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Karin attends
antenatal appointment

Karin attends antenatal appointment

View Karin’s story below.


Karin is 34 years old with no significant past medical history. She was born in Sweden and met her Australian husband Peter in England. They married in Europe and moved back to Australia for Peter’s work. They started trying for a baby soon after their return to Australia and she fell pregnant within a few months.

Peter and Karin were delighted about this wanted pregnancy and started making plans to move to a larger house. They also started making arrangements for Karin’s widowed mother to come over to Australia from Sweden for an extended visit so that she could be with Karin and help her after the baby is born.

Karin attended her first antenatal visit with a midwife at the hospital when she was 15 weeks pregnant. She complained to the midwife of increasing fatigue saying that she could not walk any distance without becoming extremely breathless and was unable to manage her work and household duties.

A number of routine blood tests were done and her Full Blood Count (FBC) showed that she had a Haemoglobin (Hb) of 7 as well as thrombocytopenia, and blasts were noted in her blood film. An urgent referral to haematology was made. Karin and Peter meet with the haematologist who explains that Karen has acute lymphoblastic leukaemia. It is his view that:

a) Karin needs urgent chemotherapy without which she will die

b) Karin cannot delay chemotherapy until after the baby’s birth

c) The chemotherapy is harmful and it could cause multiple problems for the baby.

Which of the following best represents your thoughts on how to proceed?

Refer Karin for a termination of pregnancy

Ask Karin and Peter to decide what they want to do

Refer Karin for further education and discussions about her options

The MFM team includes obstetricians, midwives, genetic specialists, and genetic counsellors. Other services who could be involved in providing information and supporting decision-making include Mothersafe, General Practitioners, and the Haematology team.

Mothers and families should be advised to seek professional guidance when complex healthcare decision making is required.

Termination of Pregnancy in NSW

Termination of pregnancy is ethically contentious, but legally quite clear. The law imposes on a medical practitioner a duty to his/her patient to exercise reasonable care and skill in the provision of professional advice and treatment. Appropriate and adequate information must be provided to patients in order for the patient to make an informed choice about treatment.

While relevant to the patient’s decision-making, the existence or extent of pregnancy complications or potential chromosomal and genetic conditions are not mentioned in the legal framework. Each state jurisdiction in Australia has different laws regarding termination of pregnancy, and in NSW the law is governed by the Abortion Law Reform Act 2019 (NSW).

For more information on termination of pregnancy and other related issues, please click on the following link:

NSW Health Summary of Abortion Law Reform Act 2019

Now watch the following video where Dr Daniel Challis, Obstetrician and Gynaecologist from the Royal Hospital for Women, Sydney discusses how clinicians manage conflicting viewpoints around termination of pregnancy in complex clinical situations.

Dr Daniel Challis

“As a clinician, how do you manage conflicting viewpoints in complex situations surrounding termination of pregnancy?”

OVERVIEW
Karin is referred to the maternal fetal medicine team