Document Detail


Late termination of pregnancy in North Holland.
MedLine Citation:
PMID:  9141586     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To estimate the extent to which late termination of pregnancy (gestational period > 24 weeks) is practised, to find out what fetal diseases and abnormalities lead to termination and to obtain insight into the clinical judgement and decision-making process by gynaecologists with regard to termination. DESIGN: A retrospective study. PLACE: Province of North Holland, The Netherlands. METHODS: An anonymous printed questionnaire, was sent to all associations or departments of gynaecology in the 21 hospitals in North Holland. The period of study covered the years 1990 to 1994. RESULTS: Completed questionnaires were received from 19 associations or departments in the 21 hospitals (90% response). In the five-year period under study in 14 of these hospitals had terminated 103 pregnancies beyond the 24th week of gestation. Antenatal sonography had been performed on all these pregnancies. Anencephaly was diagnosed before termination in 21% and severe chromosomal defects in a further 21%. Other severe abnormalities were neural groove defects, such as hydrocephaly and/or spina bifida (16%), no renal function (12%) and skeletal abnormalities (11%). In 87% the antenatal diagnosis was verified postnatally; in 78% this was done by autopsy. The diagnosis was confirmed in all these cases ('almost confirmed' in two cases). In every case the pregnant woman herself had asked for her pregnancy to be terminated. In 78% the prognosis was discussed with other medical specialists and the professionals concerned with management; there was a consultation about the termination in 91% of the cases. A report was always compiled for the medical records. CONCLUSION: Late termination of pregnancy is practised on a substantial scale in North Holland. The reasons for termination were severe structural abnormalities which, in most cases, were not compatible with survival. The gynaecologists in North Holland dealt prudently and responsibly with late termination of pregnancy, although they did not always adhere to the guidelines set out in the 1994 report of the Netherlands Association for Obstetrics and Gynaecology.
To learn more about the prevalence of and indications for late-pregnancy termination in the Netherlands, a questionnaire was mailed to all associations or departments of gynecology in the 21 hospitals in North Holland. In the 1990-94 study period, 14 of these hospitals had performed a total of 103 terminations of pregnancies beyond the 24th gestational week. Ultrasonography was used as a diagnostic procedure in all 103 cases and chromosomal testing was performed in 58 cases. Fetal abnormalities detected included anencephaly (21 cases), chromosomal defects (21 cases), neural groove defects (16 cases), lack of renal function (12 cases), and skeletal abnormalities (11 cases). There was consultation, most commonly with a pediatrician/neonatologist or clinical geneticist, about the prognosis in 78% of these pregnancies. In all cases, the decision to terminate the pregnancy was made by the pregnant woman. In 75% of cases, a plan had been agreed upon with the pediatrician about the action to take if the child was born alive. The pregnancy was terminated at 28 weeks or under in 28% of cases, between 29 and 37 weeks in 64%, and after 37 weeks in 8%. In 85% of late pregnancy terminations, labor was induced by administering prostaglandins intravenously. 80% of the fetuses were stillborn; the live-born infants all died within 24 hours of birth. Extrapolation of these data suggests that about 150 late-pregnancy terminations are performed in the Netherlands each year.
Authors:
J M Bosma; G van der Wal; S L Hosman-Benjaminse
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  British journal of obstetrics and gynaecology     Volume:  104     ISSN:  0306-5456     ISO Abbreviation:  Br J Obstet Gynaecol     Publication Date:  1997 Apr 
Date Detail:
Created Date:  1997-05-29     Completed Date:  1997-05-29     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7503752     Medline TA:  Br J Obstet Gynaecol     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  478-87     Citation Subset:  AIM; E; IM; J    
Affiliation:
Inspectorate of Health Care for North Holland, Haarlem, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Abortion, Induced* / statistics & numerical data
Decision Making*
Female
Fetal Diseases / ultrasonography
Fetus / abnormalities
Gynecology*
Humans
Judgment
Netherlands
Pregnancy
Pregnancy Trimester, Second
Pregnancy Trimester, Third
Professional Practice
Prospective Studies
Ultrasonography, Prenatal
Comments/Corrections
Comment In:
Br J Obstet Gynaecol. 1997 Apr;104(4):398-400   [PMID:  9141574 ]

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