Statement from the Institute of Obstetricians and Gynaecologists

Doctors on ward

Factual background information to inform the debate

In view of public discussion regarding disability and repeal of the Eighth Amendment, the Institute of Obstetricians and Gynecologists would like to provide factual background information to inform the debate.

Through these questions and answers the Institute addresses facts around the first 12 weeks of pregnancy.

When do women in Ireland first book for ante-natal care?

Typically when they are between 12 and 20 weeks pregnant.

What type of ante-natal care and services can they access?

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 health care services can obtain a scan earlier than 12 weeks.

What screening tests are available and how can they be accessed?

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 the 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 (e.g. 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. If organised through 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.

How can women access these screening tests?

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.

How is a diagnosis made?

Diagnosis is by way of chorion villous sampling (CVS), where a small sample is taken from the developing placenta and usually analysed in the UK. 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 twelve weeks.  To suggest therefore that disability will be eliminated by enacting legislation in line with the recommendations of the Oireachtas committee is misleading.

 

It is clear therefore that diagnosis of chromosomal abnormality, while technically possible, can rarely or realistically be achieved before twelve weeks. To suggest therefore that disability will be eliminated by enacting legislation in line with the recommendations of the Oireachtas committee is misleading.

Institute of Obstetricians and Gynaecologists

About the Institute of Obstetricians and Gynaecologists

The Institute of Obstetricians and Gynaecologists is the national professional and training body for obstetrics and gynaecology in Ireland, working to ensure the highest standards in women's health.

Members of the Institute are drawn from all maternity units across the country.

The current chair is Dr Peter Boylan, MAO, FRCPI, FRCOG, former master of the National Maternity Hospital.