Fetal anomaly diagnosis and termination of pregnancy in Ireland; evaluation following implementation of abortion services

Abstract

Approximately 3% of pregnancies are diagnosed with a fetal anomaly, of which some are fatal or life-limiting. In 2019, termination of pregnancy (TOP) for fatal fetal anomaly (FFA) was legalised in Ireland. Under this legislation, FFA is deemed present if two physicians certify there is a condition present that means it is likely that fetal or neonatal death will occur. The legislation is currently under review. This study examines all cases of TOP for fetal anomaly over the first 3-year period of service implementation, including those that did not meet the legal criteria and travelled abroad for abortion care. A retrospective service evaluation of fetal medicine clinics in 2 tertiary maternity hospitals from 2019-2021 was undertaken. We compared pregnancies diagnosed with FFA who underwent TOP in Ireland and pregnancies that did not meet the legal criteria where women travelled abroad for TOP. Overall, 139 pregnancies met inclusion criteria. Eighty-three (59.7%) cases had TOP in the tertiary maternity hospital (local), and 56 (40.3%) travelled abroad, mainly to the UK. Demographic characteristics were similar between the groups, as was gestation at diagnosis and delivery. All cases where TOP was local were discussed at fetal medicine multidisciplinary meetings, compared to 41% cases who ultimately travelled for TOP. The most common indication (25/83;30.1%) for local TOP was Trisomy 18, followed by anencephaly. Travelling to get abortion care was mainly because of the diagnosis of Trisomy 21 (30/56;53.6%), followed by other multiple structural anomalies/syndromes deemed locally as not meeting the legal criteria (Table I). Legislation for TOP for fetal anomaly, restricted to fatal diagnoses, is difficult to implement, requires significant multidisciplinary input, and is limited in the service it can provide for major fetal anomalies. Our findings emphasise the impact of legislative barriers to abortion care for fetal anomaly, and the need for policies and services that support women’s access to TOP for fetal anomaly.