Q&A with Institute of Obstetricians and Gynaecologists: Downs concerns and claims are misleading
The Institute of Obstetricians and Gynaecologists has issued information which it says will provide “factual background” to the debate around the proposal to repeat the Eighth Amendment.
The move comes in the wake of politicians such as Fianna Fáil TD Jim O’Callaghan and Independent senator Rónán Mullen raising concerns that allowing terminations up to 12 weeks would increase the rate of abortion among foetuses with Down syndrome and other disabilities.
Anti-abortion campaign group Love Both group has used images of children with Down syndrome in pamphlets
delivered to people’s homes, leading to Down Syndrome Ireland and a number of parents, including former Republic of Ireland footballer Kevin Kilbane, to issue statements asking that children with Down syndrome not be used in the debate on the repeal of the Eighth Amendment.
“We are respectfully asking both sides of the campaign debate, all political parties, and any other interested groups to stop exploiting children and adults with Down syndrome to promote their campaign views,” said Down Syndrome Ireland.
Institute chair Peter Boylan, former master of the National Maternity Hospital, claimed there was “a lot of misinformation out there, so we felt it was reasonable to inform the debate”. He said that while it is not impossible to diagnose a baby with Down syndrome 12 weeks into a pregnancy, it is very rare.
The Institute of Obstetricians and Gynaecologists of Ireland is the national professional and training body for obstetrics and gynaecology. Members are drawn from maternity units across the country.
Typically when they are between 12 and 20 weeks pregnant.
During this time, women who are pregnant will visit a midwife and have a basic scan and blood tests. These tests are not to screen for abnormalities but, in very rare cases, abnormalities can be observed. This is what is offered through the public health system. Women who access private healthcare services can obtain a scan earlier than 12 weeks.
A screening test is different from a diagnostic test. A screening test (such as ultrasound) raises the possibility of an abnormality. A diagnostic test would be subsequently required if necessary.
Much of the recent debate has focused on Trisomy 21 (Down syndrome), a chromosomal abnormality. There are two ways to screen for Trisomy 21. Firstly, an abdominal or transvaginal ultrasound is performed to measure the thickness of translucent tissue in the fetal neck (nuchal translucency) and to confirm the duration of the pregnancy. This may be performed from 11 to just less than 14 weeks. In parallel, a blood test between 10 and 13 weeks measures particular proteins in the mother’s blood. The combined results of the blood test and scan will give assessment of the degree of risk of a chromosomal abnormality, (for example 1:600 or a 1 in 600 chance). It is important to state that this is not a diagnosis.
A second method of screening is a blood test to analyse free fetal DNA in the mother’s blood stream. This test (for example, Harmony, Panorama) can be performed from nine weeks onwards. These tests cost upwards of €500 and are not funded by the State, which is an obvious limiting factor for many women. Even if organised via the public system, women still have to pay for it.
There is no facility in Ireland to analyse the samples so they have to be sent to the UK or the USA for analysis. Results are generally available within two weeks. These tests are not 100%
reliable and so a further, diagnostic, test must be performed to confirm or refute the diagnosis.
In the public health system, a screening test is either requested by the woman or is offered to them by their doctor. Those who avail of private healthcare can request a screening test be carried out earlier than 12 weeks, usually after 10 weeks. In either case the results of these screening tests are rarely available within 12 weeks.
Diagnosis is made by way of chorion villous sampling (CVS), where a small sample is taken from the developing placenta and is usually analysed in the UK, as the facilities for this test do not exist in Ireland.
This stage takes at least three working days. It should be noted that CVS has a risk of causing miscarriage in 1% of procedures and women may or may not elect to have this test.
It is clear therefore that diagnosis of chromosomal abnormality, while technically possible, can rarely or
realistically be achieved before 12 weeks. To suggest, therefore, that disability will be eliminated by enacting legislation in line with the recommendations of the Oireachtas committee is misleading.
