Termination Of Pregnancy For Fetal Abnormality Research Articles

Caring for people from Northern Ireland seeking termination of pregnancy for fetal abnormality

Despite legalisation of termination of pregnancy in Northern Ireland (NI) in 2020 many women are unable to access safe termination there. This article will focus on pregnant women and people who travel to England from NI to undergo late-stage (after 13 weeks gestation) termination of pregnancy for fetal abnormality (ToPFA) and the roles midwives and student midwives in England, Scotland and Wales play in caring for these clients in relation to the standards set in the Nursing and Midwifery Council Code.1

Incidence and predictors of paternal anxiety and depression following fetal abnormalities requiring pregnancy termination: a cross-sectional study in China

BackgroundChina is a country with a high prevalence of fetal abnormalities. Termination of pregnancy for fetal abnormalities (TOPFA) is a devastating traumatic event for parents and families, resulting in serious and lasting psychological problems. The impact of TOPFA on mothers has been extensively explored, but little research has been conducted on the resulting paternal psychological problems. This study sought to determine the prevalence and predictors of paternal anxiety and depression following TOPFA.MethodsWe analysed cross-sectional data from 169 Chinese couples (169 mothers and 169 fathers) who experienced TOPFA. Anxiety was assessed with the Self-Rating Anxiety Scale (SAS), and depression was measured with the Self-Rating Depression Scale (SDS) for fathers and the Edinburgh Postnatal Depression Scale (EPDS) for mothers. We used the Social Support Rating Scale (SSRS) to assess levels of social support.ResultsOverall, 19.5% of fathers and 24.3% of mothers had symptoms of anxiety, but there was no significant difference in the incidence of anxiety between fathers and mothers. However, depression was more common in mothers (50.3%) than in fathers (24.9%). Level of income (β = -2.945, 95% CI: -5.448 to -0.442), worry about the pregnancy (β = 3.404, 95% CI: 1.210 to 5.599) and objective support (β = -0.668, 95% CI: -1.163 to -0.173) were predictors of anxiety in fathers. Worry about the pregnancy (β = 4.022, 95% CI: 1.630 to 6.414), objective support (β = -0.652, 95% CI: -1.229 to -0.075) and maternal depression (β = 0.497, 95% CI: 0.159 to 0.836) were predictors of paternal depression.ConclusionAnxiety and depression were prevalent among parents following TOPFA in China, and fathers had similar levels of anxiety as mothers. Strategies to support fathers should consider social support and psychological interaction and draw upon father-inclusive intervention recommendations.

Keeping Women Informed Following Pregnancy Termination for Fetal Abnormality.

Keeping Women Informed Following Pregnancy Termination for Fetal Abnormality.

Effects of an expressive writing intervention in Chinese women undergoing pregnancy termination for fetal abnormality: A randomized controlled trial

ObjectiveTo explore the efficacy of an expressive writing intervention on promoting psychological well-being of women who have had a diagnosis of fetal abnormality. Design and settingAn open, randomized controlled trial with parallel group design was conducted at a tertiary hospital in China. 100 women were randomly assigned into either the expressive writing (EW) intervention group or the control group, and 80 women eventually took part in all the phases of the study. Psychological variables including post-traumatic growth (PTG), post-traumatic stress disorder (PTSD) and resilience were assessed at baseline, immediately after the intervention and 1-month follow-up. ParticipantsWomen who have had a diagnosis of fetal abnormalities and decided to terminate pregnancies. InterventionWomen in the intervention group were asked to write three 15 min essays in regard to their experiences with the fetal abnormalities. FindingsThe intervention group had significantly higher level of PTG (p = 0.003) and lower level of PTSD symptoms (p = 0.023) immediately after the intervention, as compared with the control group. In 1-month follow-up, intervention participants demonstrated significant improvement in PTG (p = 0.014) but insignificant reduction for PTSD symptoms. No significant effects were observed in both groups in terms of changes over time in resilience. Key conclusions and implications for practice: EW is efficacious for improving women's PTG and easing their symptoms of PTSD to some extent. Medical staff should pay more attention to this population's psychological status. In the future, EW interventions need to be conducted in larger samples with more severe symptoms of PTSD to validate its effectiveness. The efficacy of longer and more frequent writing interventions should also be investigated.

VP02.12: Pregnancy termination for fetal abnormality: a one‐year study

VP02.12: Pregnancy termination for fetal abnormality: a one‐year study

The role of rumination in adjusting to termination of pregnancy for fetal abnormality: Rumination as a predictor and mediator of posttraumatic growth.

