Selective Termination Of Pregnancy Research Articles

Fetoscopy for intrauterine diagnosis and treatment of amniotic band syndrome: a clinical analysis of 7 cases and literature review

Objective: To summarize the clinical value of fetoscopy in the prenatal diagnosis and treatment of amniotic band syndrome (ABS). Methods: A retrospective analysis was conducted on the clinical data of seven ABS fetuses who underwent prenatal fetoscopic intervention at the Third Affiliated Hospital of Zhengzhou University from December 2020 to August 2023. Literatures related to fetoscopic treatment of ABS were searched in databases including China National Knowledge Infrastructure, Wanfang Data, and PubMed. Clinical data were extracted and the characteristics and intervention effects of fetoscopic surgery in the treatment of ABS were summarized. Results: (1) Preoperative evaluation: the gestational age at diagnosis for the seven ABS fetuses was (19.8±4.4) weeks, and the gestational age at fetoscopic intervention was (22.2±2.8) weeks. The indications for fetoscopic intervention included umbilical cord involvement (3 cases), limb amniotic band with circular constriction (2 cases), and unclear visualization of digits (3 cases). (2) Pregnancy outcomes: among the seven ABS fetuses, four cases underwent selective termination of pregnancy due to severe intrauterine limb amputation, and three cases underwent fetoscopic lysis of amniotic bands. Among the latter three cases, one case experienced intrauterine fetal death (IUFD) two weeks after the procedure, and two cases had good postoperative outcomes. (3) Literature review: a total of 40 cases, including 37 cases from 17 articles and three cases from our institution, were included in the analysis. The indications for fetoscopic surgery included limb amniotic band with circular constriction and involvement of the umbilical cord. The success rate of the surgery was 82% (33/40), and 78% (29/37) of the affected limbs retained good functionality. Premature rupture of membranes was the most common complication, with an incidence rate of 48% (16/33). The average interval from the surgery to membrane rupture was (6.1±5.1) weeks, and the average interval from the surgery to delivery was (10.5±4.1) weeks, with an average gestational age at delivery of (33.7±3.6) weeks. The pregnant women were divided into single Trocar group (27 cases) and double Trocar group (13 cases) based on the surgical approach. The success rates in single Trocar group and double Trocar group were 78% (21/27) and 12/13, respectively, and the difference was not statistically significant (χ2=0.474, P=0.491). The gestational age of delivery in the single Trocar group and double Trocar group was (32.7±3.4) and (35.4±3.2) weeks, respectively, and the difference was statistically significant (t=-2.185, P<0.05). There were no statistically significant differences in the success rate of the surgery, incidence of premature rupture of membranes, interval between surgery and membrane rupture, interval between surgery and delivery, and preterm delivery rate between the two groups (all P>0.05). Conclusions: Fetoscopy could be used for prenatal assessment and intrauterine treatment of ABS. Fetoscopic lysis of amniotic bands may be an effective method for treating ABS, which helps preserve limb function and prevent intrauterine limb amputation and IUFD.

Efficiency of Non-Invasive Prenatal Testing in Detecting Fetal Copy Number Variation: A Retrospective Cohort Study.

Screening of pathological copy number variations (CNVs) is important for early-diagnosis of hereditary disease. This study was designed to investigate the efficiency of non-invasive prenatal testing (NIPT) in detecting fetal CNVs. This retrospective analysis included fetuses with CNVs between January 2018 and December 2020. Karyotype analysis and CNV sequencing (CNV-seq) were performed. We then analyzed the positive predictive values of the subchromosomal microdeletions and microduplications. Fifty-eight subjects with aberrant CNVs were screened after NIPT, among which 44 finally underwent amniocentesis. CNV-seq confirmed the presence of CNVs in 24 cases. This indicated that false positivity rate of NIPT was 45.5%. Among 24 cases with CNVs after CNV-seq, only 4 showed consistent findings with karyotype analysis, which showed that karyotyping analysis yielded a missed diagnosis rate of 83.3% for the genome CNV. Positive predictive value (PPV) was 50.0% for CNVs with a length of <5 Mb after NIPT screening. PPV for CNVs with a length of 5 Mb-10 Mb was 33.3%, while that for CNVs with a length of ≥10Mb was 60%. For CNVs duplication after NIPT, the PPV was 65.2%, while that for deletion was 36.4%. For CNVs detected after NIPT, it should be combined with ultrasonographic findings, karyotype analysis, CNV-seq or CMA to determine the pregnancy outcome. Expanding NIPT may increase the risk of unnecessary invasive surgery and unintended selective termination of pregnancy.

