title: Factors affecting parental decisions to terminate pregnancy in the presence of chromosome abnormalities: a Japanese multicenter study.
abstract: OBJECTIVE
  To investigate the rates of termination of pregnancy (TOP) for fetal chromosomal abnormalities and factors related to such parental decision in Japan.
  
  
  METHODS
  A multicenter retrospective cohort study of chromosomal abnormalities diagnosed before 22 weeks of gestation between April 2008 and March 2015. The pregnancy outcomes and parental decisions were investigated.
  
  
  RESULTS
  Among 931 fetuses with chromosome abnormalities, the total TOP rate was 75.1% (699/931). TOP rates were 89.3% (585/655) in autosomal aneuploidies and 40.8% (51/125) in sex chromosome aneuploidies. Trisomy 21 showed the highest TOP rate (93.8% [390/416]) followed by trisomy 18 (84.5% [163/193]) and trisomy 13 (71.9% [23/32]). Indications for karyotyping were related to a parental decision for TOP (p < 0.01): in cases of autosomal aneuploidy, with fetal abnormal ultrasound findings as the reference value, diagnoses made following positive results at non-invasive prenatal testing (adjusted odds ratio [OR]: 13.7, 95% confidence interval [CI] 4.07-45.9) and those because of advanced maternal age (adj. OR 2.91, 95% CI 1.15-7.35) were significantly more frequent.
  
  
  CONCLUSIONS
  In Japan, pregnancies with fetal trisomy 21 are more likely to result in TOP when diagnosed in utero than any other chromosome anomaly. The indications for prenatal karyotyping strongly affect the decision to TOP. © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Nishiyama
authors.affiliation: Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sekizawa
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Ogawa
authors.affiliation: Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Sawai
authors.affiliation: Department of Obstetrics, Osaka City General Hospital, Osaka, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nakamura
authors.affiliation: Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Samura
authors.affiliation: Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Suzumori
authors.affiliation: Department of Obstetrics and Gynecology, Aiiku Clinic, Tokyo, Japan.
authors.forename: Setsuko
authors.initials: S
authors.lastname: Nakayama
authors.affiliation: Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Katagiri
authors.affiliation: Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Murotsuki
authors.affiliation: Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical University, Moroyama, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Namba
authors.affiliation: Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Hamanoue
authors.affiliation: Department of Obstetrics and Gynecology, Clinical Research Institute, National Kyusyu Medical Center, Fukuoka, Japan.
authors.forename: Masanobu
authors.initials: M
authors.lastname: Ogawa
authors.affiliation: Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan.
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Miura
authors.affiliation: Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Izumi
authors.affiliation: Department of Obstetrics and Gynecology, Saitama Medical University, Moroyama, Japan.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Kamei
authors.affiliation: Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Sago
mesh_terms: D000028:Abortion, Induced; D000328:Adult; D000649:Amniocentesis; D000782:Aneuploidy; D015193:Chorionic Villi Sampling; D002869:Chromosome Aberrations; D025063:Chromosome Disorders; D002882:Chromosomes, Human, Pair 13; D002887:Chromosomes, Human, Pair 18; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000235:genetics; D003657:Decision Making; D004314:Down Syndrome; D005260:Female; D006801:Humans; D007564:Japan; D007621:Karyotyping; D008423:Maternal Age; D010290:Parents; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D012729:Sex Chromosome Aberrations; D014314:Trisomy; D000073839:Trisomy 13 Syndrome; D000073842:Trisomy 18 Syndrome; D016216:Ultrasonography, Prenatal