Rumination is important in adjusting to traumatic events. Evidence suggests that deliberate rumination predicts posttraumatic growth (PTG), and mediates the relationship between coping and PTG. This study examined the relationship between rumination and psychological adjustment following pregnancy termination for fetal abnormality (TFA). A cross-sectional, online study was conducted with women who had undergone TFA. Women were recruited from a support organization; 161 women completed the Brief COPE, the Perinatal Grief Scale, the Event-Related Rumination Inventory, and the Posttraumatic Growth Inventory. Data were analyzed using regression and mediation analyses. The results show that women engaged in high levels of intrusive and deliberate rumination post-TFA and that intrusive rumination predicted grief. Intrusive and deliberate rumination predicted PTG, although intrusive rumination was a negative predictor of growth. Deliberate rumination mediated the relationship between grief and PTG. It also mediated the path between positive reframing and PTG, and religious coping and PTG, although the mediation effect depended upon the inclusion of the grief variable in the models. The results confirm the applicability of the PTG model to TFA and support the relevance of rumination to the PTG experience. The results also have clinical implications. Given the positive relationship between deliberate rumination and PTG, promoting interventions that encourage reflective thinking and narrative construction would benefit women post-TFA, particularly those experiencing high levels of distress and/or at risk of complicated grief. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Pregnancy termination for fetal abnormality: Ambivalence at the heart of women's experience

The aim of this article is to demonstrate the centrality of ambivalence in women's experience of pregnancy termination for fetal abnormality (TFA). Data were collected from two qualitative studies conducted in England and France with women who had undergone TFA (n = 44). The findings point to eight manifestations of ambivalence throughout the process of TFA: hope and despair, a choice but no choice, standing still and rushing, bonding and detaching, trauma and peace, disclosure and secrecy, bridging past and future, and individual and societal experience. Women's ambivalence illustrates their internal struggle to reconcile the act of termination with their desire to become mothers. It also reflects societal tensions regarding abortion and disability. We argue that the absence of normative responses, social desirability bias and the potentially confusing coexistence of the fields of prenatal diagnosis and social integration of people with disability account for the ambivalence women feel as they go through TFA. As women's ambivalence may impact upon the way they adjust to TFA, it is important to remain cognisant of the complexity of TFA to support women appropriately.

Anxiety Level of Pregnant Women Before Pregnancy Termination for Fetal Abnormality

Anxiety Level of Pregnant Women Before Pregnancy Termination for Fetal Abnormality

Pregnancy termination for fetal abnormality: are health professionals\u2019 perceptions of women\u2019s coping congruent with women\u2019s accounts?

BackgroundPregnancy termination for fetal abnormality (TFA) may have profound psychological consequences for those involved. Evidence suggests that women’s experience of care influences their psychological adjustment to TFA and that they greatly value compassionate healthcare. Caring for women in these circumstances presents challenges for health professionals, which may relate to their understanding of women’s experience. This qualitative study examined health professionals’ perceptions of women’s coping with TFA and assessed to what extent these perceptions are congruent with women’s accounts.MethodsFifteen semi-structured interviews were carried out with health professionals in three hospitals in England. Data were analysed using thematic analysis and compared with women’s accounts of their own coping processes to identify similarities and differences.ResultsHealth professionals’ perceptions of women’s coping processes were congruent with women’s accounts in identifying the roles of support, acceptance, problem-solving, avoidance, another pregnancy and meaning attribution as key coping strategies. Health professionals regarded coping with TFA as a unique grieving process and were cognisant of women’s idiosyncrasies in coping. They also considered their role as information providers as essential in helping women cope with TFA. The findings also indicate that health professionals lacked insight into women’s long-term coping processes and the potential for positive growth following TFA, which is consistent with a lack of aftercare following TFA reported by women.ConclusionsHealth professionals’ perceptions of women’s coping with TFA closely matched women’s accounts, suggesting a high level of understanding. However, the lack of insight into women’s long-term coping processes has important clinical implications, as research suggests that coping with TFA is a long-term process and that the provision of aftercare is beneficial to women. Together, these findings call for further research into the most appropriate ways to support women post-TFA, with a view to developing a psychological intervention to better support women in the future.

