Dr. Kevin Walsh:

I thank Deputy Kelleher for his question. On the need for termination, I think it would be unusual. Perhaps once every few years one would need to deal with a case because of something like Ehlers-Danlos syndrome or Eisenmenger's syndrome. The numbers are relatively small, but they are real and they are difficult problems when they occur.

We use warfarin increasingly but we walk a tightrope in this regard because while warfarin is good for the heart valve, it is not good for the foetus. The mother obviously wants the best outcome for the foetus and we want the best outcome for both, but primarily for the mother. We have to strike a balance between Heparin and Warfarin and occasionally this will lead us into trouble with a valve clotting. That is a situation in which one could end up with a termination, but foetal loss is usually part of that.

With regard to the experience in the UK and other centres, I spoke with more than one centre and they had encountered only a handful of cases over many years. There are one or two occasions per year in big practices when a woman's life may have to be saved by terminating a pregnancy.