Prenatal Diagnosis | 2019
Comment on “Ethical considerations of prenatal three‐dimensional printing in craniofacial abnormalities”
Abstract
Prenatal screening for fetal craniofacial abnormalities such as cleft lip/ palate has significantly progress during the past decades, resulting in the provision of parent s information that were previously not available. Indeed, surface rendering of the fetal face is, as such, an essential prenatal tool, facilitating the communication between parents and prenatal team. More recently, three‐dimensional printing technology allowed the new parents to better apprehend the “pathologic” face of their unborn child. This new technology filled the gap due to the conceptual limit of visualizing a three‐dimensional surface‐rendered volume on a two‐dimensional monitor. While it was reserved for some hyperselected cases benefiting from prenatal scanner, it can now be performed after any prenatal ultrasound, given the democratization of compatible media on new ultrasound machines. Sonographic detection of fetal anomalies gives parents options, including the opportunity to discuss the prognosis with relevant perinatal team. Anomalies indicating serious handicaps also lead, if local policy permits, to discussion on the possible termination of the pregnancy. Given these implications about the role of prenatal screening for fetal abnormalities, a pivotal question needs to be evoked: how will a technology such as the prenatal three‐dimensional printing be experienced by the parents of an unborn child presenting such a facial abnormality? For most parents, receiving a prenatal diagnosis of a fetal facial abnormality is usually the beginning of a highly emotional and morally challenging process requiring assimilation of complex information and contemplation of possibly previously unconsidered concepts such as facial disability. Although parent s decision about the viability of the pregnancy is based on relevant knowledge, facial representation of the unborn child could highly participate in prenatal parental decision. It is indeed possible that the improvement of spatial representation of the facial anomalies of their unborn child leads the prospective parents to modify their choice concerning the continuation or not of the pregnancy. This is particularly relevant in cases of very deforming facial abnormalities, however, accessible to postnatal surgical management such as bilateral complete cleft lip and palate. Nevertheless, three‐ dimensional printing could have cognitive benefit aspects by interfering with the rollercoaster of prenatal emotional process. Indeed, it could help prospective parent in the acceptance step of the facial abnormality by anticipating the reality of the malformed facial shape and by preparing mentally for caring of a disabled child.