Factors influencing referrals for prenatal cytogenetic diagnosis

This paper reports the results of an investigation into factors influencing the referral of women for prenatal cytogenetic diagnosis, following mid-second-trimester amniocentesis. The overall diagnostic amniocentesis rate for women over the age of 35 years was 16.8%. One hundred and forty consecutive Brisbane women referred to the 2 Queensland laboratories offering chromosome analysis of amniotic fluid cells were included in this study. 72% were referred for advanced maternal age. The socioeconomic status (SES) of the 140 women was skewed very significantly towards the professional and semiprofessional classes (Classes A and B on the Congalton Australian Four-point Scale). Twenty seven percent of all women are in SES Class D in the Brisbane population, but only 7.4% of such women (SES Class D) were within the group studied. Forty nine percent of women indicated that they themselves raised the question of prenatal diagnosis with their doctor. Diagnostic amniocentesis is not acceptable to a certain proportion of couples, but it is estimated that 60% would accept it if there were medical indications, and if it were offered. Our studies have indicated that of those women who are at increased risk of having a child with a significant chromosomal abnormality (including those over the age of 35 years) and to whom prenatal diagnosis is acceptable, 28% are actually receiving it in current practice. Those who do are a well informed, self-motivated upper and middle class group.