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What a prenatal diagnosis can tell us and what options we have afterwards.

What a prenatal diagnosis can tell us and what options we have afterwards.

Since the new prenatal diagnosis began in Japan in 2013, more than 65,000 pregnant women have undergone the test in five years, and 90% of the approximately 900 people who tested positive chose to have an abortion.

90% of abortions due to positive new prenatal diagnosis

90% of abortions due to positive new prenatal diagnosis."

Have you ever heard this term before? Shockingly, since the new prenatal diagnosis began in Japan in 2013, more than 65,000 pregnant women have received the diagnosis in the past five years, and 90% of the approximately 900 people who have tested positive have chosen to have an abortion.

What does the test reveal? How is the abortion actually performed? Is there any care after the abortion? Many people have questions such as the following.

We hope you will find the following detailed explanation helpful.

age Incidence of Down syndrome
20 1/1538(0.65%)
25 1/1250(0.8%)
30 1/840(1.19%)
31 1/741(1.35%)
32 1/637(1.57%)
33 1/535(1.87%)
34 1/441(2.247%)
35 1/356(2.81%)
age Incidence of Down syndrome
36 1/281(3.56%)
37 1/217(4.60%)
38 1/166(6.03%)
39 1/125(8.00%)
40 1/106(9.4%)
41 1/70(14.29%)
42 1/52(19.06%)
43 1/40(25.21%)
age Incidence of Down syndrome
44 1/30(32.86%)
45 1/24(41.93%)
46 1/19(52.03%)
47 1/16(62.32%)
48 1/14(71.35%)
49 1/13(78.03%)

The actual incidence of Down syndrome in first pregnancies, as shown in the table, increases with age. Although the aging of the male may be a factor, the aging of the female is considered to have a greater impact. One possible reason for this is that as women age, their eggs also age. The eggs that a woman produces during her lifetime are formed in the fetal period and ovulated once a month. The longer the eggs remain in the ovaries, the more damage is done to the chromosomes that produce genetic information, which increases the probability of chromosomal abnormalities.

What the Inspection Reveals

Prenatal testing includes genetic testing for chromosomal abnormalities and ultrasound testing for organ abnormalities.

genetic testing

Genetic testing can be divided into two types: non-confirmatory testing to determine the probability of the presence or absence of a disease and confirmatory testing to confirm the diagnosis. The non-confirmatory test is characterized by a low risk of miscarriage due to a small amount of blood sampling and abdominal ultrasound, while the confirmatory test is characterized by a low risk of miscarriage due to direct needle insertion into the mother.

inconclusive (verdict)

ultrasound examination

The ultrasound exam is performed around 11-13 weeks gestation to check the thickness of the swelling at the back of the neck called NT (Nuchal Translucency), heart rate, blood flow, etc. NT can be found in a normal fetus, but if it is thicker than normal, the risk of Down syndrome or other chromosomal abnormalities is estimated. NT is also found in normal fetuses.

A mid-term ultrasound is also performed around 18 weeks' gestation, which provides more information than the first time, including the size of the cerebellum and the location of the ears.

Quattro (maternal serum marker) test

It is performed around 15 to 17 weeks' gestation and analyzes four components of blood taken from pregnant women to determine the probability of having Down syndrome, 18 trisomy, or open neural tube malformation.

New Prenatal Diagnosis (NIPT)

This test is available from 10 to 22 weeks of pregnancy, and is performed by examining a blood sample from the mother to determine chromosomal abnormalities in the fetus. The DNA of the fetus is mixed in the placenta, and by examining the DNA, the possibility of 13-trisomy, 18-trisomy, or 21-trisomy (Down syndrome) can be determined. As a general rule, the test is performed on people who are 35 years of age or older on the expected date of delivery, or who have a relative with a chromosomal abnormality within the second degree of consanguinity.

final inspection

Each is intended for chromosomal abnormalities in general, and is performed to obtain more accurate information when a non-confirmatory test is positive or when an abnormality is found on ultrasound examination. Both tests are generally reliable.

