- Open Access
How can we improve amniocentesis decision-making?
© Lehmann. 2016
- Received: 18 December 2015
- Accepted: 14 January 2016
- Published: 5 February 2016
The decision to have an amniocentesis entails a trade-off between a risk of procedure associated miscarriage and the benefit of obtaining diagnostic information to identify Down syndrome or other chromosomal aneuploidy. Ideally, this trade-off is informed by first and second trimester pre-natal screening tests, such that women with low risk screening test results are not encouraged to have an amniocentesis.
In a recent IJHPR article, Grinshpun-Cohen et al. surveyed 42 Israeli women without a medical indication for amniocentesis other than age. They found that one third of women who had a noninvasive serum screening test prior to amniocentesis did not even wait for the test results before electing to have the invasive procedure and 10 % of women did not have any serum screening test prior to amniocentesis.
There may be multiple reasons why women of advanced maternal age are not integrating screening risk information into their decision-making about amniocentesis. However, our understanding of those reasons is limited, as we don’t have information on the content of conversations between health care providers and women who are considering amniocentesis. We don’t know if health care providers counseled women on how screening risk information can inform their decision about whether or not to purse a diagnostic amniocentesis. Even if women with screening tests results suggestive of a low risk of Down syndrome were counseled not to pursue an amniocentesis, some women may have a preference for diagnostic information about a fetus’s Down syndrome status. Health care providers should, however, be encouraged to engage women in a process of shared decision making to ensure that women are informed and making deliberative decisions that meet their goals of care. Offering women a relatively new, cell-free fetal DNA test may provide reassurance that negates the impulse to have an amniocentesis. Public funding for amniocentesis for all women of advanced maternal age should continue as the decision to purse an amniocentesis is best determined by women who have to live with the consequences of their choice.
- Health Care Provider
- Down Syndrome
- Prenatal Screening
- Nuchal Translucency
- Screen Test Result
Many women who undergo first or second trimester pre-natal screening are not using this information to inform their decision about amniocentesis. It is unclear if this is a consequence of a quest for certitude associated with a diagnostic procedure or if it is a failure of health care providers to engage women in shared decision making about pre-natal screening and amniocentesis. Future research should illuminate the content of conversations between women and health care providers to better assess the quality of decision-making regarding amniocentesis. While many women with low risk screening tests decide to purse an amniocentesis that carries a risk of miscarriage, restricting public funding of amniocentesis to women with advanced maternal age and high risk prenatal screening is unlikely to dissuade women who want definitive information on the status of their fetus from having an amniocentesis. Offering women cell-free fetal DNA testing may provide women with sufficient reassurance such that they don’t feel compelled to have an amniocentesis in the setting of low risk screening.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
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