Autopsy after termination of pregnancy for fetal anomaly: retrospective cohort study

Boyd, P A

doi:10.1136/bmj.37939.570104.ee

Cited by 132 publications

(131 citation statements)

References 9 publications

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“…Central nervous system anomalies accounted for more than half of the indications for both early and late terminations. This finding is consistent with the studies which showed that central nervous system malformations are the most common structural malformations leading to the TOP (4,7,8,12,13). Fetal autopsy has a particularly valuable role in the counseling of families after the TOP (14).…”

Section: Discussionsupporting

confidence: 81%

Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre

Çorbacıoğlu¹,

Aslan²,

Aydın³

et al. 2012

J Turkish German Gynecol Assoc

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Objective:We reviewed the data of the termination of pregnancy (TOP) cases between 2002 and 2010 to evaluate the changes in fetal indications for both early and late TOPs in this period. Material and Methods:The data of 962 TOP cases were analysed in two groups according to the periods as in 2002-2006 and 2007-2010. The women were also subdivided into two categories according to their gestational age; <23 weeks' gestation (early termination) and ≥23 weeks' gestation (late termination).Results: Four hundred and fifty-eight (47.6%) of TOPs were performed between 2002 and 2006 (Group 1) and 504 (52.3%) were performed between 2007 and 2010 (Group 2). The number of early (<23 weeks) and late (≥23 weeks) terminations were 583 (60.6%) and 379 (39.3%), respectively. The vast majority of anomalies were central nervous sytem malformations (51.8%). They were followed by multiple anomalies (10.2%) and chromosomal anomalies (9.4%). Chromosomal and cardiovascular system anomalies were significantly higher in 2007-2010 in comparison to 2002-2006 (p<0.0001 and p=0.002, respectively). There was no statistically significant difference between the fetal indications that led to early termination compared to those that led to late termination. Conclusion:The distribution of indications for TOP was influenced by the development in prenatal screening policy, resulting in a significant increase in terminations due to chromosomal and cardiovascular system anomalies. Cultural, educational, religious and legal factors cause differences in the indications for TOP as well as the gestational age that TOPS are performed. Sonuç: Terminasyon endikasyonlarının dağılımı prenatal tarama politikalarındaki gelişimden etkilenmiş, buna bağlı olarak kromozom ve kardiyovaskuler sistem anomalileri nedeniyle yapılan terminasyonların sayısı önemli ölçüde artmıştır. Kültürel, eğitimsel, dini ve yasal faktörler terminasyon yapıldığı gebelik haftasının yanı sıra terminasyon endikasyonlarında da değişikliklere yol açmaktadır. (J Turkish-German Gynecol Assoc 2012; 13: 85-90)

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Section: Discussionsupporting

confidence: 81%

Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre

Çorbacıoğlu¹,

Aslan²,

Aydın³

et al. 2012

J Turkish German Gynecol Assoc

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“…This was comparable to previous similar studies. 4,9,18 In a 10-year retrospective study of autopsy after termination of pregnancy for fetal anomaly, the autopsy confirmed the suspected diagnosis in 72% cases and autopsy added information that lead to the refinement of risk of recurrence in 27% cases. 9 Hence, risk of recurrence based on ultrasonographic diagnosis of fetus may be erroneous in significant number of cases and autopsy of the fetus after termination of pregnancy is essential for genetic counseling.…”

Section: Discussionmentioning

confidence: 99%

“…9,19 The various options available for investigations in this situation was reviewed in a recent article. 19 Post-mortem MR imaging has a useful role in providing structural information of the central nervous system in fetuses and stillbirth neonates.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the differentiation between infantile (autosomal recessive) polycystic renal disease (recurrence risk -25%) and cystic renal dysplasia (recurrence risk-3%) is based on histopathology. 6,9 We had 17 cases with oligohydraminos sequence with cystic renal diseases on ultrasonogram. Of these, two cases were diagnosed as polycystic renal disease by histopathological examination.…”

Section: Discussionmentioning

confidence: 99%

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Clinical utility of fetal autopsy and comparison with prenatal ultrasound findings