Posttraumatic growth following pregnancy termination for fetal abnormality: the predictive role of coping strategies and perinatal grief

ABSTRACTBackground: Research about termination for fetal abnormality (TFA) suggests that it is a traumatic event with potential negative psychological consequences. However, evidence also indicates that following traumatic events individuals may experience growth. Although TFA’s negative psychological outcomes are well documented, little is known of the potential for growth following this event. Therefore, the study’s objectives were to measure posttraumatic growth (PTG) post-TFA, examine the relationship between PTG, perinatal grief and coping, and determine the predictors of PTG.Design: An online, retrospective survey was conducted with 161 women.Methods: Eligible participants were women over 18 who had undergone TFA. Participants were recruited from a support organisation. They completed the Brief COPE, Short Perinatal Grief Scale and Posttraumatic Growth Inventory. Data were analysed using regression analyses.Results: Moderate levels of PTG were observed for “relating to others,” “personal strengths” and “appreciation of life.” “Positive reframing” was a significant predictor of PTG. Despite using mainly “adaptive” coping strategies, women’s grief levels were high.Conclusions: “Adaptive” coping strategies such as, “positive reframing” are relevant to TFA. They may act as protective factors against distress and as foundations for growth, implicating that interventions such as Cognitive Behavioural Therapy, which aim to reframe women’s experience, may be beneficial.

Embodied experiences of prenatal diagnosis of fetal abnormality and pregnancy termination

Pregnant women routinely undergo prenatal screening in Australia and this has become a common experience of motherhood. When prenatal screening or prenatal testing results in diagnosis of a serious fetal abnormality, women are presented with a decision to continue or terminate their pregnancy. Few recent studies have explored women’s psychosocial experience of prenatal diagnosis and pregnancy termination for fetal abnormality, and within this small group of studies it is rare for research to consider the embodied aspect of women’s experiences. This paper reports on qualitative findings from in-depth interviews with 59 women in Melbourne, Australia who received a prenatal diagnosis of a significant abnormality and decided to terminate the pregnancy. Interview transcripts were coded inductively through thematic analysis. Two themes about embodiment were generated from the interviews: transitioning embodiment, and vulnerable bodies in un/comfortable spaces. Theory of pregnant embodiment was drawn on in interpreting women’s narratives. Recommendations arising from the analysis include health professionals recognising, acknowledging and accommodating the transitioning embodied state of women as they consider, prepare for, undergo and recover from pregnancy termination for fetal abnormality. Further recommendations address the connections and disconnections between this transitioning embodied state and the spaces of clinics, hospitals and home.

Trauma Following Termination of Pregnancy for Fetal Abnormality: Is This the Path From Guilt to Grief?

Termination of pregnancy for fetal abnormality (TOPFA) is a potentially traumatic event that may lead to intense grief symptomatology. The present study included 41 couples who were assessed 1–6 months after TOPFA. No gender differences were found regarding the intensity of trauma symptomatology or the prevalence of clinically relevant trauma symptomatology, present in about a third of the sample. Most couples were congruent regarding trauma symptomatology. Women experienced guilt with significantly more frequency than men. For both genders, guilt influenced both trauma and grief symptomatology. For women only, guilt influenced grief symptomatology indirectly, through trauma symptomatology. Clinical implications are discussed.

The difficulty of pregnancy termination for fetal abnormality

The difficulty of pregnancy termination for fetal abnormality

Women’s Experiences of Coping With Pregnancy Termination for Fetal Abnormality

Pregnancy termination for fetal abnormality (TFA) can have significant psychological consequences. Most previous research has been focused on measuring the psychological outcomes of TFA, and little is known about the coping strategies involved. In this article, we report on women's coping strategies used during and after the procedure. Our account is based on experiences of 27 women who completed an online survey. We analyzed the data using interpretative phenomenological analysis. Coping comprised four structures, consistent across time points: support, acceptance, avoidance, and meaning attribution. Women mostly used adaptive coping strategies but reported inadequacies in aftercare, which challenged their resources. The study's findings indicate the need to provide sensitive, nondirective care rooted in the acknowledgment of the unique nature of TFA. Enabling women to reciprocate for emotional support, promoting adaptive coping strategies, highlighting the potential value of spending time with the baby, and providing long-term support (including during subsequent pregnancies) might promote psychological adjustment to TFA.

To compare the methods of pregnancy termination for fetal abnormality in the first and second trimesters.

