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Table of Contents
COMMENTARY
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 52-53

Fetal ultrasonology and its impact on society-the neurosurgeon's perspective


Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India

Date of Web Publication02-Nov-2021

Correspondence Address:
Dr. J K. B C. Parthiban
Department of Neurosurgery, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJNO.IJNO_408_21

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How to cite this article:
C. Parthiban J K. Fetal ultrasonology and its impact on society-the neurosurgeon's perspective. Int J Neurooncol 2021;4, Suppl S1:52-3

How to cite this URL:
C. Parthiban J K. Fetal ultrasonology and its impact on society-the neurosurgeon's perspective. Int J Neurooncol [serial online] 2021 [cited 2021 Nov 27];4, Suppl S1:52-3. Available from: https://www.Internationaljneurooncology.com/text.asp?2021/4/3/52/329803



Diagnostic ultrasonography has entrenched itself in the armamentarium of radiologists for the prenatal assessment of a fetus. Its benefits and challenges have grown exponentially in Indian society. Fetal ultrasonography is now anatomy oriented. Although the sole motive of introducing this innovative technology was to learn and understand fetal development, its role in the detection of diseases, brain tumors, hydrocephalus, and dysraphic defects in the fetus made treatment planning and a safe delivery much easier [Figure 1]. Neurosurgeons started dreaming of developing foetal neurosurgery. The technology matched their enthusiasm as three-dimensional, high definition images became available, thanks to the engineering marvels prevalent. However, soon a new challenge started emerging. This included disease selection for continuing pregnancy among Indian women, particularly from the rural population. This has equally serious consequences as “gender selection” that had been frequently performed a few decades ago.
Figure 1: The enthusiasm related to the role of fetal ultrasound in developing fetal neurosurgery is tempered by the danger of fetal termination even on detection of a minor and easily correctable ailment in the fetus

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In recent years, fetal medicine has taken its position as a subspecialty and its value is being aptly disseminated among the lay public by medical institutions. Young Indian mothers are keen to get examined and eager to know with great expectation, about the health of their babies before delivery. The most sensational aspects of the ultrasonography reports include good, moderate, and ugly points regarding fetal health. While good and ugly points are easily acceptable by the parents (good points signifying that the pregnancy should continue, and ugly points signifying unequivocally that the pregnancy should be terminated), the moderate points create a decision dilemma. A neurosurgical consultant is often called upon to give an opinion regarding the future prospects of the fetus that is living and growing in the womb. In this context, the super-specialists are the best persons to provide a clear opinion, particularly on spinal dysraphisms without neurological deficits and many other treatable and reparable defects after delivery. These foetuses are otherwise normal living beings, and given the opportunity, will lead a normal life in society. Unfortunately, young parents, despite being provided clear information and assurance, view the foetus with suspicion due to the social stigma and fear, and opt to terminate the pregnancy!

This new age feticide is unreported and not widely discussed till now. Specialists such as obstetricians, pediatricians, neurologists, neurosurgeons and sonologists should have a thorough knowledge of the recent advancements in the management of fetal disorders and have a significant responsibility in imparting knowledge and assurance among the parents and their relatives. This may apply to other medical subjects as well, such as cardiology, nephrology, and gastroenterology, among other branches. The team of specialists should not instil a fear factor in the minds of parents about simple defects that are not dangerous and are completely treatable. A status of a fetus that has extensive disorders that cannot be corrected needs to be discussed in details before the recommendation of termination of pregnancy is offered. A mature and detailed guidance from specialist doctors can lead the society towards the right path at a time when information is frequently obtained from social media by parents and their relatives. Many recent developments are not known to society and young parents rely on their parents (that is, grandparents of the fetus) to take decision on this sensitive issue. Often, they make a wrong decision and go in for medical termination of pregnancy due to the fear and stigma of giving birth to a defective baby.

Female feticide was rampant in India a few decades ago and also threatened the sex ratio in our country. Though the Indian parliament enacted the Preconception and Pre-natal Diagnostic Test Act (PCPNDT) in 1994, the Supreme court ordered all states to effectively implement the law against sex selection in 2013 by giving more powers to the law. These strict measures have shown significant results and have created an awareness among the public. The abortion of female fetuses was prevented. The strict implementation of this law has deeply influenced the mind-set of the Indian population even in rural areas. Now this “new age foeticide” based on disease/defect selection needs to be controlled before it gets out of hand. This may also have deep impact on the development of fetal neurosurgery in India. If we do not take the first step in confronting this challenge, the fear is that a law may have to be enacted in the near future in the parliament to control surgical decision-making based on fetal ultrasound, potentially sounding the death-knell of fetal neurosurgery in India.




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