ArticleAnnals of medicine2025
An ethical issue in the prenatal and postnatal management of trisomy 18: a survey of obstetricians.
Article in Annals of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThis study aimed to determine how obstetricians' knowledge of T18 influences their attitudes toward the antepartum, intrapartum, and postpartum management of T18 cases and to compare these attitudes with their approaches to trisomy 21 (T21) cases. These attitudes were analysed within the framework of the medical ethics principles of beneficence and autonomy.
methodsThis cross-sectional descriptive survey study was conducted between 1 February and 31 July 2021. Data from 194 of 388 participants who completed all questionnaire items were analysed.
resultsThe study included specialists in obstetrics and gynecology (mean age: 47.8 ± 8.9 years; 56.2% female). 40.2% defined "lethal congenital malformation" as anomalies inevitably causing intrauterine death; 91.2% considered T18 "lethal" and 77.6% "incompatible with life." For T18, 82.8% always recommended termination. When pregnancy continued, most acted in line with maternal wishes; 56.8% would prefer cesarean in fetal distress and 60.5% supported perinatal palliative care. For T21, 89.0% did not define it as lethal, 94.8% did not consider it incompatible with life, and only 57.1% always recommended termination. Multivariate analysis showed older age and religious beliefs predicted lower termination recommendation for T21; only religious beliefs predicted this for T18. Female obstetricians more often provided palliative care and fetal monitoring for T21.
conclusionsThis study reveals significant gaps and variability in knowledge, attitudes, and management strategies for prenatally diagnosed T18 among obstetricians in Turkey. Such variability may result in some women not being offered appropriate care options during pregnancy or delivery. More practical training and ethical guidance are needed for consistent, patient-centred care in fetal anomaly management.
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