Journal List > Korean J Obstet Gynecol > v.53(12) > 1006371

Korean J Obstet Gynecol. 2010 Dec;53(12):1085-1091. Korean.
Published online December 21, 2010.  https://doi.org/10.5468/kjog.2010.53.12.1085
Copyright © 2010 Korean Society of Obstetrics and Gynecology
Decrease in acceptance of genetic amniocentesis after alteration of social conditions toward pregnancy termination
Byoung Jae Kim, M.D., Kyu Ri Hwang, M.D., Taek Sang Lee, M.D., Hye Won Jeon, M.D. and Kwang Bum Bai, M.D.
Department of Obstetrics and Gynecology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea.

Corresponding author (Email: bjkimmd7@snu.ac.kr )
Received October 21, 2010; Revised November 16, 2010; Accepted November 17, 2010.

Abstract

Objective

To investigate the effect of alteration of social conditions towards pregnancy termination on the acceptance of genetic amniocentesis.

Methods

Retrospective review of medical records was conducted for women (<20 weeks' gestation, singleton pregnancy) who visited our outpatient department between February 1, 2009 and August 31, 2010. Acceptance of genetic amniocentesis was compared between two groups of women: one from February 1, 2009 to November 30, 2009 (2009 group) and the other from December 1, 2009 to August 31, 2010 (2010 group) after strict regulation of pregnancy termination. The acceptance rate of those who were referred to our center for genetic amniocentesis in same time period was also evaluated.

Results

Overall, 19 of 101 (19%) women in the 2009 group and 10 of 93 (11%) in the 2010 group, opted for invasive diagnostic methods (P=0.16). Women > 35 years in the 2010 group (5/30, 17%) were less likely to accept genetic amniocentesis than 2009 group (15/30, 50%; P=0.01). Similar results were observed in those who were indicated for genetic amniocentesis. (9/35, 26% vs 19/34, 56%; P=0.02). Acceptance rate of genetic amniocentesis was increased for those who were referred from private clinic, but without statistical significance (15/21, 71% vs 13/14, 93%; P=0.20).

Conclusion

After strict regulation of pregnancy termination, acceptance rate of genetic amniocentesis was significantly decreased among women who had increased risk for chromosomal abnormalities or neural tube defect at our center. Whereas, there were no significant change in acceptance rate for those who were referred for amniocentesis from private clinic.

Keywords: Amniocentesis; Prenatal diagnosis; Therapeutic abortion

Figures


Fig. 1
Schematic diagram of patient decisions
Click for larger image


Fig. 2
Frequency of amniocentesis according to study period. Frequency of amniocentesis among pregnant women who had screening or confirmatory tests at our center between Feb 1, 2009 and Nov 30, 2009 (2009) was compared with that of those who had tests between Dec 1, 2009 and Aug 31, 2010 (2010).
Click for larger image


Fig. 3
Acceptance of amniocentesis according to study period and whether she was referred or not. Acceptance of amniocentesis was compared among 4 groups, which were pregnant women who had increased risk of chromosomal abnormalities or neural tube defect at our center between Feb 1, 2009 and Nov 30, 2009 (2009), those who were referred from private clinic in the same period (referred 2009), those who had increased risk at our center between Dec 1, 2009 and Aug 31, 2010 (2010) and those who were referred for further studies (referred 2010).
Click for larger image


Fig. 4
Schematic diagram of patient decisions in referred cases.
Click for larger image

