Continuation or Termination? Maternal Outcomes in Severe Fetal Anomalies
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Published on: June 27, 2025
Oshra Meir1, Maya Frank Wolf2, Marwan Odeh2
1Azrieli Faculty of Medicine, Bar Ilan University, Safed, Israel.
Objective:
To compare maternal and obstetric outcomes in pregnancies complicated by severe structural fetal anomalies according to management: continuation versus termination after the threshold of viability.
Methods:
This retrospective cohort study included women with singleton pregnancies complicated by prenatally diagnosed severe structural fetal anomalies managed at a tertiary center from 2010-2025. The primary outcome was a composite of adverse maternal events: cesarean delivery (CD), PPH, placental abruption, blood transfusion, uterine rupture or scar dehiscence, and prolonged maternal hospitalization.
Results:
A total of 186 women were included:139 continued the pregnancy and 47 underwent termination. Continuation was associated with higher composite adverse maternal outcomes than termination (55.4% vs 19.1%, P < 0.001). On multivariable analysis, continuation remained independently associated with adverse maternal outcome (aOR = 4.81, 95% CI 1.83-12.65). Polyhydramnios and prior CD were also independent risk factors. In the continuation group, intrauterine fetal demise occurred in 23.1% and neonatal death in 16.3%. In subsequent pregnancies, CD was more common after continuation than termination (40.5% vs 15.0%,P = 0.034).
Conclusion:
In pregnancies complicated by severe structural fetal anomalies, continuation was associated with greater maternal morbidity, and these risks should be incorporated into counseling alongside fetal prognosis and shared decision-making.
