title: Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population-based cohorts in the MOSAIC study.
abstract: OBJECTIVE
  To study the impact of terminations of pregnancy (TOP) on very preterm mortality in Europe.
  
  
  METHODS
  European prospective population-based cohort study.
  
  
  METHODS
  Ten regions from nine European countries participating in the MOSAIC (Models of OrganiSing Access to Intensive Care for very preterm babies) study. These regions had different policies on screening for congenital anomalies (CAs) and on pregnancy termination.
  
  
  METHODS
  Births 22-31 weeks gestational age.
  
  
  METHODS
  The analysis compares the proportion of TOP among very preterm births and assesses differences in mortality between the regions.
  
  
  METHODS
  Pregnancy outcomes (termination, antepartum death, intrapartum death and live birth) and reasons for termination, presence of CAs and causes of death for stillbirths and live births in 2003.
  
  
  RESULTS
  Pregnancy terminations constituted between 1 and 21.5% of all very preterm births and between 4 and 53% of stillbirths. Most terminations were for CAs, although some were for obstetric indications (severe pre-eclampsia, growth restriction, premature rupture of membranes). TOP contributed substantially to overall fetal mortality rates in the two regions with late second-trimester screening. There was no clear association between policies governing screening and pregnancy termination and the proportion of CAs among stillbirths and live births, except in Poland, where neonatal deaths associated with CAs were more frequent, reflecting restrictive pregnancy termination policies.
  
  
  CONCLUSIONS
  Proportions of TOP among very preterm births varied widely between European regions. Information on terminations should be reported when very preterm live births and stillbirths are compared internationally since national policies related to screening for CAs and the legality and timing of medical terminations differ.
authors.affiliation: Université Paris V Réné Descartes et Maternité de Port-Royal, Assistance-Publique Hôpitaux, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Papiernik
authors.forename: J
authors.initials: J
authors.lastname: Zeitlin
authors.forename: D
authors.initials: D
authors.lastname: Delmas
authors.forename: E S
authors.initials: ES
authors.lastname: Draper
authors.forename: J
authors.initials: J
authors.lastname: Gadzinowski
authors.forename: W
authors.initials: W
authors.lastname: Künzel
authors.forename: M
authors.initials: M
authors.lastname: Cuttini
authors.forename: D
authors.initials: D
authors.lastname: Di Lallo
authors.forename: T
authors.initials: T
authors.lastname: Weber
authors.forename: L
authors.initials: L
authors.lastname: Kollée
authors.forename: A
authors.initials: A
authors.lastname: Bekaert
authors.forename: G
authors.initials: G
authors.lastname: Bréart
mesh_terms: D000028:Abortion, Induced / Q000401:mortality*; D002423:Cause of Death; D000013:Congenital Abnormalities / Q000401:mortality*; D004812:Epidemiologic Methods; D005060:Europe / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006291:Health Policy; D006801:Humans; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D047928:Premature Birth / Q000401:mortality*; D013997:Time Factors