Retrospective Analysis of Pregnancy Terminations: 9-Years Experience at a Tertiary Hospital in Southeastern Turkey

Neslihan Bayramoglu Tepe,Ozge Komurcu Karuserci,Huseyin Caglayan Ozcan,Tanyeli Guneyligil Kazaz,Omer Faruk Dizibuyuk,Reyhan Gunduz,Ali Irfan Kutlar,Seyhun Sucu

doi:10.21613/gorm.2019.934

Abstract

Objective: To determine the indications for termination of pregnancy, and their consistency with autopsy data to offer an insight into termination of pregnancy having regard to conditions in Turkey.Study Design: Three hundred and ninety-one pregnancies terminated before the 24th gestational week were enrolled in this study. Maternal age, gravidity, parity, abortion, the status of folic acid usage, consanguineous marital status, gestational week, anomalies that led to termination and pathological diagnoses were recorded. Anomalies that led to termination were grouped as central nervous system , cardiovascular system, gastrointestinal system, genitourinary system, pulmonary, musculoskeletal, head-neck, chromosomal, genetic, multiple anomalies and others. Four groups were formed based on the consistency of prenatal ultrasound diagnosis with pathological diagnosis.Results: Mean age, gravidity, parity, abortion, and gestational week were 28 years, 3, 1, 1, and 15.7 weeks, respectively. One hundred and thirty-eight (35.2%) patients had consanguineous marriage. Three major causes of termination were central nervous system (45.78%), head-neck (17.4%) and multiple anomalies (14%). One hundred and twenty-eight (71.5%) patients with central nervous system anomalies were not using folic acid. Comparison of prenatal ultrasound findings with pathology results, 275 (70.3%) patients had full consistency, 46 (11.8%) had other findings at autopsy besides the confirmed sonographic findings, 34 (8.7%) had some sonographic findings not confirmed at autopsy, and 4 (1%) had no consistency between the findings.Conclusion: Central nervous system anomalies constitute the most common indication for termination of pregnancy in this retrospective study. Low rate of periconceptional folic acid among those cases is remarkable. First-trimester screening for earlier detection of fetal anomalies may be important in high-risk groups such as those with consanguineous marriages.

Highlights

Detection rates of fetal anomalies have increased due to advances in imaging modalities and early diagnosis of congenital anomalies, which has led to an increased rate of pregnancy terminations [1]
We aimed to show the distribution of indications for termination of pregnancy (TOP) over a period of eight years in our clinic and to emphasize the issues that need to be considered in TOP cases having regard to conditions in Turkey’s by comparing the consistency of prenatal diagnoses with pathological diagnoses
In Turkey, TOP for maternal and fetal reasons is legal with the approval of an obstetrician and another physician who has contributed to the diagnosis in accordance with Law No 2827 [15] and TOP after the 24th gestational week is considered unethical according to the declaration of the Maternal-Fetal and Perinatology Association published in 2011 in Ankara [15]

Summary

Methods

Three hundred and ninety-one pregnant women who presented to our clinic between January 2010-October 2018, who were not more than 24th gestational week and who opted for termination were enrolled in our study. The patients included pregnant women who presented to our clinic for routine pregnancy follow-up and were found to have fetal anomalies in their fetus as well as pregnant women who were referred to our hospital from an external center, as our hospital is a tertiary center and were confirmed to have anomalies in their children at our hospital. The obstetric and demographic data of the patients were recorded. The same experienced obstetrics team performed the ultrasonographic examinations by using Voluson E6R (GE Healthcare, Milwaukee, WI); transabdominal and transvaginal transducers with frequencies ranging between 2.14-6.10 MHz. Detected anomalies were grouped as CNS, cardiovascular system (CVS), gastrointestinal system (GIS), genitourinary system (GUS), pulmonary, musculoskeletal, head-neck, chromosomal, genetic, multiple anomalies and others (thorax, ocular, abdominal wall defects)

Results

Discussion

Conclusion