Termination of pregnancy: an analysis of indications in 1129 patients

Giriş

To determine the indications leading to termination of pregnancy (TOP) after 10 weeks of gestation in 1129 pregnancies.

Yöntem

A retrospective evaluation encompassing years 2000-2009 was performed about the indications leading to termination of pregnancy by a committee composed of three obstetricians, one neonatologist and one geneticist. Fetal structural and chromosomal abnormalities, fetal hydrops, amniotic fluid abnormalities (including premature rupture of membranes, PPROM), infections, maternal disease, drug or teratogen use and radiation exposure were tabulated.

Bulgular

There were 1120 singleton and 9 twin pregnancies. Fetal structural anomalies (726 pregnancies, 64.3%), chromosomal abnormalities (99 pregnancies, 8.7%), fetal hydrops (56 pregnancies, 4.9%), amniotic fluid abnormalities + PPROM (118 pregnancies, 10.4%), infections (35 pregnancies, 3.1%), maternal disease (50 pregnancies, 4.4%), drug or teratogen use (31 pregnancies, %2.7), and radiation exposure (14 pregnancies, 1.2%) were main indications for TOP. Mean maternal age was 27.6±6.5 years (range, 16-50 years). The termination procedures were performed at a mean gestational age of 19.3±4.5 weeks (range, 10 -36 weeks). The distribution of fetal structural anomalies were as follows: Central nervous system anomalies (387 pregnancies, 34.3%), cardiovascular and lung anomalies (46 pregnancies, 4.1%), gastrointestinal tract and thoraco-abdominal defects (30 pregnancies, 2.6%), urogenital anomalies (46 pregnancies, 4.1%), musculoskeletal defects (73 pregnancies, 6.4%), defects involving face and neck (26 pregnancies, 2.3%), multiple anomalies (102 pregnancies, 9.0%), single gene disorders (6 pregnancies, 0.6%), and others (10 pregnancies, 0.8%). Chromosomal anomalies included trisomy 21 (65 fetuses, 5.7%), trisomy 18 (13 fetuses, 1.1%), trisomy 13 (8 fetuses, 0.7%), and other (13 fetuses, 1.1%). Syphilis (3 pregnancies, 0.2%), Cytomegalovirus (5 pregnancies, 0.4%), toxoplasmosis (12 pregnancies, %1), varicella (3 pregnancies, 0.2%), mumps (2 pregnancies, 0.2%), Ebstein Barr virus (1 pregnancy), neurobrucellosis (1 pregnancy), acute Hepatitis C virus (1 pregnancy), rubella (6 pregnancies, 0.5%), and HIV (1 pregnancy) were the infectious causes.

Sonuç

First and second trimester ultrasonographic examination seems to be the single and most important parameter for detection of fetal abnormalities. The gestational age at the recognition of fetal abnormalities seems to be decreasing, whereas a declining attitude toward termination of pregnancy was evident for structural anomalies other than central nervous system and cardiovascular abnormalities. 

Anahtar Kelimeler

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