Fetal abnormality is a major cause of termination of pregnancy and preservation of the fetus is important for confirmation of the diagnosis. Various regimes have been reported for termination of pregnancy for fetal abnormality in the first and the second trimesters. In this paper, we compare those regimes that allow preservation of the fetus, in terms of the efficacy in expulsion of the fetus, the factors and the side effects.

Mifepristone and second trimester pregnancy termination for fetal abnormality in Western Australia: Worth the effort

To determine the impact on the process of second trimester medical termination for fetal abnormality following the introduction of adjunctive mifepristone in an Australian tertiary hospital. All second trimester medical terminations for fetal abnormality between July 2006 and June 2009 were prospectively identified. Two temporal therapeutic cohorts were created: the first (1 July 2006 to 31 December 2007) using vaginal misoprostol alone and the second (1 January 2008 to 30 June 2009) using mifepristone priming prior to the administration of misoprostol. The primary outcome was to evaluate the impact of mifepristone priming upon the duration of pregnancy termination. During the study period, 388 women with prenatally recognised fetal anomalies between 14 and 24 weeks gestation underwent medical termination: 189 with misoprostol alone and 199 with mifepristone priming followed by misoprostol. There was no difference between the groups for maternal age, parity or prior caesarean delivery. The median abortion duration was 15.5 h (interquartile ranges (IQR) 11.2-22.7) in the misoprostol group and 8.6 h (IQR 5.6-13.8) in the mifepristone primed group (P < 0.001). In both the groups, nulliparity and advancing gestation were associated with a significant prolongation of the abortion interval. Duration of hospitalisation was significantly longer in the misoprostol alone group (31.5 h (27-48.9) vs 27.2 h (22-31.5), misoprostol vs mifepristone priming, respectively, P < 0.001). The introduction of mifepristone priming prior to second trimester medical termination with misoprostol has resulted in a significant reduction in the duration of the termination procedure and length of inpatient stay. These observed benefits of mifepristone provide objective support for the decision to permit use of this medication in Australia.

The role of autopsy following pregnancy termination for fetal abnormality

To review the frequency of autopsy following pregnancy termination for fetal anomaly and its contribution to subsequent counselling. All medical pregnancy terminations for fetal anomaly performed after 14 weeks gestation from January 1997 to December 2006 were identified and the frequency of autopsy ascertained. The prenatal diagnosis prompting the termination was then compared with the autopsy data, and a diagnostic valuation was determined. The potential autopsy value ranged from no additional information provided, minor added value, significant added value, major added value to non-confirmation of the prenatal findings. During the ten-year study period, there were 1012 consecutive terminations for fetal abnormality. The principal indications for termination were: karyotypic (38.4%); neural tube defects (16.1%); cardiac (10.3%) and cerebral anomalies (7.5%). Autopsy was performed in 809 cases (79.9%). The autopsy rate progressively declined from 95.1% in 1997 to 67.5% in 2006 (P<0.001). Women declining autopsy were older (31 years (26,35) vs 32 years (27,37), P=0.005) and more likely to have a fetal chromosomal abnormality (30.6% vs 69.9%, P<0.001) (autopsy vs no-autopsy). In euploid cases, autopsy confirmed the prenatal diagnosis with no additional information in 63.5% (357 of 562). In 1.1% (six cases), autopsy added major diagnostic information, and in 15.1% (85 cases), significant information was provided. Although contemporary prenatal testing has improved the recognition of fetal abnormalities, autopsy remains a valued tool by providing diagnosis or clarification of some prenatal findings in 16% of cases. Fetal autopsy rates are declining and this trend may lead to a loss of diagnostic and recurrence risk-counselling information.

Long-term Psychological Consequences of Pregnancy Termination for Fetal Abnormality: A Cross-sectional Study

