Organisation of practices
In countries where abortion is legal, PND is based on a sequence of
standardised decisions and actions. The first decision-action event is
Down Syndrome (DS) screening, offered to all pregnant women in England
and France, usually during their first pregnancy
consultation.6 There are nevertheless differences in
screening uptake (75% of pregnant women in England, 85% in
France).7,8 Similarly, the threshold at which the risk
is deemed sufficient to warrant a fetal karyotype examination varies
(1:150 in England; 1:250 in France). Routine foetal ultrasound
examinations carried out at different points during the pregnancy (two
in England and three in France) enable practitioners to check that the
foetus is developing normally and look for soft markers frequently
associated with anomalies.9
Once identified as being “at increased risk”, women are referred to
PND centres located in public hospitals. Then follows the second
decision-action event involving diagnostic tests. This usually means the
extraction of amniotic fluid (amniocentesis) or sampling of trophoblast
cells (Chorionic villus sampling: CVS) with an estimated 1% risk of
triggering a miscarriage.10 Whilst some abnormalities
can be surgically repaired in utero or after birth, most of the
anomalies discovered are incurable;11 the women and
couples may then begin a third sequence of decision-action in relation
to a pregnancy termination.