Bombay High Court
Abc vs State Of Maharashtra Through The ... on 25 July, 2022
Author: Madhav J. Jamdar
Bench: S.V. Gangapurwala, Madhav J. Jamdar
2-wpl-22907-22.doc
Dusane
IN THE HIGH COURT OF JUDICATURE AT BOMBAY
ORDINARY ORIGINAL CIVIL JURISDICTION
WRIT PETITION (L) NO. 22907 OF 2022
ABC ...Petitioner
Versus
State of Maharashtra ...Respondents
BHALCHANDRA Through the Principal Secretary
GOPAL DUSANE
Digitally signed by
BHALCHANDRA
Ms Adity Saxena for Petitioner.
GOPAL DUSANE Smt. Uma Palsuledesai, AGP for State.
Date: 2022.07.27
15:35:06 +0530
CORAM : S.V. GANGAPURWALA &
MADHAV J. JAMDAR, JJ.
DATED : 25TH JULY 2022 P.C. :
1. We have heard learned counsel for the Petitioner.
2. The Petitioner seeks permission to terminate the pregnancy. The Petitioner was referred to the expert Committee at Sir J.J. Group of Hospitals and Grant Government Medical College, Mumbai. The report is submitted by the expert. The report is also received from Seth G.S. Medical College & K.E.M. Hospital, Parel, Mumbai.1/6
2-wpl-22907-22.doc
3. The pregnancy is almost 31 weeks. The opinion of the expert Committee at Sir J.J. Group of Hospitals, Mumbai reads thus:
COMMITTEE OPINION:-
"After careful examination and study of ultra-sonography reports with 30 week of gestation, it is confirmed that the fetus has bilateral club feet, echogenic focus in the left ventricle and mild placentomegaly.
The condition of the fetus does not fulfill the criteria of "substantial risk of serious physical handicap with very high morbidity and occasional mortality".
Termination of pregnancy at 30 weeks of gestation carries the same risk to the pregnant woman which is not likely to be more than delivery at term.
The pregnant woman has voluntarily expressed her desire to terminate the pregnancy and is well informed about the nature of the condition of fetus and its outcome. She is anguished with the condition of the fetus in utero. However, the micro-assay report showed a gain involving chromosome within cytoregion 6q22.1q27 indicating trisomy for this region and a loss involving chromosome at cytoregion 7q36.3 indicating monosomy for this region to rule out any syndromic association, opinion of expert geneticist is pending.
Hence, same pending the opinion of expert geneticist from KEM Hospital, there seems to be no compelling medical grounds for termination of pregnancy at this gestational case.".
4. The report prepared at the Department of Pediatrics, Seth G.S. Medical College & KEM Hospital, Parel, Mumbai on the medical history obtained from the Petitioner and available medical reports reads thus:
"The Petitioner is a G1P1A0, 32 years 7 months old (DOB:
15/12/1989) lady born of a consanguineous marriage. However, the petitioner's marriage is not consanguineous. She is having 29 weeks 6 days gestation by sonography dated 20/07/2022 and 30 weeks and 5 days by last menstrual period. The present conception occurred spontaneously after 18 months of marriage.2/6
2-wpl-22907-22.doc There is no record of taking periconceptional folic acid. During the initial 5 months of pregnancy the antenatal care was obtained in Porbandar, Gujarat. First antenatal scan at 12 week 6 days of gestation was reported to be normal.
Risk of aneuploidy by Nuchal Translucency is 1 in 3129 and Nuchal Translucency + Nasal Bone is 1 in 10431. As informed verbally the second ultrasound was done in May 2022: however the reports are not available with the patient for my scrutiny during the present consultation. Due to suspicious fetal findings in the second ultrasound further evaluation had been advised by the local doctor. A third and fourth ultrasound scans were performed in Mumbai at Precision Diagnostic Centre dated 25/5/2022 and Sir J.J. hospital dated 20/07/2022 respectively and the following fetal anomalies were reported-
1. Bilateral club feet
2. Expansion of fourth ventricle in the cisterna magna resulting in key hole appearance
3. Blake's pouch cyst
4. Echogenic intracardiac focus in left ventricle of fetal heart
5. Asymmetrical enlargement of left lateral ventricle
6. Mild Placentomegaly After detection of fetal sonographic abnormalities, amniocentesis was performed on 03/06/2022 performed at Centre For Genetic Health Care, Bandra West and amniotic fluid sample was sent for microarray to Medgenome Labs Ltd. The microarray was reported as arr [GRCh 37] 6q22.1q27x3 and 7q36.3 x 1 indicating partial trisomy of 6q22-q27 segment (due to large 54.9 Mb duplication) and partial monosomy 7q36 (due to 2.4 Mb deletion).
