Pregnancy termination indications and outcomes before 24 weeks of gestation – a case series

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Authors: Ş. Doğru ¹ ; Fatih Akkuş ¹ ; A. A. Atci ¹ ; A. C. Erdoğan ² ; A. Acar ²
Authors‘ workplace: Department of Obstetrics and Gynecology, Division of Perinatology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey ¹; Department of Obstetrics and Gynecology, Necmettin Erbakan University Medical School of Meram, Konya, Turkey ²
Published in: Ceska Gynekol 2023; 88(6): 428-434
Category: Original Article
doi: https://doi.org/10.48095/cccg2023428

Overview

Objective: This study aimed to assess termination of pregnancy (TOP) indications and obstetric outcomes before the 24^th gestational week. Materials and methods: This is a retrospective study that includes terminations performed in singleton pregnancies between December 2021 and December 2022 in the Perinatology Clinic of Necmettin Erbakan University Meram Medical Faculty. According to the reasons for TOP, all patients were divided into three groups: maternal, fetal, and obstetric reasons. The termination approach and outcomes were evaluated in all cases. Results: A total of 210 patients were included in the study. Considering termination indications, 18 (8.5%) patients had maternal causes, 127 (60.5%) had fetal causes, and 65 (31%) had obstetric causes. Maternal causes were significantly higher in the 1^st trimester and fetal causes in the 2^nd trimester (P = 0.001). In the maternal group, 77.8% dilatation and curettage were used, 70.1% misoprostol and 29.9% misoprostol + Foley catheter in the fetal group, and 66.2% misoprostol in the obstetric group (P = 0.0001). The length of hospital stay and recurrent revision curettage were not statistically different between the fetal, maternal, and obstetric groups (P = 0.099, P = 0.8, respectively). Conclusion: Termination options should be offered for complicated pregnancies due to fetal, maternal, or obstetric reasons. Pregnancy termination week and indication affect morbidity.

Keywords:

morbidity – pregnancy – termination – fetal anomaly

Sources

1. Blondel B, Cuttini M, Hindori‐Mohangoo A et al. How do late terminations of pregnancy affect comparisons of stillbirth rates in Europe? Analyses of aggregated routine data from the Euro‐Peristat Project. BJOG 2018; 125 (2): 226–234. doi: 10.1111/1471-0528.14767.

2. Gürsoy A. Abortion in Turkey: a matter of state, family or individual decision. Soc Sci Med 1996; 42 (4): 531–542. doi: 10.1016/0277-95 36 (95) 00176-x.

3. Kose S, Altunyurt S, Yıldırım N et al. Termination of pregnancy for fetal abnormalities: main arguments and a decision‐tree model. Prenat Dia gn 2015; 35 (11): 1128–1136. doi: 10.1002/pd.4662.

4. Garne E, Loane M, Dolk H et al. Prenatal dia g – nosis of severe structural congenital malformations in Europe. Ultrasound Obstet Gynecology 2005; 25 (1): 6–11. doi: 10.1002/uog. 1784.

5. Monier I, Lelong N, Ancel PY A et al. Indications leading to termination of pregnancy between 22+0 and 31+6 weeks of gestational age in France: a population-based cohort study. Eur J Obst Gynecol Reprod Biol 2019; 233: 12–18. doi: 10.1016/j.ejogrb.2018.11.021.

6. LeMoine F, Moore RC, Chapple A et al Neonatal survivability following previable PPROM after hospital readmission for intervention. AJP Rep 2020; 10 (4): e395–e402. doi: 10.1055/ s-0040-1721421.

7. Thompson KM, Sturrock HJ, Foster DG et al. Association of travel distance to nearest abortion facility with rates of abortion. JAMA Netw Open 2021; 4 (7): e2115530. doi: 10.1001/jamanetworkopen.2021.15530.

8. Garofalo G, Garofalo A, Sochirca O et al. Maternal outcomes in first and second trimester termination of pregnancy: which are the risk factors? J Perinat Med 2018; 46 (4): 373–378. doi: 10.1515/jpm-2017-0106.

