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.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
References
1. Federal Office of Justice. §219 Counselling of the pregnant woman in a situation of emergency or conflict [Internet]. 1998 [cited 28.02.19]. https://www.gesetze-im-internet.de/englisch_stgb/.Search in Google Scholar
2. World Health Organization. Mental health: a state of well-being [Internet]. 2014 [cited 28.02.19]. http://www.who.int/features/factfiles/mental_health/en/.Search in Google Scholar
3. Federal Justice Office. § 218 Abortion [Internet]. 1992 [cited 28.02.19]. https://www.gesetze-im-internet.de/stgb/__218.html.Search in Google Scholar
4. Hull D, Davies G, Armour CM. Survey of the definition of fetal viability and the availability, indications, and decision making processes for post-viability termination of pregnancy for fetal abnormalities and health conditions in Canada. J Comput Geom 2016;25:543–51.10.1007/s10897-015-9907-8Search in Google Scholar PubMed
5. Gross ML. Abortion and neonaticide: ethics, practice, and policy in four nations. Bioethics 2002;16:202–30.10.1111/1467-8519.00282Search in Google Scholar PubMed
6. Alexandre M, Votino C, De Noose L, Cos Sanchez T, Gaugue J, Jani J. The impact of prior medical termination of pregnancy on the mother’s early relationship with a subsequent infant. J Matern Fetal Neonatal Med 2016;29:1238–43.10.3109/14767058.2015.1043260Search in Google Scholar PubMed
7. McGee A, Jansen M, Sheldon S. Abortion law reform: why ethical intractability and maternal morbidity are grounds for decriminalisation. Aust N Z J Obstet Gynaecol 2018;58:594–7.10.1111/ajo.12817Search in Google Scholar PubMed
8. Savulescu J. Is current practice around late termination of pregnancy eugenic and discriminatory? Maternal interests and abortion. J Med Ethics 2001;27:165–71.10.1136/jme.27.3.165Search in Google Scholar PubMed PubMed Central
9. Marquis D. Why abortion is immoral. J Philos 1989;86:183–202.10.4324/9781315097176-54Search in Google Scholar
10. Weichert A, Braun T, Deutinger C, Henrich W, Kalache KD, Neymeyer J. Prenatal decision-making in the second and third trimester in trisomy 21-affected pregnancies. J Perinat Med 2017;45:205–11.10.1515/jpm-2016-0108Search in Google Scholar PubMed
11. Garne E, Loane M, de Vigan C, Scarano G, de Walle H, Gillerot Y, et al. Prenatal diagnostic procedures used in pregnancies with congenital malformations in 14 regions of Europe. Prenat Diagn 2004;24:908–12.10.1002/pd.1044Search in Google Scholar PubMed
12. Struksnæs C, Blaas HGK, Eik-Nes SH, Vogt C. Correlation between prenatal ultrasound and postmortem findings in 1029 fetuses following termination of pregnancy. Ultrasound Obstet Gynecol 2015;48:232–8.10.1002/uog.15773Search in Google Scholar PubMed
13. Rossi AC, Prefumo F. Correlation between fetal autopsy and prenatal diagnosis by ultrasound: a systematic review. Eur J Obstet Gynecol Reprod Biol 2017;210:201–6.10.1016/j.ejogrb.2016.12.024Search in Google Scholar PubMed
14. Federal Statistical Office. Abortions [Internet]. 2018 [cited 28.02.19]. https://www.destatis.de/DE/ZahlenFakten/GesellschaftStaat/Gesundheit/Schwangerschaftsabbrueche/Tabellen/RechtlicheBegruendung.html.Search in Google Scholar
15. Kramer RL, Jarve RK, Yaron Y, Johnson MP, Lampinen J, Kasperski SB, et al. Determinants of parental decisions after the prenatal diagnosis of Down syndrome. Am J Med Genet 1998;79:172–4.10.1002/(SICI)1096-8628(19980923)79:3<172::AID-AJMG4>3.0.CO;2-PSearch in Google Scholar
16. Association of the Scientific Medical Societies (GNPI) GfNupIeV. Frühgeborene an der Grenze der Lebensfähigkeit. Nr. 024-019 [Internet]. 2014 [cited 28.02.19]. https://www.awmf.org/leitlinien/detail/ll/024-019.html.Search in Google Scholar
17. Federal Joint Committee. Maternity guidelines: ultrasound screening in pregnancy [Internet]. 2013 [cited 28.02.19]. https://www.g-ba.de/informationen/beschluesse/1680/.Search in Google Scholar
18. Liu S, Joseph KS, Kramer MS, Allen AC, Sauve R, Rusen ID, et al. Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada. J Am Med Assoc 2002;287:1561–7.10.1001/jama.287.12.1561Search in Google Scholar
19. Wyldes MP, Tonks AM. Termination of pregnancy for fetal anomaly: a population-based study 1995 to 2004. Br J Obstet Gynaecol 2007;114:639–42.10.1111/j.1471-0528.2007.01279.xSearch in Google Scholar
20. van der Pal-de Bruin KM, Graafmans W, Biermans MC, Richardus JH, Zijlstra AG, Reefhuis J, et al. The influence of prenatal screening and termination of pregnancy on perinatal mortality rates. Prenat Diagn 2002;22:966–72.10.1002/pd.442Search in Google Scholar