Perinatal deaths from birth defects in Hunan Province, China, 2010-2020.

To describe the perinatal mortality rate (PMR) of birth defects and to define the relationship between birth defects (including a broad range of specific defects) and a broad range of factors. Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2010-2020. The prevalence rate (PR) of birth defects is the number of birth defects per 1000 fetuses (births and deaths at 28 weeks of gestation and beyond). PMR is the number of perinatal deaths per 100 fetuses. PR and PMR with 95% confidence intervals (CI) were calculated using the log-binomial method. Chi-square trend tests (χ2trend) were used to determine trends in PR and PMR by year, maternal age, income, education level, parity, and gestational age of termination. Crude odds ratios (ORs) were calculated to examine the association of each maternal characteristic with perinatal deaths attributable to birth defects. Our study included 1,619,376 fetuses, a total of 30,596 birth defects, and 18,212 perinatal deaths (including 16,561 stillbirths and 1651 early neonatal deaths) were identified. The PR of birth defects was 18.89‰ (95%CI: 18.68-19.11), and the total PMR was 1.12%(95%CI: 1.11-1.14). Birth defects accounted for 42.0% (7657 cases) of perinatal deaths, and the PMR of birth defects was 25.03%. From 2010 to 2020, the PMR of birth defects decreased from 37.03% to 2010 to 21.00% in 2020, showing a downward trend (χ2trend = 373.65, P < 0.01). Congenital heart defects caused the most perinatal deaths (2264 cases); the PMR was 23.15%. PMR is highest for encephalocele (86.79%). Birth defects accounted for 45.01% (7454 cases) of stillbirths, and 96.16% (7168 cases) were selective termination of pregnancy. Perinatal deaths attributable to birth defects were more common in rural than urban areas (31.65% vs. 18.60%, OR = 2.03, 95% CI: 1.92-2.14) and in females than males (27.92% vs. 22.68%, OR = 1.32, 95% CI: 1.25-1.39). PMR of birth defects showed downward trends with rising maternal age (χ2trend = 200.86, P < 0.01), income (χ2trend = 54.39, P < 0.01), maternal education level (χ2trend = 405.66, P < 0.01), parity (χ2trend = 85.11, P < 0.01) and gestational age of termination (χ2trend = 15297.28, P < 0.01). In summary, birth defects are an important cause of perinatal deaths. Rural areas, female fetuses, mothers with low maternal age, low income, low education level, low parity, and low gestational age of termination were risk factors for perinatal deaths attributable to birth defects. Future studies should examine the mechanisms. Our study is helpful for intervention programs to reduce the PMR of birth defects.

Frequency of Various Congenital Anomalies and Associated Maternal Risk Factors, an Experience at Tertiary Care Hospital

