Termination of pregnancy due to fetal abnormalities performed after 23 weeks' gestation: analysis of indications in 144 cases from a single medical center.
OBJECTIVE
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.
Vaknin
Zvi
Z
Department of Obstetrics and Gynecology, Assaf Harofeh Medical Center, Zerifin, affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Lahat
Yael
Y
Barel
Oshri
O
Ben-Ami
Ido
I
Reish
Orit
O
Herman
Arie
A
Maymon
Ron
R
D000025:Abortion, Eugenic / Q000706:statistics & numerical data*; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005865:Gestational Age; D006268:Health Facilities / Q000706:statistics & numerical data*; D006801:Humans; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis; D012189:Retrospective Studies