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.