Medical Interruption of pregnancy - SpeedyLook encyclopedia

The medical interruption of pregnancy (IMG) can be indicated when the Grossesse seriously endangers the life of the mother or when the Fœtus is reached of an incurable grave disease at the time of the diagnosis. It is possible in France at any age of the pregnancy until the term of the pregnancy.

Legal aspects

France

In France, " the law ensures the primacy of the person, prohibited very reached with the dignity of this one and guarantees the respect of the human being as of the beginning of its life " (Article L2211-1 of the public health code).

On the other hand, the Fœtus has, with the eyes of the French law , no legal existence as anybody. It is only with the birth that it obtains the statute of anybody. The existence of this “Hiatus” in the French law makes it possible to cause the death of a fetus In utero by medical techniques (when this act is licit), then to start the childbirth on a died fetus, without exposing itself to the crime of assassination (which is applicable only to the legal people).

The terms of the Loi Veil-Furrier (in particular article 162-12 of the Public health code) form a framework deliberately little “ directif ”, in agreement with the state of knowledge of the time (1979), leaving an important degree of medical interpretation. Practical methods of “ the medical interruption of grossesse ” since were specified, inter alia, by article 13 of law 94-654 of July 29th, 1994, which specifies that: “ Moreover, if the termination of pregnancy is considered with the reason which there exists a strong probability that the child to be born is reached of an affection of a particular gravity recognized like incurable at the time of the diagnosis, one of these two doctors must carry on his activity in a center of prenatal diagnosis pluridisciplinaire ”.

Indications

Maternal pathology

Any maternal disease, whose evolution can be seriously disturbed by a pregnancy, even normal, can be indication with a IMG. These indications are rare today.

cardiac Pathology serious, with cardiac risk of decompensation during the pregnancy
cancerous Pathology , where the delay of treatment caused by the pregnancy can be seriously prejudicial with maternal survival.
psychiatric Pathology , when the pregnancy involves the decompensation of a preexistent Névrose with suicidal risk.

In these cases of Pathology S nursery schools, the opinion of two medical experts, of which one expert of maternal pathology and the other, if possible, member of a diagnostic center anténatal, is necessary.

Fetal pathology

Any big risk of fetal pathology engraves, recognized like incurable at the time of the diagnosis.

Malformation of a functional body lethal in the more or less short term (renal sterility, pulmonary hypoplasy, extreme inescapable prematurity)
Reached cerebral or nervous being likely to involve a neurological deficit engraves (hydrocéphalie, sterility of various cerebral areas, cerebral infectious attack)
chromosomal Anomalie with intellectual deficit
Other malformations or diseases fetal involving a seriously disturbed quality of life

In these situations, the opinion of the parents is dominating. After consultations near several specialists concerned (obstetrician, infantile surgeon, neuro-pediatrist, cardio-pediatrist, geneticist, psychiatrist…), the couple Formula One a request, which is examined by a multi-field diagnostic center anténatal. The diagnostic center antenatal then delivers an opinion (favorable or unfavourable) on the IMG.

Technique

It varies according to the term of the pregnancy at the time of the interruption.

Before 22 weeks of amenorrhoea

Preparation by the anti-progesterone catch, then 48 hours after release of work by oral or vaginal prostaglandin catch, drugs involving a dilation of the collar and contractions uterine with expulsion of the pregnancy. A analgesics perfusion to the request is instituted (morphine).

In the rare circumstances where the low way is impossible (placenta in front of the collar, for example), a mini-Cesarean is possible.

After 22 weeks of amenorrhoea and until the term

The 22 weeks limit is essential since beyond this term the child is regarded as such (right to the burial, leave maternity, although the paternal leave is not granted in the event of IMG…) what is not the front case.

The risk to obtain a child living with the birth being important, one first of all carries out a foeticide the purpose of which is to result in the death of the fetus in utero. It is carried out by injection in the umbilical cord (cordocentèse) by way transabdominale (as for a amniocentèse) of morphine powerful (Sufentanyl) if need be to anaesthetize the fetus followed by the injection of the product to the properties foeticides (Xylocaïne) in a repeated way. In the event of failure of the procedure, the gesture foeticide can be supplemented by the Potassium Chloride injection which is used exclusively only by intracardiac way.

The release of work is then obtained by prostaglandin catch, with possibly rupture of the pocket of water, in the form of an induced delivery, generally under anesthesia Péridurale.

Moral aspects

The moral aspects of the IMG are multiple and continue to make run much ink…

In itself, the concept of “risk” of serious malformation is very subjective, each couple being free to choose the risk which it agrees to run to have a child (any pregnancy being in any case a taking risk). The diagnostic center anténatal must appreciate in conscience if the theoretical risk or not justifies to stop the pregnancy.

The concept of “unacceptable quality of life” is it also very subjective. One can understand for example that a couple of pianist would live like a terrible handicap the sterility of a hand in their child. There still, the mission of the diagnostic center anténatal is “to replace” this quality of life in a general direction.

The concept of “mental handicap” is entirely subjected to the idea that is made the company of it. One can wonder how by this company the handicap of the Trisomie 21 would be felt, for example, if the structures of assumption of responsibility of such children were developed, with a real will to integrate in the company of the individuals into IQ certainly lower than the normal, but happy of living with.

Lastly, the risk of eugenic drift is often mentioned because of the current idea of “perfect single child”, who makes fear excesses. To limit these possibilities of drifts, the conditions to grant a IMG are very strict. Moreover, the statistics show well that the parents who decide of a IMG make it while thinking of the possible or unquestionable suffering of their child and not because it is not " parfait".

Psychological aspects

The death of this child, even decided by the parents, is a perinatal death with whole share. A IMG should not be decided in the urgency (except danger to the mother) the more so as there is not, in France, of limiting times. Alternatives, according to pathologies, can exist: palliative care in maternity, adoption, childbirth under X. It is an extremely complex mourning where it is essential to have the maximum of memories (photographs, prints, family record book), because often the entourage does not recognize the existence of this child.

Bonds

Small Emilie ''' (French Association helping the parents confronted with the possibility of a IMG as of the diagnosis)

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