21. Jong A, Wert GMWR. Prenatal screening: an ethical agenda for the near future. Bioethics 2015;29:46–55.10.1111/bioe.12122Search in Google Scholar
22. Domrose CM, Bremer S, Buczek C, Geipel A, Berg C, Gembruch U, et al. Termination of pregnancy after prenatal diagnosis of spina bifida: a German perspective. Arch Gynecol Obstet 2016;294:731–7.10.1007/s00404-016-4032-ySearch in Google Scholar
23. Dommergues M, Cahen F, Garel M, Mahieu-Caputo D, Dumez Y. Feticide during second- and third-trimester termination of pregnancy: opinions of health care professionals. Fetal Diagn Ther 2003;18:91–7.10.1159/000068068Search in Google Scholar
24. Kiver V, Boos V, Thomas A, Henrich W, Weichert A. Perinatal outcomes after previable preterm premature rupture of membranes before 24 weeks of gestation. J Perinat Med 2018;46:555–65.10.1515/jpm-2016-0341Search in Google Scholar
25. Merz E, Eichhorn KH, von Kaisenberg C, Schramm T. [Updated quality requirements regarding secondary differentiated ultrasound examination in prenatal diagnostics (=DEGUM level II) in the period from 18 + 0 to 21 + 6 weeks of gestation]. Ultraschall Med 2012;33:593–6.Search in Google Scholar
26. Chaoui R, Heling K, Mielke G, Hofbeck M, Gembruch U. [Quality standards of the DEGUM for performance of fetal echocardiography]. Ultraschall Med 2008;29:197–200.10.1055/s-2008-1027302Search in Google Scholar
©2019 Walter de Gruyter GmbH, Berlin/Boston
Articles in the same Issue
- Frontmatter
- Review
- The role of complement in preterm birth and prematurity
- Original Articles – Obstetrics
- Variation in C-reactive protein at 1 month post-partum by etiology of preterm birth: selective identification of those at risk for both poor pregnancy outcome and future health complications
- Procedure related risk of premature delivery and fetal growth reduction following amniocentesis, transcervical and transabdominal chorionic villus sampling: a retrospective study
- Cervical length at 31–34 weeks of gestation: transvaginal vs. transperineal ultrasonographic approach
- The origin of amniotic fluid monocytes/macrophages in women with intra-amniotic inflammation or infection
- Placental elasticity assessment by point shear wave elastography in pregnancies with intrauterine growth restriction
- A 17-years analysis of terminations of pregnancy ≥14 weeks of gestation in a German level 1 perinatal center
- Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program
- Academic tweeting in #ObGyn. Where do we stand?
- Original Articles – Fetus
- Fetal heart examination at the time of 13 weeks scan: a 5 years’ prospective study
- Comparison of fetal cardiac functions between small-for-gestational age fetuses and late-onset growth-restricted fetuses
- Original Article – Newborn
- Protocols for early discharging of premature infants: an empirical assessment on safety and savings
- Letter to the Editor
- Maternal blood pressure levels prepartum correlate with neonatal birth weight in preeclampsia
Articles in the same Issue
- Frontmatter
- Review
- The role of complement in preterm birth and prematurity
- Original Articles – Obstetrics
- Variation in C-reactive protein at 1 month post-partum by etiology of preterm birth: selective identification of those at risk for both poor pregnancy outcome and future health complications
- Procedure related risk of premature delivery and fetal growth reduction following amniocentesis, transcervical and transabdominal chorionic villus sampling: a retrospective study
- Cervical length at 31–34 weeks of gestation: transvaginal vs. transperineal ultrasonographic approach
- The origin of amniotic fluid monocytes/macrophages in women with intra-amniotic inflammation or infection
- Placental elasticity assessment by point shear wave elastography in pregnancies with intrauterine growth restriction
- A 17-years analysis of terminations of pregnancy ≥14 weeks of gestation in a German level 1 perinatal center
- Simulation of an impacted fetal head extraction during cesarean section: description of the creation and evaluation of a new training program
- Academic tweeting in #ObGyn. Where do we stand?
- Original Articles – Fetus
- Fetal heart examination at the time of 13 weeks scan: a 5 years’ prospective study
- Comparison of fetal cardiac functions between small-for-gestational age fetuses and late-onset growth-restricted fetuses
- Original Article – Newborn
- Protocols for early discharging of premature infants: an empirical assessment on safety and savings
- Letter to the Editor
- Maternal blood pressure levels prepartum correlate with neonatal birth weight in preeclampsia