Objective: To determine frequency of congenital anomalies in children and associated risk factors of mothers. Setting: Department of obstetrics and gynecology Rai Medical College Sargodha. Study design: Descriptive observational study. Duration: July 2022 to December 2022. Methodology: All babies with congenital anomalies born within study duration and their mothers were included in this study. Anomalies of neonates were evaluated after proper clinical evaluation by a neonatologist. A questionnaire was designed to evaluate maternal risk factors. All collected data was analyzed using SPSS version 20. Results: Total 1900 babies delivered during this study period and out of them congenital anomalies were found in 31 (1.6%) cases. Most common anomaly was hydrocephalus in 10(32.2%) and meningomyelocele in 6(19.3%) cases. Most common maternal risk factor was consanguineous marriage in 15(48.3%) cases. Most commonly mothers with the age of 19-30 years were having babies with congenital anomalies. Practical Implication: This study helps us to understand the importance of avoiding consanguineous marriages, screening of high risk cases using various diagnostic techniques like ultrasonography during 16-20 weeks, use of folic acid supplements and in case of detecting congenital anomalies option of selective termination of pregnancy can be offered to the parents. Proper awareness of the parents and their counselling after birth of a baby with anomaly can prevent its recurrence in their future pregnancies Conclusion: Most common congenital anomaly reported in this study was hydrocapahlus followed by meningocele and most common maternal risk factor associated with these anomalies was consanguineous marriage. Keywords: Congenital anomaly, consanguineous marriage, Maternal risk factor, Neural tube defects

Regulating non-invasive prenatal testing (NIPT) for fetal sex determination.

Non-invasive prenatal testing (NIPT) can be used to determine the chromosomal sex of the fetus at an early stage in a pregnancy. The use of NIPT for fetal sex determination raises concerns about potential selective termination of pregnancy by prospective parents who desire a child of a particular sex. Although sex selection for medical reasons is generally accepted, non-medical sex selection (NMSS) has been the subject of considerable controversy. In this article, we explore the current regulatory landscape around reproductive genetic testing techniques that may lead to NMSS, both internationally and within Australia. Specifically, we contrast the approach to regulating preimplantation genetic testing (PGT) with the minimal regulation of NIPT in Australia as a case study for reform. We examine ethical concerns raised in relation to NMSS, which form the basis of the current moratorium on the use of PGT for NMSS. We then highlight some key differences between using PGT for NMSS and NIPT for fetal sex determination to determine whether access to the latter should be regulated and, if so, how. We conclude that there is insufficient evidence to restrict access to NIPT for fetal sex determination and, based on our Australian case study, recommend a facilitative approach to regulating NIPT that would support individuals to make informed reproductive decisions.

Pregnancy and perinatal outcomes of early vs late selective termination in dichorionic twin pregnancy: systematic review and meta-analysis.

To evaluate outcomes of dichorionic twin pregnancies undergoing early vs late selective termination of pregnancy (ST). MEDLINE, EMBASE, CINAHL and the Web of Science databases were searched electronically up to March 2022. The primary outcome of this study was pregnancy loss prior to 24 weeks' gestation. The secondary outcomes included preterm birth (PTB) before 37, 34, and 32 weeks, preterm prelabor rupture of membranes (PPROM), gestational age (GA) at delivery, Cesarean delivery, mean birth weight, 5-min Apgar score < 7, overall neonatal morbidity and neonatal survival. Only prospective or retrospective studies reporting data on the outcome of early (before 18 weeks) vs late (at or after 18 weeks) ST in dichorionic twin pregnancies were considered suitable for inclusion. Quality assessment of the included studies was performed using the Newcastle-Ottawa scale for cohort studies. Random-effects head-to-head meta-analysis was used to analyze the data. Seven studies reporting on 649 dichorionic twin pregnancies were included in this systematic review. The risk of pregnancy loss prior to 24 weeks was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST (1% vs 8%; odds ratio (OR), 0.25 (95% CI, 0.10-0.65); P = 0.004). The risk of PTB was significantly lower in dichorionic twin pregnancies undergoing early compared with late ST when considering PTB before 37 weeks (19% vs 45%; OR, 0.36 (95% CI, 0.23-0.57); P < 0.00001), before 34 weeks (4% vs 19%; OR, 0.24 (95% CI, 0.11-0.54); P = 0.0005) and before 32 weeks (4% vs 20%; OR, 0.21 (95% CI, 0.05-0.85); P = 0.03). The mean birth weight was significantly greater in the early-ST group (mean difference (MD), 392.2 g (95% CI, 59.1-726.7 g); P = 0.02), as was the mean GA at delivery (MD, 2.47 weeks (95% CI, 0.04-4.91 weeks); P = 0.049). There was no significant difference between dichorionic twin pregnancies undergoing early compared with late ST in terms of PPROM (P = 0.27), Cesarean delivery (P = 0.38), 5-min Apgar score < 7 (P = 0.35) and neonatal survival of the non-reduced twin (P = 0.54). The risk of pregnancy loss prior to 24 weeks and the rate of PTB before 37, 34 and 32 weeks were significantly higher in dichorionic twin pregnancies undergoing late vs early ST, thus highlighting the importance of early diagnosis of fetal anomalies in twin pregnancies. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Prise en charge des grossesses monochoriales biamniotiques réunionnaises avec indication de transfert in utero