chorionic test

It can be performed around 10-13 weeks gestation, and depending on the location of the fetus, a chorionic villus is extracted by needle or tube through the pregnant woman's abdomen or vagina to determine chromosomal abnormalities. It may take up to 3 weeks for the results.

amniotic diagnosis

The procedure, which can be performed around 16-17 weeks' gestation, involves inserting a needle directly into the pregnant woman's abdomen and draining amniotic fluid to check for chromosomal abnormalities in the fetus. It may take up to 4 weeks for the results.

Because of the technology required, it is believed that more medical institutions perform amniotic fluid testing than chorionic villus testing.

man-made cooling

If an abortion is chosen, it must be performed by less than 22 weeks (21 weeks and 6 days) according to the Maternal Protection Law (which stipulates matters concerning sterilization or abortion and is intended to protect the life and health of the mother), and only a doctor designated under the Maternal Protection Law can perform the abortion procedure.

Abortion is performed differently in early pregnancy (less than 12 weeks) and mid-pregnancy (12-22 weeks).

Initial case

suction method

A method in which suction is applied by a machine to suck out the patient. The operation time is short, but it takes time for sterilization and disinfection to prevent infection.

scratch (the surface) method

A special scissors-like instrument is used to remove the contents. Most hospitals in Japan use this method because the machine is simple and the possibility of infection is low.

Both procedures take a few hours and are day surgeries.

Mid-term

After 12 weeks, the abortion is treated as an artificial stillbirth, and the baby is artificially induced and delivered in the same way as a normal delivery. The abortion is performed in the form of labor and delivery rather than surgery. The hospital stay is usually 3 to 5 days because it takes several days and it is necessary to check the return of the uterus after the fetus has been released.

After 12 weeks of pregnancy, a stillbirth notification must be submitted to the local government office within 7 days, and burial by cremation is mandatory.

In addition, most abortion surgeries are not covered by health insurance and are self-paid.

  • 130,000-150,000 yen for less than 10 weeks
  • 10-11 weeks, 150,000-200,000 yen.
  • Approximately 210,000 yen for 12-15 weeks
  • About 440,000 yen for 16-21 weeks

Other costs in the mid-term include notification processing and hospitalization costs, which vary depending on the number of weeks and the size of the fetus at the time of consultation.

If you choose to have an abortion

Since NIPT was implemented, the number of people undergoing the procedure has increased each year due to its high accuracy and the fact that only a small amount of blood is needed to be drawn. As mentioned at the beginning of this article, more than 60,000 people have been diagnosed since 2013, and about 90% of pregnant women who tested positive chose to have an abortion.

Many people choose to have abortions because of discrimination and prejudice against the disability, the financial and psychological burden after giving birth, and the anxiety caused by ignorance about Down syndrome.

Some women are not able to have abortions at the medical facilities that perform pregnancy examinations, and are swamped by the results and forced to make a choice in a short period of time. Abortion is physically and psychologically taxing, resulting in a mental breakdown and depression.

Nowadays, we are able to hear from people in similar situations through social networking sites. The final decision is yours or your partner's, but it is very important to seek help from doctors, counselors, and other professionals as well as people in the same situation.

summary

The number of facilities where prenatal diagnosis such as NIPT is available has increased, and the accuracy of the test has improved, making it possible to detect fetal abnormalities at an early stage. However, there are some medical facilities that only mail the results or do not provide aftercare after an abnormality is found or an abortion is chosen. Many people do not know where to go, who to talk to, and how to ask for help, and many suffer from mental illness due to the guilt of choosing to have an abortion after the abortion cycle has passed.

Society as a whole is not yet ready to accept people with disabilities.

It is said that NIPT promotes abortion, but other people do not have the right to make personal decisions. We can only hope that society will progress toward a world where it is not difficult to live regardless of whether one chooses to have an abortion or to give birth.

References