Dilemmas encountered by health practitioners offering nuchal translucency screening: a qualitative case study

To explore dilemmas experienced by practitioners involved in routine prenatal nuchal translucency (NT) screening.

Qualitative study incorporating multidisciplinary practitioner discussion groups led by a health care ethicist.

Inner-city teaching hospital with fetal medicine unit.

Thirty-two practitioners whose work relates directly or indirectly to perinatal care.

Practitioners identified a number of dilemmas, many of which centred on the tension between pregnancy being seen as a normal or a 'risky' time. Practitioners and women were perceived to have contrasting reasons for screening, with women welcoming the opportunity to 'see' their baby on the ultrasound scan, whilst practitioners were screening for abnormalities. These differing agendas led to various dilemmas particularly in relation to information giving, performing scans incorporating NT screening and promoting individual client choice.

Plans to introduce routine NT screening need careful prospective consideration of the potential implications for both providers and users of the service. The discussion groups also identified the need for training in the complex communication skills required and an awareness of the related ethical dilemmas, plus the need for increased time and resources to enable practitioners to promote informed choice.