Q&A: Why Not Just Scan for Defects Earlier?

Posted on Posted in D&E, Induction/L&D, Omphalocele, Opinion, Q&A, Stories

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QUESTION

scan earlier
It is the rare parent who will end a wanted pregnancy based on the kind of “maybes” that are sometimes presented at 12 weeks. But most are told everything is “fine” at that point anyway.

Why have an abortion so late? Why not just scan for defects earlier? A 12-week scan can pick up most issues. I had a scan at 12 weeks and discovered our baby had a giant omphalecele (all his internal organs were in a sack on the outside of his body). We were told his lungs and heart would not develop properly and he had a 1 in 10,000 chance of surviving to the age of two.

Because nerve endings don’t develop until about the 18 week mark, we made the heartbreaking decision to end the pregnancy while he couldn’t feel anything, even though he was so wanted and loved. I’m not sure what we’d have done at 20 weeks! Probably carried him for organs to save another life.

ANSWER

I am so sorry to hear about your loss. The reality is that a very large percentage of parents are told there are no problems at all at the 12 weeks scan. Occasionally they’re told something doesn’t “look quite right” and instructed to wait for a later scan. Then at the later scan, severe or deadly problems are revealed. This is especially common with major brain and heart defects which are not so obvious at 12 weeks, but can happen with just about any kind of prenatal diagnosis, including omphalocele.

It is the rare parent who will end a wanted pregnancy based on the kind of “maybes” that are sometimes presented at 12 weeks. But most are told everything is “fine” at that point anyway. I’ve seen this over and over in the hundreds of parents’ stories submitted to our site or shared in our private support group.

Further, as one of those parents who terminated a pregnancy at 20 weeks (after a “normal” 12-week scan and even a false “normal” blood screen), believe me I asked if we could go full term and donate his organs. I was told in no uncertain terms “No,” because the transplant team would not deal with the organs of an otherwise sickly or dying infant. This is especially true when the fetus in question has been diagnosed with a chromosomal issue, and that’s actually pretty common in cases of severe malformations.

We’d encourage anyone who really wanted to carry a prenatally diagnosed pregnancy full-term for the sake of organ donation to discuss it with their medical team. But organ donation is an extremely complex and personal issue and would be an awful lot for outsiders to expect of parents who have just received the worst pregnancy news imaginable.

It’s also important to note that regardless of “nerve ending development” the fetal brain, according to scientists, does not process pain until at least the third trimester

Here is what the Journal of the American Medicine Association (JAMA) has to say about fetal pain:

Pain is an emotional and psychological experience that requires conscious recognition of a noxious stimulus. Consequently, the capacity for conscious perception of pain can arise only after thalamocortical pathways begin to function, which may occur in the third trimester around 29 to 30 weeks’ gestational age, based on the limited data available. Small-scale histological studies of human fetuses have found that thalamocortical fibers begin to form between 23 and 30 weeks’ gestational age, but these studies did not specifically examine thalamocortical pathways active in pain perception.

While the presence of thalamocortical fibers is necessary for pain perception, their mere presence is insufficient—this pathway must also be functional. It has been proposed that transient, functional thalamocortical circuits may form via subplate neurons around midgestation, but no human study has demonstrated this early functionality. Instead, constant SEPs appear at 29 weeks’ PCA, and EEG patterns denoting wakefulness appear around 30 weeks’ PCA. Both of these tests of cortical function suggest that conscious perception of pain does not begin before the third trimester.

Even so, D&E pregnancy terminations typically involve maternal anesthesia which crosses the placenta to anesthetize the fetus as well. And induction or L&D terminations are no more “painful” to the fetus than natural childbirth is because it functions exactly the same way, just earlier.

I hope this information helps you to better understand why many pregnancy terminations due to fetal anomaly take place at a later gestational age, that carrying a pregnancy to term for organ donation is rarely an option (and even when it is, is an outlandish expectation to put on bereaved parents), and that pregnancy termination later in pregnancy does not cause fetal pain.

 

 

Image courtesy of Pixabay.