Sankar

Phadke

2006

J Perinatol

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Objectives: To present a comprehensive analysis of autopsy findings in 206 fetuses referred to our genetic center and to assess the clinical utility of fetal autopsy in reaching a final diagnosis, which is essential for counseling regarding the risk of recurrence. We also compared the autopsy findings with prenatal ultrasound findings to evaluate the potential benefit of fetal autopsy in fetuses terminated after prenatal diagnosis of malformations.Study design: Retrospective review of patient records in a tertiary referral genetic center in North India during 5-year period (April 2000-March 2005. This includes 206 fetuses, 138 terminated after detecting an anomaly in ultrasonogram and 68 spontaneous fetal losses. In all cases, fetal autopsy was carried out and complimented by radiography, karyotype wherever possible and histopathological examination wherever necessary. In fetuses with prenatally diagnosed malformations, ultrasound findings were compared with autopsy findings.Results: Fetal autopsy was able to provide a definite final diagnosis in 59% (122/206) cases. Fetal autopsy confirmed the ultrasound findings in all cases but two. Moreover, autopsy provided additional findings in 77 cases and of these, 24 cases had a significant change of recurrence risk. Conclusion:This study confirms the utility of fetal autopsy in identifying the cause of fetal loss, which will help in the genetic counseling of the couple. In cases with prenatally diagnosed anomalies, the new information from fetal autopsy changes the predicted probability of recurrence in 18% cases. Even though the prenatal ultrasonogram reasonably predicts the malformations, fetal autopsy gives significant additional malformations in one-third of the cases and is essential for genetic counseling.

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“…It is a 19-non-steroid, which binds with high affinity to the progesterone receptor, thus inhibiting the effect of progesterone resulting in vascular damage, decidual necrosis and bleeding , which leads to cervical softening, increased uterine sensitivity to PG and conversion of the quiet pregnant uterus into an organ of spontaneous activity with maximal effect at 36-48 hours. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] PGs play an important role in the regulation of uterine contractility during pregnancy. 25 The receptors are present throughout the pregnancy; hence, PGs and PG analogues are effective for termination of pregnancy.…”

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confidence: 99%

A prospective comparative study of oral and vaginal misoprostol after pre-treatment with single dose of mifepristone for second trimester abortion

Bhaskar

Kaushik

Kumar

2017

Int J Reprod Contracept Obstet Gynecol

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Background: Misoprostol is a synthetic PGE1 analogue which induces cervical ripening as well as strong uterine contractions and leads to expulsion of pregnancy. Misoprostol has been shown to have several advantages over other prostaglandins; it is cheap, stable at room temperature and can be given by various routes. Administration of mifepristone 24 to 48 hours before misoprostol decreases mean induction time which varies with route of administration of misoprostol. Methods: 50 women with single intrauterine pregnancy with gestational age 13-20 weeks, admitted in labour room of Obstetrics and Gynaecology, Pt. B.D. Sharma PGIMS, Rohtak for termination of pregnancy (on account of missed abortion, absent liquor or gross congenital malformation) were given 200 mg of mifepristone orally after taking written informed consent and excluding scarred uterus, placenta praevia, bronchial asthma, any cardiovascular disease, clotting disorder, long term use of glucocorticoids and history of glaucoma. Then they were randomized into two groups of 25 women each. Group I included 25 women who received oral misoprostol and group II included 25 women who received vaginal misoprostol. Complete abortion was defined as successful expulsion of both foetus and placenta without any intervention. Failure was defined as cases with incomplete expulsion or incomplete dilatation or no dilatation. Results: The mean number of doses of misoprostol used in groups I and group II were 2.80±1.19 and 2.20±0.86 respectively and the difference was statistically significant (p value 0.04). Out of 25 patients included in each group, 64% (n=16) in group I and 80% (n=20) in group II patients had complete expulsion with misoprostol and remaining 36% (n=9) in group I and 20% (n=5) in group II either needed syntocinon or post expulsion evacuation for retained product of conceptions and who did not respond to the given doses of misoprostol at all required mechanical dilatation and evacuation. But this difference was not statistically significant. The mean induction abortion interval in cases of complete expulsion observed in group I was 10.74±4.12 hours and 8.67±3.23 hours in group II which was statistically significant (p value 0.05). Conclusions: Vaginal route is better than oral route for second trimester termination of pregnancy as it requires less number of Misoprostol doses and shorter induction abortion interval.

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Autopsy after termination of pregnancy for fetal anomaly: retrospective cohort study

Cited by 132 publications

References 9 publications

Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre

Trends in fetal indications for termination of pregnancy between 2002 and 2010 at a tertiary referral centre

Clinical utility of fetal autopsy and comparison with prenatal ultrasound findings

A prospective comparative study of oral and vaginal misoprostol after pre-treatment with single dose of mifepristone for second trimester abortion

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