An ethical issue in the prenatal and postnatal management of trisomy 18: a survey of obstetricians.

BACKGROUND

This study aimed to determine how obstetricians' knowledge of T18 influences their attitudes toward the antepartum, intrapartum, and postpartum management of T18 cases and to compare these attitudes with their approaches to trisomy 21 (T21) cases. These attitudes were analysed within the framework of the medical ethics principles of beneficence and autonomy.

METHODS

This cross-sectional descriptive survey study was conducted between 1 February and 31 July 2021. Data from 194 of 388 participants who completed all questionnaire items were analysed.

RESULTS

The study included specialists in obstetrics and gynecology (mean age: 47.8 ± 8.9 years; 56.2% female). 40.2% defined "lethal congenital malformation" as anomalies inevitably causing intrauterine death; 91.2% considered T18 "lethal" and 77.6% "incompatible with life." For T18, 82.8% always recommended termination. When pregnancy continued, most acted in line with maternal wishes; 56.8% would prefer cesarean in fetal distress and 60.5% supported perinatal palliative care. For T21, 89.0% did not define it as lethal, 94.8% did not consider it incompatible with life, and only 57.1% always recommended termination. Multivariate analysis showed older age and religious beliefs predicted lower termination recommendation for T21; only religious beliefs predicted this for T18. Female obstetricians more often provided palliative care and fetal monitoring for T21.

CONCLUSIONS

This study reveals significant gaps and variability in knowledge, attitudes, and management strategies for prenatally diagnosed T18 among obstetricians in Turkey. Such variability may result in some women not being offered appropriate care options during pregnancy or delivery. More practical training and ethical guidance are needed for consistent, patient-centred care in fetal anomaly management.