Key result
Structural abnormalities were the most common indication for late termination of pregnancy (70%), and more than half of fetal anomalies could have been diagnosed earlier.
Observational (n=144)
No
p-value: p=< 0.001
More than half of late terminations of pregnancy due to fetal abnormalities could potentially be diagnosed earlier with timely anomaly scans.
May support earlier anomaly screening to reduce late terminations; observational data leave open whether routine timing changes alter outcomes.
BACKGROUND/AIMS: To assess the indications for late termination (> or =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 < or =23 weeks' gestation, but LTOP was performed >23 weeks; Group 2 - the first test indicating an abnormal finding was performed > or =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 ( approximately 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.
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Vaknin et al. (2009) conducted an observational in Late termination of pregnancy due to fetal abnormalities (n=144). First test indicating abnormal finding ≥23 weeks' gestation or uncertain prognosis vs. First test indicating abnormal finding ≤23 weeks' gestation was evaluated on Indication for termination (structural abnormalities vs chromosomal/genetic) (p=< 0.001). Structural abnormalities were the most common indication for late termination of pregnancy (70%), and more than half of fetal anomalies could have been diagnosed earlier.
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