TERMINATION OF PREGNANCY FOR FETAL ANOMALIES – ANALYSIS OF CASES OVER A 4-YEAR PERIOD
Background: The consequence of prenatal detection of fetuses with congenital anomalies is induced ter- mination of pregnancy (TOP). The analysis of the indications for TOP and the agreements between prenatal and pathohistological findings is required to assess the quality of work and the appropriateness of diagnostic procedures.
Methods: This retrospective analysis involved the indications for TOP performed for congenital fetal anomalies between January 2005 and March 2009. The TOP cases were divided into two groups: the early (up to 22 week, abortion) and the late (≥ 22 weeks 0/7, delivery) termina- tion group. With regard to the agreement between prenatal and pathohistological postmor- tem findings, 3 groups were created: complete agreement, agreement with additional data provided by pathohistological analysis, disagreement of findings.
Results: Of the 220 cases of TOP for congenital anomalies, 180 (82 %) were abortion cases and 40 (18 %) were labour cases. In both groups, the most frequent causes for TOP were fetal structural abnormalities that were not due to chromosomal anomalies (102 (57 %) in the abortion group and 38 (95 %) in the delivery group). The percentage of chromosomal/monogenic anomalies was statistically significantly higher in the abortion (43 %) than in the labour group (only 5 %) (p < 0.001). Pathohistological examination was performed in 172 cases. In 126 (73 %) cases the agreement between prenatal ultrasound and pathohistological find- ings was complete and in 37 (22 %) pathohistological findings provided additional data on congenital anomalies that did not change the prenatally made diagnosis and would not affect the management of pregnancy. In none of the cases did pathohistological findings reject the prenatally made diagnosis.
Conclusions: Fetal structural anomalies are frequent cause of TOP. Pathohistological examination of the fetus confirmed the prenatal diagnosis in all the cases, whereas in one fourth of the cases it provided additional information on congenital anomalies.
Smith GCS, Fretts RC. Stillbirth. Lancet 2007; 370: 1715–25.
PinterB.UmetnaprekinitevnosečnostivSlovenijiinvEvropi.In: Pinter B, Pretnar-Darovec A, eds. Umetna prekinitev nosečnosti v Sloveniji. Zbornik 1. spominski sestanek prof. dr. Lidije Andolšek- Jeras; 2004 nov 19; Ljubljana: Slovensko društvo za reproduktivno
medicino; 2004. p. 15–20.
Zakon o zdravstveni dejavnosti 1992. UL RS 9/92.
sečnosti zaradi razvojnih nepravilnosti v drugem trimesečju. In: Tul-Mandić N, ed. Šola ultrazvočne diagnostike z mednarodno udeležbo. Zbornik predavanj Ultrazvočni pregled v 2. trimesečju nosečnosti; 2008 okt 16–19; Ljubljana Ljubljana: Združenje za perinatalno medicino; 2008. p.33–9.
Cerar VM, Blejec T, Debevec M, Završnik T. Selektivni feticid. Zdrav Vestn 1990; 59: 11–4. Bosma JM, van der Wal G, Hosman-Benjamise SL. Late termina- tion of pregnancy in North Holland. Br J Obstet Gynaecol 1997; 104: 478–87.
Boyd PA, Tondi F, Hicks NR, Chamberlain PF. Autopsy after ter- mination of pregnancy for fetal anomaly: retrospective cohort study. BJM 2004; 328: 137–40.
Dommergues M, Benachi A, Benifla JL, des Noettes R, Dumez Y. The reasons for termination of pregnancy in the third trimester. Br J Obstet Gynaecol 1999; 106: 297–303.
Vakin Z, Ben-Ami I, Reish O, Herman A, Maymon R. Fetal ab- normalities leading to termination of singelton pregnancy: the 7-year experience of a single medical center. Prenat Diagn 2006; 26: 938–43.
Guillem P, Fabre B, Cans C, Robert-Gnansia E Jouk PS. Trends in elective termination of pregnancy between 1989 and 2000 in French county (the Isere). Prenat Diagn 2003; 23: 877–83.
Štucin Gantar I. Prirojene nepravilnosti pri novorojenčkih. In: Tul-Mandić N, edr. Šola ultrazvočne diagnostike z mednarodno udeležbo. Zbornik predavanj Ultrazvočni pregled v 2. trimesečju nosečnosti; 2008 okt 16–19; Ljubljana. Ljubljana: Slovensko zdravniško društvo, Zrduženje za perinatalno medicino; 2008. p. 40–3. :
Ramalho C, Matias A, Brandao O, Montenegro N. Critical evalu- ation of elective termination of pregnancy in a tertiary center during 43 months: correlation of prenatal diagnosis findings and postmortem examinations. Prenatal Diagn 2006; 26: 1084–8.
Manchester DK, Pretorius DH, Avery C. Accuracy of ultrasound diagnoses in pregnancies complicated by suspected fetal anoma- lies. Prenatal Diagn 1988; 8: 109–17.
Sabbagha RE, Sheikh Z, Tamura RK, DalCompo S, Simpson JL, Depp R, et al. Predictive value, sensitivity, and specificity of ul- trasonic targeted imaging for fetal anomalies in gravid women at high risk for bith defects. Am J Obstet Gynecol 1985; 152: 822–7.
Kaiser L, Vizer M, Arany A, Veszpremi B. Correlation of prenatal clinical findings with those observed in fetal autopsies: patho- logical approach. Prenatal Diagn 2000; 20: 970–5.
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