Fetal diagnostic indications for second and third trimester outpatient pregnancy termination

Abstract

ObjectiveTo determine the frequency of diagnostic indications among women seeking to terminate pregnancies for reasons of fetal abnormality, spontaneous fetal demise, or a genetic disorder in a private outpatient clinic specializing in late outpatient abortion procedures.MethodA total of 1005 women requested termination of pregnancy for reasons of genetic disorder, fetal anomaly, or fetal demise over 20 years (1992–2012). Gestational ages ranged from 12 to 39 weeks. In all cases, a documented diagnosis of fetal abnormality or fetal demise was made prior to referral. Records were reviewed to verify fetal diagnosis for all patients seeking termination of pregnancy for reasons of fetal disorder. Major complications included major unintended surgery, hemorrhage requiring transfusion, or pelvic infection.ResultsPreoperative diagnoses included the following: chromosomal abnormalities (n = 378), genetic syndromes and single gene disorders (n = 30), structural anomalies (n = 494), and other conditions (n = 103). These include 26 cases of spontaneous fetal demise and nine selective terminations of one abnormal twin. The major complication rate was 0.5%.ConclusionsThe majority of diagnoses were in the categories of genetic disorder and neurologic abnormality. © 2014 The Authors. Prenatal Diagnosis published by John Wiley & Sons Ltd.

The analysis of the termination of pregnancies at and after ten weeks of gestation – a monocenter study

“…Excluding amniotic fluid anomalies, isolated structural anomalies (n=114, 30.1%) and CNS anomalies among them were the most common ones in line with the literature. [1,4,[10][11][12][13][14] Also, Down syndrome is the leading indication in the terminations with chromosomal anomaly indication, which is consistent with the literature. [1,12,14,15] This can be explained with the higher rate of diagnosing trisomy 21 in the countries carrying out national screening program during first trimester as in Turkey.…”

Termination of pregnancy for fetal abnormalities: main arguments and a decision-tree model

“…Termination of pregnancy for fetal abnormality (TOPFA) is currently one of a few clinical practices that persistently lack international recognition in terms of its indications and medicolegal aspects. Some countries have strict laws that forbid TOPFA, whereas other countries provide almost total freedom for both families and clinicians when the procedure is preferred . Between these extremes, academic studies that aimed to find a more standardized approach for such cases are still ongoing.…”

Perinatal post-mortem ultrasound (PMUS): radiological-pathological correlation

“…Congenital disorders of the central nervous system (CNS) are the commonest group of structural anomalies leading to termination of pregnancy. Approximately 32–37.7% of all terminations of pregnancies may be for prenatally diagnosed CNS anomalies [14, 30], with neural tube defects accounting for the largest proportion (approximately a third of cases) [31].…”