Tables


Table 1
Demographic characteristics of study population
Click for larger image

References
1. Elimian A, Demsky M, Figueroa R, Ogburn P, Spitzer AR, Gerald Quirk J. The influence of IVF, multiple gestation and miscarriage on the acceptance of genetic amniocentesis. Prenat Diagn 2003;23:501–503.
2. American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 27: Clinical Management Guidelines for Obstetrician-Gynecologists. Prenatal diagnosis of fetal chromosomal abnormalities. Obstet Gynecol 2001;97(5Pt1):suppl 1–suppl 12.
3. Kim HM. The necessity and direction of revising article 14 of the mother and child health law. Korean J Obstet Gynecol 2009;52:487–498.
4. Son YS. The medicolegal understanding regarding fetocide in the criminal law and artificial termination in the mother and child health law. Korean J Obstet Gynecol 2010;53:467–474.
5. Chae YH, Seo K, Yoon DK, Oh JR, Lee MB, Lee KE. A research on the actual condition of antenatal screening application in obstetric clinics in Korea and suggestions for preparation of antenatal screening guideline. Korean J Obstet Gynecol 2006;49:55–63.
6. Park IY, Shin JC, Kim SC, Ahn HY, Moon HB, Park CH, et al. Cytogenetic analysis in 3,503 cases of midtrimester smniocentesis: CUMC experience (II). Korean J Obstet Gynecol 2004;47:96–103.
7. Chun YY, Ku JY, Song JW, Kim BS, Bae YY, Sun JG, et al. Clinical analysis of 739 cases of midtrimester amniocentesis. Korean J Perinatol 2005;16:146–153.
8. Jang SK, Choi OH. Cytogenetic and clinical analysis in 3,537 cases of midtrimester smniocentesis. Korean J Perinatol 2007;18:29–36.
9. Shim JY, Kim SH, Kim JS, Ahn SM, Seo EJ, Yoo HW, et al. Clinical snalysis of prenatal cytogenetic diagnoses: four-year experience at Asan Medical Center. Korean J Obstet Gynecol 2004;47:487–494.
10. Kim KM, Cho JY, Park MH, Kim SH, Kim BJ. Matermal serum screening test for fetal Down syndrome. Korean J Obstet Gynecol 1998;41:2593–2598.
11. Choi YK, Kim MY, Han JY, Ryu HM, Yang JH, Kim ES, et al. A Study about the effect iveness of triple marker test as a screening test for chromosomal aneuploidy. Korean J Obstet Gynecol 1999;42:1935–1942.
12. Green JM, Hewison J, Bekker HL, Bryant LD, Cuckle HS. Psychosocial aspects of genetic screening of pregnant women and newborns: a systematic review. Health Technol Assess 2004;8:iii, ix-x, 1-109.
13. Kuppermann M, Learman LA, Gates E, Gregorich SE, Nease RF Jr, Lewis J, et al. Beyond race or ethnicity and socioeconomic status: predictors of prenatal testing for Down syndrome. Obstet Gynecol 2006;107:1087–1097.
14. Garcia E, Timmermans DR, van Leeuwen E. The impact of ethical beliefs on decisions about prenatal screening tests: searching for justification. Soc Sci Med 2008;66:753–764.
15. Kelly SE. Choosing not to choose: reproductive responses of parents of children with genetic conditions or impairments. Sociol Health Illn 2009;31:81–97.
16. Markens S, Browner CH, Press N. 'Because of the risks': how US pregnant women account for refusing prenatal screening. Soc Sci Med 1999;49:359–369.
17. Viljoen D, Oosthuizen C, van der Westhuizen S. Patient attitudes to prenatal screening and termination of pregnancy at Groote Schuur Hospital: a two year prospective study. East Afr Med J 1996;73:327–329.
18. Elimian A, Demsky M, Figueroa R, Ogburn P, Spitzer AR, Quirk JG. The influence of genetic counselors on the acceptance of mid-trimester amniocentesis. J Matern Fetal Neonatal Med 2005;17:219–221.
19. Saucier JB, Johnston D, Wicklund CA, Robbins-Furman P, Hecht JT, Monga M. Racial-ethnic differences in genetic amniocentesis uptake. J Genet Couns 2005;14:189–195.
20. Usta IM, Nassar AH, Abu-Musa AA, Hannoun A. Effect of religion on the attitude of primiparous women toward genetic testing. Prenat Diagn 2010;30:241–246.
21. Sharda S, Phadke SR. Uptake of invasive prenatal diagnostic tests in women after detection of soft markers for chromosomal abnormality on ultrasonographic evaluation. J Perinatol 2007;27:550–555.
22. Wray AM, Ghidini A, Alvis C, Hodor J, Landy HJ, Poggi SH. The impact of first-trimester screening on AMA patients' uptake of invasive testing. Prenat Diagn 2005;25:350–353.
23. Zoppi MA, Ibba RM, Putzolu M, Floris M, Monni G. Nuchal translucency and the acceptance of invasive prenatal chromosomal diagnosis in women aged 35 and older. Obstet Gynecol 2001;97:916–920.
24. Nakata N, Wang Y, Bhatt S. Trends in prenatal screening and diagnostic testing among women referred for advanced maternal age. Prenat Diagn 2010;30:198–206.