ObjectiveComplicated monochorionic biamniotic (MCBA) twin pregnancies may require treatment with fetoscopic laser photocoagulation, in case of Twin Oligo-Polyhydramnios Sequence or need of a selective termination of pregnancy. Patients requiring these treatments would need medical transfer to Metropolitan France because these are unavailable in Réunion Island. We evaluated the outcomes of MCBA pregnancies in Reunion Island with indications for fetoscopy, with a view to discussing the interest of training doctors on the Reunion Island, to practice fetoscopy on site. Materials and methodsRetrospective hospital study running from 2015 to 2018. We included all MCBA pregnancies between 15 and 25 weeks of gestation, with indications for in utero transfer. Our objective was to examine whether and why they were transferred and pregnancy outcomes. ResultsOf the 23 patients, 17 (73.9%) benefited from sanitary transfers. The survival rate of the fetuses in 15 pregnancies with Twin Oligo-Polyhydramnios Sequence (TOPS) was 73.3% for one twin and 53.3% for both twins. For the eight cases of Selective Termination of the pregnancy (ST), the survival rate of the twin was better with a transfer (n=5/6, 83.3%) than without a transfer (n=1/2 or 50%). The rate of premature rupture of the membranes after sanitary transfer among patients with TOPS was 63.6%. ConclusionThe sanitary transfer allows the management in expert center of complicated MCBA twin pregnancies, but is not always feasible and is accompanied by a high rate of premature ruptures of membranes.

Fertility and prognosis assessment between bleomycin/etoposide/cisplatin and paclitaxel/carboplatin chemotherapy regimens in conservative treatment of malignant ovarian germ cell tumor: a multicenter and retrospective study (096)

Objectives: To evaluate the impact of bleomycin/etoposide/cisplatin (BEP) and paclitaxel/carboplatin (TC) chemotherapy regimens on fertility and prognostic outcomes among patients with malignant ovarian germ cell tumor (MOGCT) who received fertility-sparing surgery (FSS). Methods: The study included 213 women with MOGCT who underwent FSS. We performed a 3:1 propensity score matching between the BEP and TC groups. The Chi-square test and the Kaplan-Meier method were used to compare the fertility outcome, disease-free survival (DFS), and overall survival (OS). The Cox proportional hazards regression analysis was used to identify risk factors of DFS. Results: A total of 185 (86.9%) patients underwent BEP chemotherapy, and 28 (13.1%) patients underwent TC chemotherapy. The median age was 22 years (range: 8-44 years), and the median follow-up was 63 months (range: 1-191 months). Fifty-one (29.3%) patients had a pregnancy plan, 43 (84.3%) patients got pregnant, and 35 (81.4%) patients delivered successfully. Fourteen (6.6%) patients experienced recurrence, and four (1.9%) patients died. In the before and after matching cohorts, there were no significant differences in spontaneous abortion, selective termination of pregnancy, during pregnancy status, and live birth between BEP and TC groups (p >0.05). Also, there were no significant differences in DFS and OS between BEP and TC groups (p >0.05). The clinical staging is the only risk factor of postoperative recurrence (HR: 21.3, p <0.001). Conclusions: There was no significant difference between the effects of BEP and TC regimens on the fertility and prognosis of MOGCT patients who received FSS. The TC regimen seems to be a viable alternative to the BEP regimen for MOGCT patients. Objectives: To evaluate the impact of bleomycin/etoposide/cisplatin (BEP) and paclitaxel/carboplatin (TC) chemotherapy regimens on fertility and prognostic outcomes among patients with malignant ovarian germ cell tumor (MOGCT) who received fertility-sparing surgery (FSS). Methods: The study included 213 women with MOGCT who underwent FSS. We performed a 3:1 propensity score matching between the BEP and TC groups. The Chi-square test and the Kaplan-Meier method were used to compare the fertility outcome, disease-free survival (DFS), and overall survival (OS). The Cox proportional hazards regression analysis was used to identify risk factors of DFS. Results: A total of 185 (86.9%) patients underwent BEP chemotherapy, and 28 (13.1%) patients underwent TC chemotherapy. The median age was 22 years (range: 8-44 years), and the median follow-up was 63 months (range: 1-191 months). Fifty-one (29.3%) patients had a pregnancy plan, 43 (84.3%) patients got pregnant, and 35 (81.4%) patients delivered successfully. Fourteen (6.6%) patients experienced recurrence, and four (1.9%) patients died. In the before and after matching cohorts, there were no significant differences in spontaneous abortion, selective termination of pregnancy, during pregnancy status, and live birth between BEP and TC groups (p >0.05). Also, there were no significant differences in DFS and OS between BEP and TC groups (p >0.05). The clinical staging is the only risk factor of postoperative recurrence (HR: 21.3, p <0.001). Conclusions: There was no significant difference between the effects of BEP and TC regimens on the fertility and prognosis of MOGCT patients who received FSS. The TC regimen seems to be a viable alternative to the BEP regimen for MOGCT patients.

