A 17-years analysis of terminations of pregnancy ≥14 weeks of gestation in a German level 1 perinatal center

Abstract

Background When discussing termination of pregnancy (TOP) after the first trimester, the main foci are the ethics and psychological reasoning/consequences. In daily clinical practice, physicians are often faced with affected women querying the frequency of their condition(s) and decisions made by women in similar situations. The present study aimed to provide an overview of a representable number of such cases. Methods Cases of TOP beyond 14 + 0 weeks of gestation were collected between January 2000 and December 2017 in the Department of Obstetrics. Fetal and/or maternal medical causes leading to TOP were extracted and presented. Results A total of 1746 TOPs ≥14 + 0 weeks were performed. Reasons leading to TOP were subcategorized into 23 groups. The main medical diagnoses were trisomy 21 (15.5%), neurological malformations (11.0%), and cardiac and major vessel malformations (7.9%). There was no statistical difference concerning maternal age or gravida/para between the groups. The average gestational age (GA) was 21.0 weeks, varying between 16.2 and 24.2 weeks in the 23 subgroups, with an average of 23.6% per year of TOPs after viability. Conclusion An overview of the various causes of TOP and their frequency within a large dataset are shown here. According to data provided by the German Federal Statistical Office, the overall number of TOPs has declined over the past two decades; however, the number and percentage of TOPs beyond viability have increased continuously in Germany. Only early detection of maternal and fetal constitution can prevent a portion of TOP after viability.

Retrospective analysis of pregnancy terminations and indications in a tertiary center

“…Kiver et al reported that chromosomal disorders (trisomy 21 with 15.5%) were the most common indication of TOP in 1746 cases terminated > 14 weeks for maternal and fetal indications [17]. In our study, we found similarly with previously reports that chromosomal disorders constitute the most common indication for TOP, followed by central nervous system abnormalities [9,[15][16][17][18][19][20][21].…”

“…According to the German Federal Statistical Office data, the TOP rate has decreased in the last two decades, but there has been an increase in the termination rates above the viability limit. It was stated that only early screening of maternal and fetal conditions can considerably prevent pregnancy terminations above the viability limit [17]. Fetal viability is defined as the point at which the fetus can survive independently of pregnancy.…”

Effect of prenatal screening on trends in perinatal mortality associated with congenital anomalies before and after the introduction of prenatal screening: A population‐based study in the Northern Netherlands

“…Next to very preterm birth and foetal growth restriction, congenital anomalies are the principal contributors to perinatal mortality 27 . However, because of the poor prognosis of the most severe anomalies and the risk of long‐term disability, the rates of termination of pregnancy are much higher in cases with congenital anomalies 31 …”

“…27 However, because of the poor prognosis of the most severe anomalies and the risk of long‐term disability, the rates of termination of pregnancy are much higher in cases with congenital anomalies. 31 When parents opt for pregnancy continuation, delivery of affected newborns is scheduled in tertiary care centres with neonatal intensive care units where postnatal surgical correction of structural defects can take place. Indeed, neonatal surgery has been proven to be an effective strategy to considerably reduce neonatal deaths, especially in newborns with isolated abdominal wall, gastrointestinal, cardiac and diaphragmatic congenital defects.…”

Abortion in Countries with Restrictive Abortion Laws—Possible Directions and Solutions from the Perspective of Poland

“…It also increases the safety of such procedures. Terminations performed later are usually due to structural fetal defects which develop at later stages of pregnancy [21]. In the second trimester, abortion may usually be performed for medical, social, or legal reasons [22].…”