Fetal structural anomalies to blame for many pregnancy terminations

Just weeks after the United States Supreme Court overturned a prior ruling protecting abortion rights nationally, a new analysis on the etiologies behind the termination of pregnancy (TOP) offers more insight on the polarizing topic. 

The retrospective analysis consisted of reviewing nearly 500 pregnancy terminations over a 10-year period. Using the patients’ medical records and reports, experts concluded that just over 11% of pregnancies were subject to elective termination. All others were the result of multiple factors that rendered the pregnancy nonviable, including severe structural anomalies. 

Corresponding author of the study Ching Hua Hsiao, of the Department of Obstetrics and Gynecology at Taipei City Hospital, Women and Children Campus in Taiwan, and colleagues elaborated on the importance of advancing our understanding of fetal death, suggesting that improvements could ease the decision-making burden on patients, families and providers: 

“An improvement in technique measuring vital status, birth weight,and gestational age, as well as a smooth communication between healthcare providers and pregnant women and their families are key to advance the stillbirth data, to eliminate preventable stillbirths and to ameliorate the burden on families.” 

Fetal abnormalities that could inform the necessity of TOP can be identified on routine ultrasound imaging, as well as during anatomy scans that take place at 20-weeks gestation. In this study, fetal death and/or pregnancy termination occurred for several reasons. The 488 patients—aged 12 to 46—were divided based on the etiology of TOP, identified by medical records and reports. Their results are as follows: 

  1. Chromosomal and genetic abnormalities (146/488, 29.9%) 

  1. No intrauterine heartbeats (126/488, 25.8%) 

  1. Structural anomalies of the central nervous system, cardiovascular system, abdomen, skeleton, urogenital system or fetal hydrops (`84/488, 17.2%) 

  1. Elective termination (56/488, 11.5%) 

  1. Preterm premature rupture of membranes (42/488, 8.6%) 

  1. Cervical incompetence (32/488, 6.6%) 

  1. Other conditions (2/488, 0.4%) 

The authors indicated that understanding these factors could improve family counseling and planning and reduce the number of unsafe and unwanted TOPs. 

This research was published in the Taiwanese Journal of Obstetrics and Gynecology

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