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Perinatal management of the lower margin of viability
  1. SUSAN BEWLEY, Director of Obstetrics
  1. Women’s Services Directorate
  2. Guy’s and St Thomas’s Trust
  3. Lambeth Palace Road
  4. London SE1 7EH

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    Editor—I was very impressed with Janet Rennie’s article on perinatal management.1 However, she claimed that: “in recent years the courts have ascribed increasing rights to the fetus, even requiring caesarean section against the mother’s wishes.” This might be true of the American courts, but this is not the case in the United Kingdom, where fetuses still have no legal existence until after birth. The one case of a caesarean section (Re S; Adult: Refusal of treatment, 1993) was not made on the basis of the fetus having “rights,” and legal commentators think the judgment was anomalous. The case was particularly unusual in that S was in obstructed labour and Sir Stephen Brown made reference to saving the mother’s life in his short judgment. In the event, the fetus died in utero before the caesarean section was performed.

    The Royal College of Obstetricians and Gynaecologists guidelines produced since this case concluded: “that it is inappropriate, and unlikely ro be helpful or necessary, to invoke traditional intervention to overrule an informed and competent woman’s refusal of her post-medical treatment, even though her refusal might place her life and that of her fetus at risk.”2 With the good information and thoughtful management proposed by Dr Rennie, we hope that these sorts of cases of physician-maternal conflict (rather than maternal-fetal conflict, as it is often termed), could be kept to a minimum.