Ethical Discussion: Termination of Pregnancy after Prenatal Diagnosis of Cleft Lip in a Chinese Population in Hong Kong

Abstract

Objectives: To determine factors influencing the decision to terminate or continue a pregnancy after prenatal diagnosis of congenital cleft lip with or without cleft palate (CLP) and discuss the ethical dilemmas in prenatal counselling in terms of autonomy and social issues.
Methods: A total of 38 fetuses or newborns with congenital CLP in a regional district hospital in Hong Kong born over a 6-year period were studied. Outcomes of the 26 fetuses detected to have non-syndromic CLP (before 24 weeks) were studied with respect to demographic, social, and prenatal factors.
Results: The overall frequency of CLP was 1.11 per 1000 births. Approximately 31% (8/26) non-syndromic CLP detected prenatally (before 24 weeks) opted for termination of pregnancy. The only identifiable factor in the decision was attendance of counselling by plastic surgeons.
Conclusion: A multidisciplinary approach with contribution from a plastic surgeon in joint counselling was potentially beneficial to the patients and their families. Advances in early prenatal diagnosis of facial cleft with a significant number of women electing abortion raise serious ethical questions.