Is it an abortion: Classification of pregnancy-ending interventions after 24 weeks in the presence of lethal fetal anomalies

Abstract

ObjectiveTo determine how obstetrician-gynecologists categorize pregnancy-ending interventions in the setting of lethal fetal anomalies. Study DesignWe conducted a sequential explanatory mixed methods study of U.S. obstetrician-gynecologists from May to July 2021. We distributed a cross-sectional online survey via email and social media and completed qualitative telephone interviews with a nested group of participants. We assessed institutional classification as induced abortion versus indicated delivery for six scenarios of ending a pregnancy with lethal anomalies after 24 weeks, comparing classification using McNemar chi-square tests with Benjamini-Hochburg correction for multiple comparisons with false discovery rate of 0.05. We performed thematic analysis of qualitative data and then performed a mixed methods analysis. ResultsWe included 205 respondents; most were female (84.4%), had provided abortion care (80.2%), and were general OB/GYNs (59.3%), with broad representation across pre-Dobbs state and institutional abortion policies. Twenty-one qualitative participants had similar characteristics to the whole sample. Scenarios were classified as induced abortion by the majority of respondents, ranging from 53.2% for 32-week induction for anencephaly, to 82.9% for feticidal injection and 24-week induction for anencephaly. Mixed methods analysis revealed the relevance of gestational age (later interventions less likely to be considered induced abortion) and procedure method and setting (dilation and evacuation, feticidal injection, and freestanding facility all increasing classification as induced abortion). ConclusionThere is wide variation in classification of pregnancy-ending interventions for lethal fetal anomalies, even among trained OB/GYNs. Method, timing, and location of ending a nonviable pregnancy influence classification, though perinatal outcome is unchanged. ImplicationsThe classification of pregnancy-ending interventions for lethal fetal anomalies after 24 weeks as indicated delivery versus induced abortion is reflective of sociopolitical regulatory factors as opposed to medical science. The regulatory requirement for classification negatively impacts access to care, especially in environments where induced abortion is legally restricted.