What is a \u2018serious\u2019 genetic condition? The perceptions of people living with genetic conditions

Despite no consensus on the definition of ‘seriousness’, the concept is regularly used in policy and practice contexts to categorise conditions, determine access to genetic technologies and uses of selective pregnancy termination. Whilst attempts have been made to create taxonomies of genetic condition seriousness to inform clinical and policy decision-making, these have often relied on condition appraisals made by health and genetics professionals. The views of people with genetic conditions have been largely under-represented. This study explores the concept of seriousness through the perspectives of people with a range of ‘clinically serious’ conditions (fragile X conditions, spinal muscular atrophy, cystic fibrosis, haemophilia, thalassaemia). Attitudes towards suffering, quality of life (QoL) and selective pregnancy termination were elucidated from 45 in-depth qualitative interviews and 469 postal/online surveys. The majority of participants reported good health/wellbeing, and the capacity for good QoL, despite experiencing suffering with their condition. Notably, participants with later-onset conditions held more negative views of their health and QoL, and were more likely to view their condition as an illness, than those with early-onset conditions. These participants were more likely to see their condition as part of their identity. Whilst most participants supported prenatal screening, there was little support for selective termination. Moreover, social environment emerged as a critical mediator of the experience of the condition. The complex and rich insights of people living with genetic conditions might usefully be incorporated into future genetic taxonomies of ‘seriousness’ to ensure they more accurately reflect the lived reality of those with genetic conditions.

Association between preconceptional air pollution exposure and medical purposes for selective termination of pregnancy

BackgroundExposure to air pollutants is associated with adverse pregnancy outcomes. But evidence on the effects of preconceptional air pollution exposure on the risk of termination of pregnancy (TOP) caused by pregnancy losses and congenital malformations is lacking. MethodsThe distributed lag nonlinear model (DLNM) was used to evaluate the impact of short-term air pollutants exposure on the risk of TOP. Stratified analyses by age (<35 years old, ≥ 35 years old) and season (warm season, cold season) were further conducted. Relative risk (RR) and 95 % confidential interval (95 % CI) were calculated for per interquartile range (IQR) increment in air pollutants during the study period. ResultsPM2.5, PM10, and O3 exposure were significantly associated with elevated risk of TOP. The risk of TOP was associated with PM2.5 exposure from lag11 to lag15 in the single-pollutant model, and the strongest association was observed at lag13 (RR = 1.021, 95%CI:1.002–1.040). PM10 exposure from lag10 to lag15 was associated with increased TOP risk, with the corresponding peak association being at lag13 (RR = 1.020, 95%CI: 1.004–1.037). For O3, the single-day lag association appeared to be statistically significant from lag26 to lag27, with the highest RR of TOP cases being at lag27 (RR = 1.044, 95%CI: 1.005–1.084). Similar results were observed for pregnancy losses (PL). However, no significantly association between air pollution exposure and the risk of congenital malformations (CM) was found in this study. Stratified analyses showed that pregnant women with more advanced ages were more susceptible to PM2.5, PM10, and O3 exposure. The effect of PM2.5 exposure was statistically significant in cold season subgroups. ConclusionThe findings suggest that exposure to PM2.5, PM10, and O3 before pregnancy are associated with the risk of TOP in Lu'an, China, reflecting the significance of preconceptional environmental exposure in the development of adverse pregnancy outcomes.

