Termination of Pregnancy due to Fetal Abnormalities Performed after 23 Weeks’ Gestation: Analysis of Indications in 144 Cases from a Single Medical Center

Abstract

Background/Aims: To assess the indications for late termination (≥23 weeks’ gestation) of pregnancy (LTOP), and to evaluate the rate of cases potentially diagnosable earlier. Methods: Cases of singleton pregnancy ending in LTOP due to fetal abnormalities in our institute between 1/1998 and 12/2005 were retrospectively reviewed. The women were divided into two groups according to the sequence of events that led to LTOP: Group 1 – the first test indicating an abnormal finding was performed ≤23 weeks’ gestation, but LTOP was performed >23 weeks; Group 2 – the first test indicating an abnormal finding was performed ≥23 weeks of gestation, or the fetal prognosis was not certain at the time of diagnosis and there was a medical recommendation to continue investigation. Results: There were 144 cases of LTOP (average gestational age 26.2 ± 3.4 weeks). More than 70% of the cases were aborted because of chromosomal/genetic indication in Group 1; many of them could have been detected earlier in pregnancy, while about 80% of the cases were aborted because of structural abnormalities in Group 2 (p < 0.001). The structural anomaly could have been diagnosed earlier in 56 cases (∼74%) if the pregnant woman had undergone an earlier anomaly scan. In another 13 cases (9%), fetal prognosis was not certain and continuing prenatal investigation was required. Conclusions: The most common indications for LTOP were structural abnormalities (91 cases, 70%) which included the central nervous system (26 cases, 29%), cardiac abnormalities (24 cases, 26%), and multiple malformations (18 cases, 20%). The diagnosis of fetal anomaly could have been made earlier in more than half of the pregnant women undergoing LTOP.

Late termination of pregnancy due to fetal abnormalities: An analysis of 229 cases

“…Çalışmamızda geç terminasyon uygulanan olguların önemli bir kısmını, erken prenatal tanı olasılığı olan anomaliler (özellikle anensefali ve benzeri anomaliler, spina bifida, Down sendromu, bilateral renal agenezi vb.) oluşturmaktaydı (Tablo 3) (11,12) . Mevcut bulgular ışığında çalışmalar arasındaki fark ülkemiz-de ulusal tarama programının bulunmaması sonucunda erken gebelik döneminde tarama etkinliğinin az olması, gebelerin tarama testlerine erişiminin ve tarama testleri hakkında bilgilendirilmesinin yetersiz olması, tarama testlerinin toplumuz tarafından kabulünün sosyokültürel ve dini faktörlerin de etkisiyle değişkenlik göstermesi nedeniyle olabilir (1,13) .…”

“…Erken terminasyonların aksine geç terminasyonların en sık nedeni, fetal yapısal anomaliler olup, bunlar içinde en sık görülen fetal yapısal anomaliler MSS anomalileridir (9,11,14,15,16) . Hidrosefali, korpus kallosum agenezisi ve lizensefali gibi genellikle ikinci ve erken üçüncü trimesterde belirgin hâle gelen MSS anomalilerinin geç terminasyonlardaki sıklığı daha fazladır (11) .…”

“…Hidrosefali, korpus kallosum agenezisi ve lizensefali gibi genellikle ikinci ve erken üçüncü trimesterde belirgin hâle gelen MSS anomalilerinin geç terminasyonlardaki sıklığı daha fazladır (11) . Ayrıca aileye danışmanlık ve prognoz hakkında bilgilendirme sırasında henüz prognozu öngörülemeyen bazı MSS patolojilerinin önceki yıl-lara göre terminasyon oranını arttığı düşünülmektedir (12) .…”

Acute Coronary Artery Vasospasm Associated with Misoprostol for Termination of Pregnancy

“…Mid-trimester abortion represents 10-15% of all induced abortions performed nowadays, and accounts for about two thirds of all major complications related to TOP [1,2] . Although surgical abortion is one of the oldest techniques and is widely used, second-trimester medical abortion is becoming the norm in many European countries.…”

The Utility of Feticide Procedure to Shorten the Induction-to-Abortion Interval in Medical Abortion

“…Similar to some states of the United States and Israel [5,6], termination of pregnancy for fetal abnormalities can be performed in Turkey at any GA with an approval of more than 2 practitioners. As mifepristone is not available in Turkey, misoprostol is the first-line abortifacient in most settings.…”