Most couples that conceive a child having a severe congenital anomaly decide to terminate the pregnancy. In The Netherlands, approximately 500 of 200,000 annual pregnancies end in termination of pregnancy (TOP) because of fetal anomaly. Such terminations are complex life events; many women-and their partners-find the decision to be an almost inhuman act. The voluntary nature of the act may conflict with normal grief responses. Studies have shown that gestational age, severity of the anomaly, and its compatibility with extrauterine life all play a major role in the decision-making process. This cross-sectional study enrolled 254 woman 2 to 7 years after TOP for fetal anomaly. In all cases, TOP took place before 24 weeks gestation. The mean age at termination was 34 years and the mean gestational age was 18 weeks. Standard questionnaires served to estimate grief, posttraumatic symptoms and psychologic and somatic sequelae. Final results were available for 196 women who completed all the questionnaires. Scores on tests of grief, posttraumatic stress, and psychosomatic symptoms correlated closely with one another. These measures, however, correlated only moderately, at best, with feelings of doubt and regret. Eight of the women reported feelings of regret, and 10% reported being in doubt. Both educational level and perceived support from the partner correlated closely and consistently with outcome measures. Less educated women and those perceiving limited support from their partners had the lowest scores on psychologic outcomes. None of the predictors correlated significantly with feelings of regret. Outcomes did not relate significantly to religion, having living children, method of TOP, or recent life events. On multiple regression analysis, grief was independently predicted by educational level, gestational age, and lethality. Educational level significantly predicted posttraumatic stress. Less educated women more often had somatic complaints. Both anxiety and depression appeared to increase over time. Advanced gestational age at TOP predicted doubt about the decision to terminate, as did presumed fetal viability and having living children. Perceived partner support independently influenced grief, most aspects of posttraumatic stress, anxiety, and depression. Five women (2.6% of those studied) had pathologic scores for grief and 33 (17%) for posttraumatic stress. In the latter group, elevated scores did not relate to the time since TOP. Women having TOP before 14 completed weeks of gestation had relatively low scores for grief and posttraumatic stress. The major modifiable factor predicting subsequent psychologic status in this study was perceived support by the partner, suggesting that more attention to counseling of partners would be appropriate. Less educated women are in particular need of support. Outcomes are likely to be best when prenatal screening and diagnostic tests are carried out early in the course of pregnancy.

Long‐term psychological consequences of pregnancy termination for fetal abnormality: a cross‐sectional study

We examined women's long-term psychological well-being after termination of pregnancy (TOP) for fetal anomaly in order to identify risk factors for psychological morbidity. A cross-sectional study was performed in 254 women, 2 to 7 years after TOP for fetal anomaly before 24 weeks of gestation. We used standardised questionnaires to investigate grief, posttraumatic symptoms, and psychological and somatic complaints. Women generally adapted well to grief. However, a substantial number of the participants (17.3%) showed pathological scores for posttraumatic stress. Low-educated women and women who had experienced little support from their partners had the most unfavourable psychological outcome. Advanced gestational age at TOP was associated with higher levels of grief, and posttraumatic stress symptoms and long-term psychological morbidity was rare in TOP before 14 completed weeks of gestation. Higher levels of grief and doubt were found if the fetal anomaly was presumably compatible with life. Termination of pregnancy for fetal anomaly is associated with long-lasting consequences for a substantial number of women. Clinically relevant determinants are gestational age, perceived partner support, and educational level.

A Comparison of Oral Misoprostol With Vaginal Misoprostol Administration in Second-Trimester Pregnancy Termination for Fetal Abnormality

In Brief OBJECTIVE To compare the clinical efficacy and side effects of oral misoprostol with vaginal misoprostol for second-trimester pregnancy termination. METHODS A randomized clinical trial of medical pregnancy termination between 14 and 26 weeks' gestation was conducted. Three misoprostol regimens were compared: 400 μg vaginally at 6-hour intervals (group 1), 400 μg orally at 3-hour intervals (group 2), and a loading dose of 600 μg vaginally followed by 200 μg orally at 3-hour intervals (group 3). A sample size of 225 women was required for equivalence of the three regimens, with an interim safety analysis planned at 80 women. RESULTS A significant difference between the groups was evident at the interim safety analysis and the study ceased. The subset of 84 women recruited before the study closure is described. There was a significant difference in the median time to achieve delivery among the three groups: group 1, 14.5 hours (95% confidence interval 12.0, 16.9), versus group 2, 25.5 hours (13.5, 23.8), versus group 3, 16.4 hours (interquartile range 14.2–37.3) (P = .042). Within 24 hours of commencement 85.7% of women in group 1, 44.8% in group 2, and 74.1% in group 3 delivered (P = .003). At 48 hours 0% in group 1, 20.7% in group 2, and 3.7% in group 3 were undelivered (P = .011). There was no difference in women's perceptions of the termination process. CONCLUSION In second-trimester pregnancy termination, a vaginal misoprostol regimen of 400 μg every 6 hours was 1.9 times more likely to result in delivery within 24 hours from commencement than an oral regimen of 400 μg every 3 hours. In second-trimester pregnancy termination for fetal abnormality, avaginal misoprostol regimen was 1.9 times more likely to result indelivery within 24 hours from commencement than an oral regimen.