Termination of pregnancy for fetal abnormality
A small but important minority of pregnant women will be diagnosed with a fetal abnormality, and most women diagnosed with a serious fetal abnormality choose to terminate the pregnancy. Midwives have a key role to play in providing high quality care to women given a diagnosis of fetal anomaly. This includes provision of information about the option of and methods of termination, which may be discussed before women opt into screening.
Both medical and surgical termination are safe and effective, but involve very different experiences for the patient and her support person. Therefore, both options should be available to all women having a termination for fetal abnormality up to 24 weeks gestation and health professionals should help women to choose the method which best suits their individual coping style. In addition to medical advice about future pregnancy planning, women may need ongoing emotional and psychological support after their termination.
Antenatal testing for fetal abnormalities allows parents and their health care team to plan appropriately for the pregnancy, birth and beyond, or consider the option of termination. While some abnormalities can be treated in utero or after birth, many cannot, and each year in England and Wales at least 2500 terminations for fetal abnormality take place (Department of Health (DH), 2012). About a third of these are for chromosomal abnormalities, of which trisomy 21 (Down's syndrome) is the most common (Royal College of Obstetricians and Gynaecologists (RCOG), 2010); over 90% of women given an antenatal diagnosis of this condition choose to terminate the pregnancy (National Down's Syndrome Cytogenetic Register (NDSCR), 2011). Structural abnormalities detected by ultrasonography, most commonly affecting the nervous or musculoskeletal systems, represent another group of fetal anomalies, and the prognosis of these conditions depends on the severity of the anomaly and the organ system involved. As would be expected, women are more likely to terminate pregnancies affected by more severe conditions (Grevengood et al, 1994).
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