Does non-invasive prenatal testing affect the livebirth prevalence of Down syndrome in the Netherlands? A population-based register study.

ObjectiveTo evaluate if non‐invasive prenatal testing (NIPT) affects livebirth (LB) prevalence of Down syndrome (DS) in the Netherlands.MethodData from clinical genetics laboratories and the Working Party on Prenatal Diagnosis and Therapy (2014–2018) and previous published data (1991–2013) were used to assess trends for DS LB prevalence and reduction percentage (the net decrease in DS LBs resulting from selective termination of pregnancies). Statistics Netherlands provided general population data.ResultsDS LB prevalence increased from 11.6/10,000 in 1991 to 15.9/10,000 in 2002 (regression coefficient 0.246 [95% CI: 0.105–0.388; p = 0.003]). After 2002, LB prevalence decreased to 11.3/10,000 in 2014 and further to 9.9/10,000 in 2018 (regression coefficient 0.234 (95% CI: −0.338 to −0.131; p < 0.001). The reduction percentage increased from 26% in 1991 to 55.2% in 2018 (regression coefficient 0.012 (95% CI: 0.010–0.013; p < 0.001)). There were no trend changes after introducing NIPT as second‐tier (2014) and first‐tier test (2017).ConclusionsIntroducing NIPT did not change the decreasing trend in DS LB prevalence and increasing trend in reduction percentage. These trends may be caused by a broader development of more prenatal testing that had already started before introducing NIPT.

The Pro-Life Paradox of Pregnancy Termination and Disability Exclusion

The debate over the use of genetic testing to inform expectant mothers regarding fetal anomalies, with the intention of enabling her to decide whether or not to terminate pregnancy based on testing outcomes, is arguably deemed by many physicians and scientists to be major medical advancement. Proponents of testing believe that this information prevents the potentiality of lifelong suffering for of the unborn child, as well as encourages a healthier population. There are, however, scientists, geneticists, theorists, and disability advocates, who disagree with this theory. Furthermore, pro-life allies appear to take very differing stances on this topic, from opposing any termination of pregnancy, even in cases of severe disability or a likelihood of infant or maternal mortality, while some may believe abortion is acceptable under these unique circumstances, even if they oppose others. It is difficult to understand how the criteria is evaluated, particularly in cases of the former, when support and resources for disabled persons are greatly lacking, which can lead to a more challenging life, and when the stigma of bearing and raising a defective child is widespread. Thus, it is a crucial topic in women’s studies to understand when there is a pro-life paradox of disability exclusion is and how it may inform decision-making and advocacy regarding selective termination of pregnancy

Maternal age in the epidemiology of common autosomal trisomies.

