Attitudes on the ethics of abortion, sex selection, and selective pregnancy termination among health care professionals, ethicists, and clergy likely to encounter such situations

Article Abstract:

A survey was carried out of health care professionals, clergy, and ethicists concerning their views on selected ethical aspects of abortion. The 737 participants were members of the American Society of Human Genetics, the International Fetal Medicine and Surgery Society, or the Society of Perinatal Obstetricians (79 percent); also included were members of the clergy and ethicists. Subjects completed questionnaires prior to the recent Supreme Court decision in Webster v. Reproductive Health Services. Respondents were asked to indicate the extent of their agreement or disagreement to statements about the acceptability of social abortion (performed for nonobstetric or nonmedical reasons); abortion for lethal birth defects; for significant, but nonlethal birth defects; for sex selection; and selective termination of one or more fetuses in the case of pregnancy with two or more fetuses. Results from these mostly male (76 percent) and mostly over 40 (68 percent) respondents showed that 74 percent disagreed strongly with the statements that abortion during the first trimester of pregnancy is morally unacceptable. Jewish respondents were more likely to find abortion acceptable than Moslem, Protestant, or Catholic respondents. Most considered sex selection an unacceptable reason for abortion. Abortion was considered more acceptable for single fetuses with more serious birth defects and at earlier gestational times. Selective termination became more acceptable as the number of hypothetical fetuses increased and the gestational age decreased; several aspects of selective termination are discussed. A discussion is presented of some ethical considerations relevant to abortion. Some views of the authors are also presented. Eugenics, defined as a deliberate attempt to alter or avoid fetal characteristics unrelated to disease (such as sex), must be avoided. It is recommended that physicians offer prenatal testing to patients who want to determine their fetus's suitability as a tissue donor. More consideration needs to be given to selective termination of multiple pregnancies. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surveys, Medical personnel, Beliefs, opinions and attitudes, Ethical aspects, Abortion, Clergy, Ethicists, Abortion, Therapeutic, Therapeutic abortion

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Fetal surgery in the 1990s

Article Abstract:

Before prenatal diagnosis became available in the 1960s, the structure and function of the fetus was unknown until birth. Techniques to visualize the fetus, such as ultrasonography (the use of high frequency sound to visualize internal structures) and biochemical and genetic analysis of blood or amniotic fluid, make it possible diagnose defects before birth. Many fetal defects can be detected before 24 weeks of pregnancy, allowing parents to make decisions regarding pregnancy termination. With the advent of less invasive medical interventions, some abnormalities can be treated during pregnancy. Before fetal abnormalities can be treated with surgery before birth, the potential outcome of the defect and the risk of the procedure to the mother and fetus must be determined. Only if the abnormality can be altered by surgery and the risk is low, should a procedure be considered. The International Fetal Medicine and Surgery Society has established guidelines for fetal intervention. Surgical intervention for a particular abnormality in the heart called fetal ventriculomegaly is controversial. The use of a shunt to divert fluid from one compartment in the heart to another can be used in only a few cases. Obstructive uropathy, a condition causing dilation of the urinary structures because of blockage in the urinary tract system, can be treated by surgery only if the abnormality appears on both sides of the urinary tract and there are no other anomalies present. Open surgery, a more invasive type of surgery involving both the mother and the fetus, is more successfully performed today. Whether the less invasive percutaneous procedures (the threading of small catheters to affected sites) or open surgery are used, fetal surgery can improve the quality of life for selected fetuses after birth. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Birth defects

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Successful repair in utero of a fetal diaphragmatic hernia after removal of herniated viscera from the left thorax

Article Abstract:

A congenital diaphragmatic hernia is a condition in which abdominal contents (stomach, intestines) protrude into the chest cavity through an opening in the diaphragm. One consequence of this is inadequate lung development, due to compression. Even with modern techniques, approximately three-quarters of the infants born with this condition do not survive. However, experimental evidence suggested that, if the organs could be removed from the chest before birth, an infant could survive. Surgical repair in this manner was attempted unsuccessfully six times previous to the current report. The successful repair of a diaphragmatic hernia in a fetus between 24 and 25 weeks gestational age is described. This infant had most of its abdominal organs herniated into the left side of the chest, with little visible lung. The operative procedure is detailed. The patient went home on the seventh day after surgery and the baby was delivered by cesarean section at the age of 32 weeks. It required ventilatory (breathing) support for the first few weeks. At eight months of age, the baby appears to be developing normally. This groundbreaking surgery succeeded only after more than 10 years' preparation, practice, and mixed failures and successes. Fetal surgery does not endanger the mother; all four of the women who underwent unsuccessful attempts who tried again to have a baby, did so. Fetal surgery is now feasible; whether it will also be effective depends on the results of properly controlled clinical trials. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hernia, Hernia repair, Diaphragm, Diaphragmatic hernia

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