What is needed for prenatal diagnosis

Sir, — Prenatal diagnosis of major foetal abnormality can involve significant pain and loss, especially when the prognosis is lethal, involves a significant disability or is uncertain. Whether parents continue the pregnancy or end the pregnancy, we recognise the profound grief they experience and the additional traumatic process involved for those who currently travel out of Ireland to access termination of pregnancy. The soon to be published national standards for bereavement care following pregnancy loss and perinatal death specifically identify a range of needs and services for parents, making it clear they must receive consistent compassionate care from a specialist bereavement team irrespective of their choices.

The current debate on “fatal fetal abnormality” has focused attention on parents’ right to choose to terminate an affected pregnancy in Ireland, while acknowledging those who choose to continue their pregnancy and access perinatal palliative care services. In this debate we must take greater care to balance regard for those for whom continuing a very abnormal pregnancy could result in psychological damage for the whole family, and who travel abroad in secrecy when grieving and vulnerable, with regard for the value of short lives and precious experience of those families who continue their pregnancies.

What is not apparently realised in this debate is the role that prompt recognition and timely diagnosis of foetal abnormality, largely through access to detailed ultrasound during pregnancy, and rapid availability of expert foetal medicine specialists where the suspected diagnosis is confirmed and explored, all play in facilitating parents to make this choice. Related to this, it does not seem that the relevance of weeks of gestation at diagnosis in making decisions or having choice is widely understood.

The National Maternity Strategy states that “all women must have equal access to standardised ultrasound services, to accurately date the pregnancy, to assess the fetus for ultrasound diagnosable anomalies as part of a planned prenatal fetal diagnostic service, and for other indications if deemed necessary during the antenatal period”.


Neither specialist ultrasound nor foetal medicine services are available to all pregnant women in the Republic. For example, Cork University Maternity Hospital, a large tertiary-referral teaching hospital where 8,113 infants were born in 2015, still cannot provide access to second-trimester foetal anomaly ultrasound for the majority of pregnant women attending for antenatal care.

If we are serious about equity of care for all pregnant women and argue for equal access to either termination of pregnancy or perinatal palliative care in pregnancies with major foetal abnormality, we must first address this largely unacknowledged deficit in our maternity hospitals and ensure all the services that underpin prenatal diagnosis are in place. – Yours, etc,




Consultant Obstetricians

and Gynaecologists,

Cork University

Maternity Hospital,