The Influence of Gestational Age at Diagnosis of Down Syndrome on Patient's Choice for Pregnancy Termination [20O

Abstract

INTRODUCTION: To report the influence of gestational age (GA) on patients' decisions to terminate pregnancies affected with Down syndrome (DS). METHODS: A retrospective cohort analysis of a prospectively collected database on pregnancies in our region affected with DS from November 2003 thru July 2015 was performed. RESULTS: A total of 258 pregnancies with DS were recorded, of which 185 were diagnosed within the GA where pregnancy termination was legal and available. Of these, 41 were diagnosed by CVS from 11–14 weeks gestation and 144 were diagnosed by amniocentesis from 15–22 weeks GA. Of patients opting to undergo pregnancy termination, 29 cases (71%) diagnosed in the late first trimester opted for termination, while 65 cases (45%) diagnosed in the second trimester opted to undergo termination (P=.007). CONCLUSION: Although the decision to terminate a pregnancy with DS is based on a myriad of social, economic, personal, spiritual, and religious factors, GA at time of diagnosis has been frequently shown to be one of the most significant factors. Since the introduction of first trimester screening in our practice in 2006 and subsequently noninvasive prenatal testing in 2012, there has been a significant shift in prenatal diagnosis from amniocentesis to CVS. There has also been a significant increase in the percentage of patients choosing pregnancy termination. This confirms the importance of early prenatal diagnosis in allowing patients the maximum amount of pregnancy options and to have greater access to safer termination services.