online First 19 January 2012

Abstract

Objective Standards of care regarding obstetric management of life-threatening anomalies are not defined. It is hypothesised that physicians' management of these pregnancies is variable and influenced by demographic factors.

Design A questionnaire was mailed to members of the Society of Maternal–Fetal Medicine with valid US addresses assessing obstetric management of both ‘uniformly lethal’ (eg, anencephaly, renal agenesis) and ‘uniformly severe, commonly lethal’ (eg, trisomy 13 and 18) anomalies. Respondents were asked to answer as if not limited by state/institutional restrictions. Fisher's exact or χ2 tests were used as appropriate and correction made for multiple comparisons in analyses that were not prespecified.

Results The response rate was 36% (732/2038). Nearly 100% of respondents discuss termination for both uniformly and commonly lethal anomalies. In continuing pregnancies, with patient request for obstetric non-intervention 99% of providers would comply for either uniformly or commonly lethal anomalies. The majority ‘encourage’ such management, but some were non-directive or discouraged this management. In continuing pregnancies, with patient request for full obstetric intervention the majority of respondents was willing to comply for both uniformly (71%) and commonly (82%) lethal anomalies. While most practitioners ‘discouraged’ full intervention, some were non-directive or encouraged this management. Demographics and severity of anomaly influenced counselling.

Conclusion Discrepancies exist regarding the management of life-threatening fetal anomalies. Patients may be offered different options based on practitioner demographics. The majority of physicians comply with patient wishes. Differences were noted when comparing the management of lethal with that of severe commonly lethal anomalies, suggesting that practitioners make a distinction when counselling patients.

Footnotes

  • Competing interests None.

  • Ethics approval Ethics approval was obtained from the University of Utah institutional review board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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