References

Ashok P, Templeton A, Wagaarachchi P, Flett G Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception. 2004; 69:(1)51-8

Asplin N, Wessel H, Marions L, Georgsson Öhman S Pregnancy termination due to fetal anomaly: Women's reactions, satisfaction and experiences of care. Midwifery. 2013; pii:(13)S0266-6138 https://doi.org/10.1016/j.midw.2013.10.013

Bourguignon A, Briscoe B, Nemzer L Genetic abortion: Considerations for patient care. J Perinat Neonatal Nurs. 1999; 13:(2)47-58

Bryant AG, Grimes DA, Garrett JM, Stuart GS Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation. Obstet Gynecol. 2011; 117:788-92

Chasen ST, Kalish RB, Gupta M, Kaufman J, Chervenak FA Obstetric outcomes after surgical abortion at ≥20 weeks' gestation. Am J Obstet Gynecol. 2005; 193:1161-4

Choi H, Van Riper M, Thoyre S Decision making following a prenatal diagnosis of Down syndrome: an integrative review. J Midwifery Womens Health. 2012; 57:(2)156-64

Goyal V Uterine rupture in second-trimester misoprostol-induced abortion after cesarean delivery: a systematic review. Obstet Gynecol. 2009; 113:1117-23

Grevengood C, Shulman L, Dungan J, Martens P, Phillips O, Emerson D, Felker RE, Simpson J, Elias S Severity of abnormality influences decision to terminate pregnancies affected with fetal neural tube defects. Fetal Diagn Ther. 1994; 9:(4)273-7

Grimes DA, Smith MS, Witham AD Mifepristone and misoprostol versus dilation and evacuation for midtrimester abortion: a pilot randomised controlled trial. BJOG. 2004; 111:(2)148-53

Jackson JE, Grobman WA, Haney E, Casele H Mid-trimester dilation and evacuation with laminaria does not increase the risk for severe subsequent pregnancy complications. Int J Gynaecol Obstet. 2007; 96:12-5

Kalish RB, Chasen ST, Rosenzweig LB, Rashbaum WK, Chervenak FA Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome. Am J Obstet Gynecol. 2002; 187:882-5

Kelly T, Suddes J, Howel D, Hewison J, Robson S Comparing medical versus surgical termination of pregnancy at 13–20 weeks of gestation: a randomised controlled trial. BJOG. 2010; 117:1512-20

Kerns J, Vanjani R, Freedman L, Meckstroth K, Drey EA, Steinauer J Women's decision making regarding choice of second trimester termination method for pregnancy complications. Int J Gynaecol Obstet. 2012; 116:244-8

Korenromp MJ, Page-Christiaens GC, van den Bout J, Mulder EJ, Visser GH Maternal decision to terminate pregnancy in case of Down syndrome. Am J Obstet Gynecol. 2007; 196:(2)

Korenromp M, Page-Christiaens G, van den Bout J, Mulder E, Visser G Adjustment to termination of pregnancy for fetal anomaly: a longitudinal study in women at 4, 8, and 16 months. Am J Obstet Gynecol. 2009; 201:(2)160.e1-7

Lohr P, Fjerstad M, DeSilva U, Lyus R Abortion. BMJ. 2014; 348

Lyus R., Robson S, Parsons J, Fisher J, Cameron M Second trimester abortion for fetal abnormality. British Medical Journal. 2013; 347

Exeter: UK National Screening Committee; 2011

National Down's Syndrome Cytogenetic Register. 2011. http://archive.wolfson.qmul.ac.uk/ndscr/reports/NDSCRreport11.pdf

London: NICE; 2012

London: RCN; 2007

London: RCOG; 2010

London: RCOG; 2011

Shaffer BL, Caughey AB, Norton ME Variation in the decision to terminate pregnancy in the setting of fetal aneuploidy. Prenat Diagn. 2006; 26:(8)667-71

Sloan EP, Kirsh S, Mowbray M Viewing the fetus following termination of pregnancy for fetal anomaly. J Obstet Gynecol Neonatal Nurs. 2008; 37:(4)395-404

Society of Family Planning. 2011. http://tinyurl.com/legz6f8

Steinberg JR Later abortions and mental health: psychological experiences of women having later abortions--a critical review of research. Womens Health Issues. 2011; 21:(3 Suppl)S44-8

Vogt C, Blaas HG, Salvesen KÅ, Eik-Nes SH Comparison between prenatal ultrasound and postmortem findings in fetuses and infants with developmental anomalies. Ultrasound Obstet Gynecol. 2012; 39:666-702

Whitley KA, Trinchere K, Prutsman W Midtrimester dilation and evacuation versus prostaglandin induction: a comparison of composite outcomes. Am J Obstet Gynecol. 2011; 205

Termination of pregnancy for fetal abnormality

02 May 2014
14 min read
Volume 22 · Issue 5

Abstract

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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