On reviewing the individual clinical manifestations of partial trisomy 6q and partial monisomy of 7q, except bilateral club feet and brain anomaly, no other major features of the two conditions are evident in fetal sonography report [no microcephaly; fetal head circumference just above 50th centiles on Hadlock chart; normal fetal skull shape; normal fetal craniofacial features; normal neck; no joint contractures or anomalies of extremities except club feet; normal spine; no obvious visceral fetal anomalies like cardiac, renal, gastro-intestinal anomalies; no evidence of caudal regression; no fetal growth restriction].
3/62-wpl-22907-22.doc Medical issues that cannot be detected on ultrasound and which have been reported in individuals with partial trisomy 6q and partial monosomy 7q are intellectual impairment, psychomotor retardation, development of spasticity and seizures. However, published information currently available in medical literature indicates highly variable physical manifestations and highly variable severity of manifestations in such individuals. A list of features of partial trisomy 6q and partial monosomy 7q is enclosed herewith.
Advice after genetic review :
1. Fetal 2D ECHO
2. Fetal MRI Brain for better delineation of brain anomalies
3. Fetal 3D Ultrasound for detailed examination of fetal face and other body structures
4. In the neonate -
a) Detailed physical examination
b) screening for cardiac, gastrointestinal, renal and brain anomalies
c) Ophthalmology examination including vision
d) Neonatal screening for 57 panel of disorders.
e) Neonatal hearing screening
f) Pediatric Neurology consultation
g) Pediatric Orthopedic consultation
h) Early intervention programme.
On karyotyping of the mother of the fetus, she was detected to have balanced translocation 46XX, t (6;7) (q21; q35). Since, mother is a carrier of balanced translocation there is increased risk of fetal chromosomal aneuploidies in the couple's future pregnancies. The recurrence risk of partial trisomy of 6q is 50%. Prenatal diagnosis is advisable in all future pregnancies."
5. The learned counsel for the Petitioner has strenuously submitted that the length of pregnancy may not be a matter of consideration in such cases.
It is the right of the woman to take a decision. More particularly when there is a substantial risk, if the child were born, it would suffer from any serious physical or mental abnormality. Emphasis was also given to the 4/6 2-wpl-22907-22.doc mental health of the lady. The learned counsel for the Petitioner would submit that whenever the continuance of pregnancy would cause mental anguish to the lady, the permission needs to be granted for termination of pregnancy. The judgment to that effect were referred to of the Apex Court in the case of Sonali Kiran Gaikwad v. Union of India (Writ Petition (C) No. 928 of 2017 with Writ Petition (C) No. 929 of 2017) and also the Division Bench of this Court in the case of Shaikh Ayesha Khatoon v.
Union of India and Ors, reported in [2018 (3) Mh LJ page 486. In the said case, the pregnancy was of 27 weeks. The judgment of the learned Single Judge at Delhi High Court in Writ Petition No. 9768 of 2021 dated 22nd September 2021 was a case where the pregnancy was of 22 weeks and 3 days.
6. In the present case, the pregnancy is of 31 weeks. The expert committee consists of the Doctors from Departments of OBGY, Orthopaedics, Radiology, Neurosurgery, Neurology, Psychiatry and Pediatrics have opined that there seems to be no compelling medical grounds for termination of pregnancy at this gestational age.
7. The possibility is that if the pregnancy is terminated now, the child born would be born alive with further deformity because of the premature birth.
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8. Considering the report of the expert committee, it may not be possible to accede to the request of the Petitioner.
9. The Writ Petition is disposed of.
(MADHAV J. JAMDAR, J.) (S.V. GANGAPURWALA, J.) 6/6