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You are asked to see Karie in an antenatal consult. Karie is an 18-year-old single mother and she is now 19 weeks pregnant. At an 18-week ultrasound, the female fetus was found to suffer from gastroschisis. There is a moderate amount of bowel exteriorized and there is no bowel dilatation. The amount of amniotic fluid is normal and the fetus has a normal biophysical profile.

Karie is just finishing high school. She wants to go to university and become an engineer. She has been in a relationship on and off with her boyfriend for 2 years. He is here with her for the consultation, as well as her mother. Karie lives at home with her 2 younger siblings and her parents. Both of her parents are working; father is an electrician and mother is a secretary.

The pregnancy was not planned and with the news of the gastroschisis, Karie thinks she wants to terminate the pregnancy. She has agreed to meet with a pediatric surgeon to know more about this condition before she makes her final decision.

  1. What would you tell her? What are the important facts she needs to know to make an informed decision?
  2. Who is your patient during this consultation?
  3. Karie’s mother asks you if it was your child, what you would do. What would you answer?
  4. Discuss the dilemma of caring for a mother as a pediatric surgeon.
  5. How do you reconcile your own beliefs and this young mother’s decision?

Workshop 6

Topic: Prenatal consultation: Maternal-fetal dilemmas

Curricular objectives

To be able to negotiate life-sustaining treatment with respect to autonomy, reproductive freedom, beneficence and justice.

Ethical messages:

  • The mother is the patient during the prenatal consultation and her freedom of choice should be respected

Pre-workshop readings:

  1. Ciniano DA, Baylis F.  Ethical considerations in prenatal surgical consultation.  Ped Surg Int 1999;15;303-309
  2. Flake A.  Prenatal Intervention: Ethical considerations for life-threatening and non-life-threatening anomalies.  Sem Pediatr Surg 2001:10;212-221.

Paradigm case:

18-year-old mother, 20 weeks pregnant; the ultrasound diagnosed a gastroschisis.  Mother is seeking termination.

Teaching modality:

Case related discussion, pre and post interactive presentation..

CanMeds competencies targeted:

Medical expert