Posted on 12/31/2004 9:28:08 AM PST by frog_jerk_2004
Interview With Neonatologist Carlo Bellieni
SIENA, Italy, DEC. 23, 2004 (Zenit) - Far from offering or requesting prenatal diagnosis as a routine examination, people should use it with great care, warns a neonatologist.
Dr. Carlo Bellieni of the Santa Maria alle Scotte Polyclinic explains in this interview the risks of using -- or abusing -- prenatal diagnosis.
Q: What is prenatal diagnosis?
Bellieni: It is the way of knowing the fetus' health conditions. It can be done in an invasive way -- by extracting fetal material: blood, chorionic villi, amniotic fluid -- or in a non-invasive way.
In the latter case, it can be done by analyzing the maternal blood or carrying out instrumental examinations such as fetal ultrasounds. Chorionic villous sampling is usually done in the first trimester, while amniocentesis is carried out more frequently in the second trimester.
Q: In whose interest is it done?
Bellieni: Good question. Prenatal diagnosis is very useful to be able to determine a good number of fetal pathologies; many of these can be treated, some directly before birth. But prenatal diagnosis may also be used for selective purposes, recently also in the form of pre-implantation testing.
In this latter case it is carried out in in-vitro fertilization, before introducing the "ideal" embryos in the uterus. There are those who suggest that this testing can be done not only to determine major pathologies, but also secondary features, such as sex.
So a distinction must be made between a prenatal diagnosis done in the interest of all the individuals -- embryo-fetus and mother -- and one which, instead, considers only the interests of the one already born.
Q: Amniocentesis is an ever more widespread examination, yes?
Bellieni: In the 35 years since Jacobson and Barten referred to the first 56 cases of amniocentesis, the number of amniocenteses has increased progressively. Recently, endeavors are under way to overcome the need for invasive examinations in pregnancies, because of the risk of abortion that they entail.
Q: Is it an omissible risk?
Bellieni: A recent study by Seeds in the American Journal of Obstetrics and Gynecology, of 2004, refers to an abortion rate of 0.6%.
Considering that in 2003 in Italy close to 100,000 amniocenteses were carried out, it turns out, according to this data, that more than 500 normal and wanted pregnancies did not end in birth because of this technique, with the consequent trauma for the woman. It is not an omissible fact, despite surgeons being extremely scrupulous and skillful.
Q: You have spoken on other occasions of the fetus' right to privacy. To what are you referring?
Bellieni: I understand that the fetus is an individual who has the right of non-interference in his innermost sphere. In 1998 the World Health Organization also recommended that prenatal diagnosis be carried out exclusively in the interest of the fetus, and not to satisfy the parents' curiosity.
Q: Do ultrasounds hold surprises in store?
Bellieni: We must be clear: Ultrasounds are absolutely safe and not harmful. Moreover, they can contribute useful information in the interest of the mother and the fetus. However, we must not trivialize them, as we must not trivialize anything in medicine.
In 2004 the Food and Drug Administration warned about the excess of videos recorded as "mementos." Many international studies recommend an ultrasound in the course of a pregnancy. In Italy and France the number is even higher than the three that are usually recommended.
Q: What would you say by way of conclusion?
Bellieni: That prenatal diagnosis is too often carried out in the ambit of already widespread anxiety over pregnancy, which stems for the concept of the "search for the perfect child," since the idea that the pregnancy might end in a way other than perfection is "simply not granted to women."
Invasive prenatal diagnosis is an instrument that must be used with care -- in the first place, knowing its risks and real indications, and not offering or requiring it as a routine examination; in the second place, knowing lamentably that it cannot give the yearned for certainty of the absence of fetal pathology, the pathologies that a pregnancy might entail being so many and of such a varied nature.
Pregnancy must be released from the grip of anxiety, and prenatal diagnosis must be given back its role as coadjutor of a mental and emotional process, and not as an obligation for social ends.
Contact: Catholic Online http://www.catholic.org CA, US Catholic Online - Publisher, 661-869-1000 Email: info@yourcatholicvoice.org Keywords: Abortion, Prenatal, Neonatologist, Birth, Baby
The level 2 ultrasound seemed to indicate a spot (echogenic intracardiac focus) that was possibly indicadive of down syndrome. The doctor that was reading the results of the ultra sound suggested that my wife get an amniocentisis. Unfortunately, I had just walked out of the room when this happened to take my other daughter to the bathroom. I was really pissed because I wanted to be there to support her because we knew somebody was going to try spout this "quality of life" crap. When she declined because of the risk that it would put on my future daughter, the doctor responded that some people think they can deal with special children but find out later they can't.
