Abstract

PIP: The rapid development of early prenatal diagnostic tests for some fetal malformations and abnormalities and the introduction of this approach to malformation into clinical practice in most areas of the United Kingdom has, to a great extent, been made possible by the 1967 Abortion Act. Although at least 30 of every 1000 pregnancies will end in a seriously malformed infant with reduced survival, or survival with impaired quality of life, only less than 1/3 of these abnormal fetuses are currently amenable to early antenatal detection. Yet, it has been estimated that about 10% of all pregnancies can be identified as having a risk of 1 of these detectable abnormalities of more than 1 in 100. Most prenatal diagnostic tests available at this time involve an amniocentesis, which cannot generally be carried out safely and successfully before 15 or 16 weeks' gestation. Laboratory tests on the amniotic fluid itself or on the cells it contains must follow, generally after a period of cell culture. Fetosocopy at about 18 weeks or later is at present rarely used because of its technical difficulties as well as its relatively high risk of complications. Ultrasound is largely used as a preliminary to amniocentesis or to identify anencephaly. 1 of the problems of these prenatal tests often involving lengthy laboratory techniques is reflected in the late termination times reported from 1 large center, where barely 1/2 the terminations for fetal malformations could be performed before 20 weeks' gestation. 2 provisions of John Corrie's Bill now before Parliament may have a profound effect on prenatal diagnosis and related aspects of secondary prevention of fetal malformation. These are the suggested lowering of the gestational age at which abortions can normally be performed, and the strengthening of the conscience clause enabling physicians to refuse to provide a certificate for abortion.