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The reasons for termination of pregnancy in the third trimester
M Dommergues1, A Benachi, J L Benifla
1AP-HP Service de Gynécologie-Obstétrique, Hôpital A. Béclère, Clamart, France.
Objective:
To analyse the process in making decisions leading to termination of pregnancy in the third trimester and to evaluate the maternal morbidity associated with this procedure.
Design:
Retrospective study.
Setting:
The Maternité Port Royal University Hospital, Paris, France.
Population:
A consecutive series of 956 terminations of pregnancy performed for fetal anomalies in singleton pregnancies, 305 of which were in the third trimester and 651 in the second.
Main Outcome Measures:
Indications for termination of pregnancy; process leading to late termination of pregnancy; maternal morbidity.
Results:
One hundred and thirteen (37%) third trimester terminations of pregnancy were associated with false negative resulted from the results of earlier screening tests. In 15 terminations (5%), the decision was postponed, although the poor fetal prognosis was established earlier. In 55 (18%) the diagnosis was not possible earlier than the third trimester, and in 122 (40%) the diagnosis was possible earlier but the poor prognosis for the fetus was not established until the third trimester. Maternal morbidity due to termination of pregnancy was similar in the second and third trimester.
Conclusion:
One-third of late terminations of pregnancy could have been avoided by more efficient screening in the second trimester. However, because fetal prognosis is not always clear when a malformation is diagnosed, postponing the decision until fetal development allows more thorough evaluation and may avoid unnecessary termination of pregnancy in the second trimester. This could be the main beneficial aspect of not setting a limit to the gestational age for performing termination of pregnancy.