The mother’s choice is ultimate in the termination of pregnancy, the Delhi High Court ruled on Tuesday while dealing with the plea of a 26-year-old married woman who sought termination of her over 33-week foetus since it suffered from certain cerebral abnormalities.
Justice Pratibha M Singh underlined that the ultimate choice in pregnancy cases involving foetal abnormalities is of the mother and emphasised that medical boards in such cases must give qualitative reports.
In this case, the petitioner sought to terminate her pregnancy after she found out that the foetus was suffering from certain cerebral abnormalities, casually known as brain abnormalities.
Experts told News18.com that brain structural abnormalities can be seen either prenatally (before birth) or post-natally (after birth) and the developmental processes of the brain can be impacted by environmental, viral, disruptive, or hereditary reasons.
Cerebral abnormalities indicate a group of neurological disorders that appear in babyhood or early childhood which can permanently affect the body movement and muscle coordination of a child.
While the details of the exact medical condition of the foetus are not discussed, News18.com spoke to experts to understand what cerebral abnormalities mean and how they affect the quality of life.
What are cerebral abnormalities?
Researchers have linked the presence of brain abnormalities to a variety of conditions including developmental disorders such as Autism, Schizophrenia, various types of brain tumours, and dementias.
Cerebral palsy is one of the most common causes of neurological disability in children and it refers to a group of permanent disorders related to the development of the child’s movement and posture.
It may cause activity limitations that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain of a child.
Such abnormalities inside the developing brain can affect the brain’s ability to control movement and maintain posture and balance. “The term cerebral refers to the brain and palsy refers to the loss of or damage to the motor function. It affects the motor function area of the brain’s outer layer known as the cerebral cortex that controls muscle movement,” Dr Bilal Khan, a paediatrician at Narayana Superspeciality Hospital in Gurugram, explained.
He added: “In some other cases, the impairment is a result of injury to the brain either before birth, during birth, or after birth and in some cases, the damage is not treatable and the disabilities in a child remain permanent.”
According to Dr Ashish Sahani, senior consultant, paediatric, at Sri Balaji Action Medical Institute, “one of the most common cerebral palsy incidence risk factors is prematurity”. He said the abnormality affects “2.1 to 3.0 per 1000 live births”.
In India, nearly 15-20 per cent of physically disabled children are affected by cerebral palsy.
Sahani explained that the prevalence and severity of neurodevelopmental disorders are correlated with pregnancy duration — the shorter the pregnancy, the more severe are the disorders. Another risk factor is birth weight in premature babies. These disorders are also common in pre-term and babies with a history of delayed crying at birth.
How are such anomalies detected?
Dr Reema Bhatt, head of the department of foetal medicine at Faridabad-based Amrita Hospital, said such cases are “rather common” and “the developmental processes of the brain can be impacted by environmental, viral, disruptive, or hereditary reasons resulting in brain abnormalities”.
Cerebral malformations can range from mild to severe with no or severe impact on the neurodevelopmental outcome of the baby after birth. These abnormalities, if severe, can be diagnosed during an early anomaly scan at 12-13 weeks (known as level 1 ultrasound).
There are other cerebral abnormalities that are picked up during targeted anomaly scans between 18-20 weeks like ventriculomegaly which could be mild or severe.
“However there are certain central nervous system (CNS) problems which develop late in pregnancy or after birth like hydrocephalus, malformations of cortical development like lissencephaly etc,” she said.
The prognostication of CNS anomalies depends on the gestation at which they are diagnosed, the severity of the lesion and other associations.
To predict these pregnancies, further work like neurosonogram by an expert or a foetal MRI may be required. “Only a detailed evaluation can prognosticate the neuro-developmental outcome in foetuses with cerebral abnormalities,” Bhatt added.
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