title: Termination of pregnancy for maternal indications at the limits of fetal viability: a retrospective cohort study in the Dutch tertiary care centres.
abstract: OBJECTIVE
  Maternal morbidity, either pregnancy related or pre-existent, can become life threatening and of such severity as to warrant termination of pregnancy (TOP). In this situation, chances of fetal survival are usually poor, either because of low gestational age and/or because of the fetal effects of the maternal condition. Examples include severe growth restriction in pre-eclampsia and intrauterine infection due to the very early preterm prelabour rupture of membranes. There are very few reports on the prevalence of TOP for maternal indication at the limits of fetal viability. We investigated the prevalence of and indications for TOP on maternal indication in the 10 tertiary care centres in the Netherlands during the past decade.
  
  
  METHODS
  We conducted a retrospective review of the medical records of all women who underwent TOP for maternal indications between 22 and 27 completed weeks of gestation in all 10 tertiary care centres from 2000 to 2009.
  
  
  RESULTS
  During the study period, there were 1 929 470 deliveries; 163 052 (8.4%) of these took place in one of the 10 tertiary care centres and 177 pregnancies were terminated for severe maternal disease, 131 for hypertensive disorders, 29 for intrauterine infection and 17 for other reasons. The mean gestational age at TOP was 171 days (24(3/7))±10 days. No maternal deaths were recorded. The overall perinatal mortality was 99.4%.
  
  
  CONCLUSIONS
  Over a 10-year period, TOP for maternal indications was performed in 1 in 1000 deliveries in the 10 Dutch tertiary care centres. Hypertensive disorders comprised three-quarters of the cases.
authors.affiliation: Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: L
authors.initials: L
authors.lastname: van Eerden
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Groningen, The Netherlands.
authors.forename: G G
authors.initials: GG
authors.lastname: Zeeman
authors.affiliation: Department of Obstetrics, University Medical Center, Utrecht, The Netherlands.
authors.forename: G C M
authors.initials: GC
authors.lastname: Page-Christiaens
authors.affiliation: Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: F
authors.initials: F
authors.lastname: Vandenbussche
authors.affiliation: Department of Obstetrics and Gynecology, Maxima Medical Center, Veldhoven, The Netherlands.
authors.forename: S G
authors.initials: SG
authors.lastname: Oei
authors.affiliation: Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: H C J
authors.initials: HC
authors.lastname: Scheepers
authors.affiliation: Isala Clinics, Zwolle, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: van Eyck
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Middeldorp
authors.affiliation: Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Pajkrt
authors.affiliation: Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Groningen, The Netherlands.
authors.forename: J J
authors.initials: JJ
authors.lastname: Duvekot
authors.affiliation: Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: C J M
authors.initials: CJ
authors.lastname: de Groot
authors.affiliation: Department of Obstetrics and Gynecology, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Bolte
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data*; D015331:Cohort Studies; D005260:Female; D005328:Fetal Viability; D005865:Gestational Age; D006801:Humans; D009426:Netherlands; D011247:Pregnancy; D011248:Pregnancy Complications / Q000601:surgery*; D012189:Retrospective Studies; D062606:Tertiary Care Centers
keywords: PERINATOLOGY