Prenatal management of anencephaly

Abstract

About a third of anencephalic fetuses are born alive, but they are not conscious or viable, and soon die. This neural tube defect can be limited by dietary consumption of foliates, and detected prenatally by ultrasound and other means. Many laws permit abortion, on this indication or on the effects of pregnancy and prospects of delivery on a woman's physical or mental health. However, abortion is limited under some legal systems, particularly in South America. To avoid criminal liability, physicians will not terminate pregnancies, by induced birth or abortion, without prior judicial approval. Argentinian courts have developed means to resolve these cases, but responses of Brazilian courts are less clear. Ethical concerns relate to late-term abortion, meaning after the point of fetal viability, but since anencephalic fetuses are nonviable, many ethical concerns are overcome. Professional guidance is provided by several professional and institutional codes on management of anencephalic pregnancies.

Sexual and reproductive health and rights in Latin America: an analysis of trends, commitments and achievements

“…49 Except in one case in 2005, Brazilian courts have generally based their decisions on the Catholic claim of the right to life from conception, even if moral and religious language is not apparent in the judgements. 51 Advocacy by the Catholic Church against emergency contraception, falsely describing it as abortifacient, has also influenced politicians and judges. 52 The dominance of this stance is evident in jurisprudence on emergency contraception in Chile in 2008 and Argentina in 2002.…”

The costs of drugs and medical care for pregnancy termination. How much is the abortion?

“…In a small number of countries, where maternal mortality is low despite restrictive abortion laws, many women have access to safe or relatively safe abortion through seeking care from neighbouring countries, through provision of safe, but illegal abortion care domestically, or through self-use of misoprostol (47)(48)(49).…”

“…The provision of safe, legal abortion is considerably less costly than treating the complications of unsafe abortion (43)(44)(45)(46)(47). Costs for providing abortion care with vacuum aspiration include infrequent, modest capital investments, such as a suction machine or MVA equipment; an examination table; a steam sterilizer or autoclave; renovation of waiting, consultation and recovery rooms; and toilets.…”

“…Vacuum aspiration can be performed by a trained midlevel health-care provider in an office or examination room, whereas D&C is often performed in an operating theatre by a physician. Also, vacuum aspiration usually requires less medication for pain than D&C (23,47,48).…”

“…Such lists tend to be restrictive and are therefore a barrier to women accessing safe abortion services. In some countries, no reference is made in the law to fetal impairment; rather, health protection or social reasons are interpreted to include distress of the pregnant woman caused by the diagnosis of fetal impairment (46,47).…”