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Termination of Pregnancy for Fetal Abnormality in England, Scotland and Wales

Published: 25/06/2010

This working party report, in addition to termination of pregnancy, also covers the continuation of a pregnancy following a diagnosis of fetal anomaly. The Nuffield Council on Bioethics recommended that we clarify the document’s contents, and also requested that further guidance is produced so healthcare professionals can better support women who decide to continue with their pregnancy

The RCOG is currently producing Care after non-invasive prenatal testing (NIPT) (Green-Top Guideline No. 74) which will provide further guidance on this, and its scope can be found here.

This report follows a review of the previous working party report on the same topic, published in January 1996.

Executive summary

This report is intended to assist doctors and other health professionals to support women and their families when a fetal abnormality is diagnosed and to help women to decide, within the constraints of the law, whether or not to have the pregnancy terminated. It is designed to be explanatory rather than prescriptive and does not purport to give ethical guidance.

Since the last RCOG guidance on termination of pregnancy for fetal abnormality was issued in 1996, advances in the detection of congenital abnormalities have resulted in earlier diagnosis and clearer indications for the offer of termination of pregnancy. Improved imaging, with follow-up of specific abnormalities, has led to a better understanding of their natural history, a more accurate assessment of prognosis and better informed counselling. In addition, antenatal screening has expanded and improved and is now part of routine antenatal care.

The law relating to termination of pregnancy has not changed since 1990 although it has been tested in a number of specific cases. The 1967 Abortion Act, as amended, sets out the grounds and time limits for termination of pregnancy, as well as stating who can perform an abortion and where it can be performed. Termination of pregnancy for fetal abnormality may only be considered if there is a substantial risk that the child, if born, would suffer physical or mental abnormalities that would result in serious handicap. Termination for fetal abnormality will only be lawful, except in an emergency, when the two practitioners, who testify by signing the certificate of opinion form, believe in good faith that the grounds for termination of pregnancy are met.

There is no legal definition of substantial risk. Whether a risk will be regarded as substantial may vary with the seriousness and consequences of the likely disability. Likewise, there is no legal definition of serious handicap. An assessment of the seriousness of a fetal abnormality should be considered on a case-by-case basis, taking into account all available clinical information.

Technical improvements in diagnostic ultrasound continue to be made. More recently, three- dimensional ultrasound technology has been introduced for diagnostic purposes, although its exact role remains unclear. Magnetic resonance imaging can be effective as an adjunct to ultra- sound in diagnosing and evaluating structural abnormalities, particularly those involving the fetal central nervous system. Progress in fetal diagnosis is improving knowledge of the natural history of many fetal disorders. While amniocentesis, chorionic villus sampling and fetal blood sampling remain standard methods for the diagnosis of aneuploidy, noninvasive techniques are being developed which should reduce the need for invasive procedures in the future.