9. Morris JL, Winikoff B, Dabash R et al. FIGO‘s updated recommendations for misoprostol used alone in gynecology and obstetrics. Int J Gynaecol Obstet 2017; 138 (3): 363–366. doi: 10.1002/ijgo.12181.

10. Choudhary N, Saha SC, Gopalan S. Abortion procedures in a tertiary care institution in India. Int J Gynaecol Obstet 2005; 91 (1): 81–86. doi: 10.1016/j.ijgo.2005.06.012.

11. Vaknin Z, Ben‐Ami I, Reish O et al. Fetal abnormalities leading to termination of singleton pregnancy: the 7‐year experience of a single medical center. Prenat Dia gn 2006; 26 (10): 938–943. doi: 10.1002/pd.1531.

12. Vaknin Z, Lahat Y, Barel O et al. Termination of pregnancy due to fetal abnormalities performed after 23 weeks’ gestation: analysis of indications in 144 cases from a single medical center. Fetal Dia gn Ther 2009; 25 (2): 291–296. doi: 10.1159/000229501.

13. van Eerden L, Zeeman GG, Page-Christiaens GC et al. Termination of pregnancy for maternal indications at the limits of fetal viability: a retrospective cohort study in the Dutch tertiary care centres. BMJ Open 2014; 4 (6): e005145. doi: 10.1136/bmjopen-2004-005145.

14. Ozyuncu O, Orgul G, Tanacan A et al. Retrospective analysis of indications for termination of pregnancy. J Obstet Gynaecol 2019; 39 (3): 355–358. doi: 10.1080/01443615.2018.1506 427.

15. Beksaç MS. Doğum Hekimliği – Meternal – Fetal Tıp’ta Etik ve Yasal Boyut. Ankara: Mebas Medikal Basin Yayin 2006: 639–644.

16. Barrett HL, Lust K, Callaway LK et al. Termination of pregnancy for maternal medical indications: failings in delivery of contraceptive advice? Aust N Z J Obstet Gynaecol 2011; 51 (6): 532–535. doi: 10.1111/j.1479-828X.2011.013 71.x.

17. Calì G, Timor-Tritsch IE, Palacios-Jaraquemada J et al. Outcome of cesarean scar pregnancy managed expectantly: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51 (2): 169–175. doi: 10.1002/uog.17 568.

18. Abrahami Y, Saucedo M, Rigouzzo A et al. Maternal mortality in women with pre-viable premature rupture of membranes: an analysis from the French confidential enquiry into maternal deaths. Acta Obstet Gynecol Scand 2022; 101 (12): 1395–1402. doi: 10.1111/aogs.14 452.

19. Norwitz ER, Zelop CM, Miller DA et al. Evidence-based obstetrics and gynecology. Vol. Chapter 3. Oxford: John Wiley and Sons Ltd 2019.

20. Kulier R, Fekih A, Hofmeyr GJ et al. Surgical methods for first trimester termination of pregnancy. Cochrane Database Syst Rev 2001; 2001 (4): CD002900. doi: 10.1002/14651858.CD002900.

21. Tunçalp Ö, Gülmezoglu AM, Souza JP. Surgical procedures for evacuating incomplete miscarriage. Cochrane Database Syst Rev 2010; 2010 (9): CD001993. doi: 10.1002/14651858.CD001993.

22. Costescu D, Mui C. When there is only one patient: induction of labour for termination of pregnancy. Best Pract Res Clin Obstet Gynaecol 2022; 79: 81–94. doi: 10.1016/ j.bpobgyn.2021.11.001.

23. Mazouni C, Provensal M, Porcu G et al. Termination of pregnancy in patients with previous cesarean section. Contraception 2006; 73 (3): 244–248. doi: 10.1016/j.contraception.2005.09. 007.

24. Kaunitz AM, Rovira EZ, Grimes DA et al. Abortions that fail. Obstet Gynecol 1985; 66 (4): 533–537.

25. Bryant AG, Grimes DA, Garrett JM et al. Second-trimester abortion for fetal anomalies or fetal death: labor induction compared with dilation and evacuation. Obstet Gynecol 2011; 117 (4): 788–792. doi: 10.1097/AOG.0b013e 31820c3d26.