Needless to say my daughter was born perfectly normal, thank God. But the reasoning for some of these tests is to steer you toward abortion. Some doctors like to claim that they want you to know what to expect from the birth, but their real adjenda is for you to think about abortion, which is absolutely sickening...
Ping
That is true. Here in Washington State, we were recommended to have an amniocentesis during the birth of our first son. My wife's blood test was in an 'abnormal' category and they forced us to sit through an hour of 'genetic counseling', in which they told us our son almost positively was Trisomy 21 Down's syndrome. They were trying to get us to think about abortion.
Our son was 100 percent normal. We had an amnio a couple weeks ago, and we outright refused to sit through the counseling. This son will also be normal (the amnio came back OK). We wouldn't abort either way the test came out so what's the point?
Our choice for amnios was based on our first son having a serious heart defect common to children with Down's. It is correctable, but you would still want to have the staff ready to deal with it. One doctor wanted to do an amnio just because we had a child with Down's and immediately started talking about first trimester deadlines. We dropped him like a bad habit, filed a complaint with our insurance company, and found a doctor that would go along with our wishes.
I think the point might be the risk involved with amnios. There is no way that a blood test could give you an almost 100 percent chance of Down's. If that test was the alpha fetal protein test it is merely a risk screening. Doctors should weigh the risk of defects against the risk of the amnio procedure.
No, this was a purely genetic counseling session. The OB doctor explains the risks.
Also, the genetic counseling is required by law here in Washington, since people who are born with birth defects can sue for "wrongful life". Lovely, huh?
I wish I were kidding! From here:
COLUMBIA, S.C. - The state Supreme Court threw out a "wrongful life" lawsuit claiming a doctor failed to tell a pregnant woman about her son's severe birth defect.
Jennie Willis contended she would have legally aborted had she known when she was pregnant that most of her son's brain was missing, according to her lawyer, O. Fayrell Furr Jr. The lawsuit was filed by Willis on behalf of her now 8-year-old son, Thomas.
In a unanimous ruling Monday, South Carolina's high court said it recognizes the severe nature of the boy's condition, but it could not accept the wrongful birth claim.
"Even a jury collectively imbued with the wisdom of Solomon would be unable to weigh the fact of being born with a defective condition against the fact of not being born at all," Associate Justice E.C. Burnett wrote. "It is simply beyond the human experience."
Furr had argued that the boy "has enough brain tissue to keep him alive but not enough to know his mother exists. ... She would not want her child to ... live that existence."
South Carolina joins 27 other states that either reject or limit the "wrongful life" claim, the court said. California, Washington and New Jersey are the only other states that allow such claims.
In her lawsuit, Willis argued that obstetrician Dr. Donald S. Wu, failed to tell her about her fetus' birth defect before the deadline to have a legal abortion.
Wu disputed that, saying in court papers that he informed Willis of a potential problem. He said she refused to undergo a second test by a specialist, even after another exam a week later showed her son "lacked any significant brain."
Willis had appealed to the Supreme Court after a lower court judge ruled in the doctor's favor.
I had a very similar circumstance with my (now) perfectly healthy, ten year old son. My MSAFP came back in the high range, my OB strongly suggested amnio, I requested a Level II ultrasound (some anomolies associated w/Downs can be visualized). His heart was fine--all chambers visualized, the thickness of the skin at the nape of neck was 'ordinary' and (the first thing I looked for) he had fists. His hands were in tight fists (Downs babies generally cannot pull in the pinky into a fist formation). I felt confident (though the MD reading the ultrasound would not give any more than a 98% accuracy to ultrasound read). That all said, my OB (who I quit going to after the delivery) still insisted that the amnio was needed. My husband and I felt the pressure from the OB to have the amnio was akin to buying the rustproofing from a car dealership. He was trying to make a 'sale' of a service we emphatically said we didn't want (due to the inherent risk w/amnio--not as easy of a procedure as you are lead to believe.)
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