You are asked to see Karie in an antenatal consult. Karie is an 18-year-old single mother and she is now 19 weeks pregnant. At an 18-week ultrasound, the female fetus was found to suffer from gastroschisis. There is a moderate amount of bowel exteriorized and there is no bowel dilatation. The amount of amniotic fluid is normal and the fetus has a normal biophysical profile.
Karie is just finishing high school. She wants to go to university and become an engineer. She has been in a relationship on and off with her boyfriend for 2 years. He is here with her for the consultation, as well as her mother. Karie lives at home with her 2 younger siblings and her parents. Both of her parents are working; father is an electrician and mother is a secretary.
The pregnancy was not planned and with the news of the gastroschisis, Karie thinks she wants to terminate the pregnancy. She has agreed to meet with a pediatric surgeon to know more about this condition before she makes her final decision.
- What would you tell her? What are the important facts she needs to know to make an informed decision?
- Who is your patient during this consultation?
- Karie's mother asks you if it was your child, what you would do. What would you answer?
- Discuss the dilemma of caring for a mother as a pediatric surgeon.
- How do you reconcile your own beliefs and this young mother's decision?
Topic: Prenatal consultation: Maternal-fetal dilemmas
To be able to negotiate life-sustaining treatment with respect to autonomy, reproductive freedom, beneficence and justice.
Ciniano DA, Baylis F. Ethical considerations in prenatal surgical consultation. Ped Surg Int 1999;15;303-309
Flake A. Prenatal Intervention: Ethical considerations for life-threatening and non-life-threatening anomalies. Sem Pediatr Surg 2001:10;212-221.
18-year-old mother, 20 weeks pregnant; the ultrasound diagnosed a gastroschisis. Mother is seeking termination.
Case related discussion, pre and post interactive presentation..
CanMeds competencies targeted: