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triceretops
01-15-2007, 01:09 AM
I have a female inmate who is five months pregnant, and no one knows who is responsible for this amongst the male staff. Is it possible to extract DNA from a five-month-old fetus to determine the blood type and sequence? The prison warden wants to catch the guilty donor. How would they do it?

Tri

veinglory
01-15-2007, 01:15 AM
You can extract fetal DNA from the amniotic fluid, e.g. [link removed upon request from the company linked to] -- but the procedure is not without risk and so is normally only done for health reasons (to detect genetic disorders). The greatest risk at 5months would be loss of the baby, as much as a 1% chance.

ColoradoGuy
01-15-2007, 02:53 AM
Agreed. It would violate medical ethics to do a test with a small but real risk, but which is of no benefit to the patient(s). This would be true even if the woman consented.

Elektra
01-15-2007, 03:02 AM
I think it's called an amniocentresis, if that's of any help.

ColoradoGuy
01-15-2007, 03:04 AM
Amniocentesis

triceretops
01-15-2007, 03:30 AM
Yes, all of this has helped and is quite accurate. I'm portraying this prison system (this particular branch) as a little on the seedy side, since they initiate this procedure because it is strongly suspected that a high up staff member is involved. I had my patient/inmate sign a release, absolving the prison of all blame in case something goes awry. But she's under extreme duress, so she allows the procedure.

Tri

veinglory
01-15-2007, 03:37 AM
An MD who did it would still be liable, legally, if the child died. Ergo, most wouldn't risk doing it unless a medical reason could be trumped up.

ColoradoGuy
01-15-2007, 03:48 AM
I definitely agree. He/she could lose their medical license.

triceretops
01-15-2007, 03:48 AM
Okay, I'll think of something that would endanger her, prompting the procedure. I admit, it's a fine line here.

I've got to figure out a way where the baby ends up adopted by her husband's brother. That would mean that the parents on both sides refused. A whole new can of worms. I don't know how an adoption works with in a case where a female death row inmate is impregnated whilst in custody, and the father is not found.

Tri

ColoradoGuy
01-15-2007, 03:49 AM
I had my patient/inmate sign a release, absolving the prison of all blame in case something goes awry. But she's under extreme duress, so she allows the procedure.Tri
This makes the consent invalid, even if the procedure is medically indicated.

ColoradoGuy
01-15-2007, 03:53 AM
Okay, I'll think of something that would endanger her, prompting the procedure. I admit, it's a fine line here.

I've got to figure out a way where the baby ends up adopted by her husband's brother. That would mean that the parents on both sides refused. A whole new can of worms. I don't know how an adoption works with in a case where a female death row inmate is impregnated whilst in custody, and the father is not found.

Tri
Cases similar to this happen--I've been involved with them, although they were not so spectacular as your scenario. In most states, the county protective services department assumes custody (it's called different things in different places) and would place the child in foster care. Adoption by a family member would probably go through easily if the adoptive family passed muster. Most judges prefer that.

ETA: Most jurisdictions would appoint a guardian ad litem (GAL) for the child to look after his/her interests

AnnieColleen
01-15-2007, 04:06 AM
Okay, I'll think of something that would endanger her, prompting the procedure. I admit, it's a fine line here.

The most common reason for an amnio would be to check for chromosomal abnormalities or genetic disorders, so a family history of a disorder or "advanced maternal age" (I forget what the cutoff is, but younger than it sounds; can increase the risk for chromosomal abnormalities) might be the easiest way to go if it fits with the story. Leaving aside consent issues etc.

ColoradoGuy
01-15-2007, 04:22 AM
Good suggestion, although 5 months would be late to do this--it's typically done in the first trimester. And yes, "advanced maternal age" means older than 35.

AnnieColleen
01-15-2007, 04:29 AM
True, but if it's just a cover story they could probably ignore that. (Claim not to be sure of the dates?)

ColoradoGuy
01-15-2007, 04:30 AM
Five months is pretty obvious.

triceretops
01-15-2007, 05:39 AM
She's 41-years old. thanks about those suggestions. I think the staff can scribble on the form something like "checking for genetic disorders and chromosomal abnormalities", just so they can get away with the procedure.

ColoradoGuy
01-15-2007, 05:46 AM
That would work for your plot. Amniocentesis would ordinarily be offered to any pregnant 41-year-old as part of standard care. As I said, usually it's done earlier, but a heavy woman could disguise her pregnancy into the 5th month (or beyond--I've seen surprises at term). So maybe they just found out.

smallthunder
01-15-2007, 08:04 AM
I don't have anything new to add, except to say that I immediately thought: "Heck, they could check the DNA of the fetus -- even at 5 months, an amnio would be called for, assuming the pregnant woman wasn't really young."

FYI, regarding Down's Syndrome:

"For example, the risk of having a baby with Down's at age 20 is 1 in 1500, at age 35 it is 1 in 350 and at age 40 it is 1 in 100."

Jamesaritchie
01-15-2007, 09:48 PM
In real life, they'd just wait until the baby is born.

jennifer75
01-15-2007, 10:20 PM
Sounds like a Maury Povich topic....:P

I think it can be done. Wether that is harmful or not, I'm clueless. I say work in the mistery of waiting until birth to find out. Maybe a relationship with another guard develops....then the "guilty guard" confesses after birth.

Soccer Mom
01-16-2007, 12:52 AM
Reasons for an amnio at 5 mos would be age: Often routinely to women over the age of 35 because of increased risk of defects. Another reason is an abnormal reading on her "tri-screen" for a possible chromosomal defect. I tested high for possiblity of downs on my last baby but refused the amnio because of the risk of miscarriage. I wasn't willing to jeapordize his life just to know. We knew from the sonograms that his heart was healthy.

Petroglyph
01-16-2007, 02:11 AM
It depends.

I had a patient who would have had an abortion if the baby's father was one guy vs. another guy. An amnio would have established paternity, and yes, people will perform an amnio for this reason. She paid for it out of pocket to prove paternity before carrying the baby to term. She was about 14 weeks. "Five months" is not very specific and might depend on your states' laws re: when an abortion could occur. You could play with the gestational age to make it more plausible. An amnio can be done at any stage of the pregnancy, but it comes down to why are you doing it and what would you do with the information.

For your story, could a woman be bullied into giving consent and could there be a sleazy doc who would do it? I would say yes. There are people who would do an amnio to check for paternity. It would be a challenge, but it would not be impossible. If a 41 year old wants to have an amnio in her mid-trimester to check for Downs, that would be very realistic and they could compare it to potential FOB's (father-of-baby) to establish paternity.

Edited to add: you could have a blood type incompatibility as well. Say her antibody screen comes back showing her body has learned to (potentially) attack the baby's red blood cells. You could do a cordocentesis and get dna that way, although that is messing with some serious stuff and she would need to be in the loop with some perinatologists. An amnio would be simpler. Also, there are some newer studies finding fetal cells in maternal circulation. If this is set in the near future (2008 possibly) one could isolate fetal cells from a maternal blood draw. That is cutting edge (where I live anyway). Sorry for the rambling. There have been many babies in my life recently and very little sleep.

ideagirl
01-19-2007, 09:30 PM
Okay, I'll think of something that would endanger her, prompting the procedure.

Why not just wait until the baby's born? What's the rush? If the issue is the baby's adoption, etc., can't it wait?

I'm guessing that the doctor would still be guilty of a breach of medical ethics even if the amniocentesis didn't trigger a miscarriage--just doing it is the violation, regardless of whether a miscarriage occurs. If one occurred the doctor would be liable for more things, but merely doing the test could well be a violation of medical ethics that would get him/her in potentially serious trouble with the licensing board.

Cat Scratch
01-19-2007, 10:33 PM
Good suggestion, although 5 months would be late to do this--it's typically done in the first trimester. And yes, "advanced maternal age" means older than 35.

I wasn't offered any type of genetic testing until I was in my 5th month, which would have included amnio if any results were wonky. Also, at 5 months I was most definitely not showing yet. (I'm still not, on month 6.) So it's plausible for the purposes of fiction that the pregnancy wasn't discovered until very late.

I could also see an unethical prison doc giving misinformation to an inmate/patient or doing something else shady to get the test done, if the timeline is important.

triceretops
01-20-2007, 12:00 AM
The pregnancy was a violation against prison rules and the warden is a pretty nefarious character. He's not willing to wait until full term to discover which one of his employees is guilty of this. Any way, that's how I have it written into the storyline.

Tri

PattiTheWicked
01-20-2007, 04:52 AM
Perhaps the woman's family has a history of genetic disorders or neural tube defects. Combined with her age of 41, and amnio would probably be indicated as far as any OB/GYN is concerned.

ideagirl
01-20-2007, 11:39 PM
The pregnancy was a violation against prison rules and the warden is a pretty nefarious character. He's not willing to wait until full term to discover which one of his employees is guilty of this. Any way, that's how I have it written into the storyline.

Well, if that's how you want things to go down, it would be advisable for you to take into account how totally unethical that is, and how the doctor would also have to be in some respects corrupt to go along with this. You cannot get around the fact that the doctor would be committing a serious ethical violation that could get his license at least suspended, and he's also committing a crime (technically, doing an invasive medical test on someone without their consent is battery), as well as exposing himself to civil liability (i.e. a lawsuit). And the warden is doing likewise. So what I'm saying is, you can't just write it as if this is easy and okay and without any potential repercussions for the warden and the doctor; so you may need to come up with some credible reason that the doctor would go along with this.

I am also not even sure that paternity testing can be done while the child is still in the womb, so you may want to check out the science end of this. A friend of mine was accused, by a psycho ex-girlfriend, of being the father of the baby she was carrying (they had a regrettable one-night stand within a few weeks of the time she conceived, which one-night stand involved her cheating on her live-in boyfriend, who, it turned out, was indeed the father). And he couldn't get the testing done until after the baby was born--in fact for some reason he had to wait a couple of months; this had something to do with the fact that the fetal circulatory system is linked to the mother's circulatory system, so the mother's DNA can interfere with test results until the baby is not just born, but a little more mature. This was 8 or 9 years ago though, so the science may have progressed since then. But if I were you, I would look up some paternity-testing place online, and call or email them to ask when is the earliest time such a test can be done (can it be done on amniotic fluid, etc.).

ideagirl
01-20-2007, 11:42 PM
Perhaps the woman's family has a history of genetic disorders or neural tube defects. Combined with her age of 41, and amnio would probably be indicated as far as any OB/GYN is concerned.

But amnio does not include paternity testing. You would, I'm guessing, need to withdraw more fluid than is normally withdrawn for an amnio--that is, you'd need to do the regular amnio for the usual reasons (checking for Down's syndrome etc.), and then you'd need more amniotic fluid in order to run the paternity test (the other fluid would be used up in the regular genetic testing). And by withdrawing extra fluid, my guess is you'd be making the amniocentesis riskier than usual (greater risk of miscarriage--that fluid is there for a reason, the fetus needs it!). So the doctor would still be performing an unnecessary test that's riskier than it needs to be, for no benefit to the patient or the fetus. So he'd still be in hot water, as far as medical ethics go.