The birth prevalence rate of each common autosomal trisomy generally increases with advancing maternal age and there is a substantial fetal loss rate between late first trimester and term. The literature is reviewed in order to provide the best estimates of these rates, taking account where possible of biases due to prenatal diagnosis and selective termination of pregnancy. There is an almost exponential increase in Down syndrome birth prevalence between ages 15 and 45 but at older ages the curve flattens. There is no evidence of the claimed relatively high birth prevalence at extremely low ages. Gestation-specific intra-uterine fetal loss rates are estimated by follow-up of women declining termination of pregnancy after prenatal diagnosis, comparison of observed rates with those expected from birth prevalence and comparison of age-specific curves developed for prenatal diagnosis and birth. Down syndrome fetal loss rates reduce with gestation and increase with maternal age. Edwards and Patau syndrome birth prevalence is approximately 1/8 and 1/13 that of Down syndrome overall, although the ratio differs according to maternal age, particularly for Patau syndrome where it reduces steadily from 1/9 to 1/19. Fetal loss rates are higher for Edwards and Patau syndromes than for Down syndrome.

Selective Termination of Pregnancy: About a Case of Anencephaly on a Bi-Chorial Twin Pregnancy

Background: The discovery of a lethal or disabling malformation requires a thoughtful decision in the event of a termination of pregnancy on medical grounds. The termination of pregnancy can be selective in the case of multiple pregnancies if a twin is suffering from a serious condition. Objective: To report a case of anencephaly on a twin pregnancy and conduct a review of literature. Case: This is a 30-year-old woman carrying a pregnancy obtained after the third attempt at in vitro fertilization (IVF) with transfer of two embryos. No risk factor was found on this pregnancy except for the twinning. The diagnosis was made at 14 weeks +1 day during first term ultrasound, which discovered an on-going bi-chorial bi-amniotic twin pregnancy, with twin B (TB) carrying a defect on his head. A selective interruption was performed on TB at 16 weeks by cordonal injection with potassium chloride. The pregnancy went on without incident and with spontaneous vaginal delivery of the second twin at 39 weeks of pregnancy. Despite the selective termination, the pregnancy went on without any complication. Conclusion: Anencephaly on twin pregnancy is a rare occurrence. In a bichorial pregnancy, a selective feticide can improve the gestational age at birth.

Healthy children without fear: Reproductive options for patients or couples carrying inherited diseases.

Assisted reproduction has become a standard treatment for prospective parents who cannot conceive children normally because one or both partners are subfertile or infertile owing to congenital birth defects, childhood infection, cancer therapy or accidents. In vitro fertilisation, often in combination with intracytoplasmic sperm injection (ICSI), offers these patients a safe and efficient option to have children. The development of new technologies has further expanded the application of assisted reproductive technologies (ART) to help patients with inherited mutations for severe diseases—such as cystic fibrosis, Huntington or Duchenne muscular dystrophy—who have a high risk that their children would inherit a devastating disease and either die at young age and/or suffer greatly throughout life. Many couples who prefer to become the genetic parents of a disease‐free child can now achieve this by either prenatal diagnosis (PND) and selective termination of pregnancy or preimplantation genetic diagnosis (PGD) and selective transfer of embryos without the disease‐causing mutations. Whatever their choice, couples or individuals who carry disease‐causing mutations need genetic and reproductive counselling to inform them about the disease and its causes and its recurrence risk and discuss the options for having healthy children. After counselling, couples need to take an autonomous decision to refrain from having children, to adopt, to opt for gamete donation or to use ART with PND or PGD. In the 1960s, it became possible to obtain amniotic fluid for genetic analysis of the embryo's genome. Amniocentesis is commonly performed at the 16th week of pregnancy when there is sufficient amniotic fluid to take a sample of about 20 ml for cell culture. It was first done blindly, which means that the puncture site was located by external palpation of the uterus. In the 1970s, ultrasound scanning became available, which drastically improved safety as the gynaecologist can see the puncture needle on …

“Simply providing information”: Negotiating the ethical dilemmas of obstetric ultrasound, prenatal testing and selective termination of pregnancy

Obstetric ultrasound is key to opposing ways of valuing foetuses, that is, both to the ascription of foetal personhood and to foetal selection and termination of pregnancy. Whilst ultrasound images are increasingly common within the public sphere there has been relatively little public discussion of its role in identifying actual or potential foetal anomaly and the consequences of this. This paper examines how professionals working with obstetric ultrasound encounter, navigate and make sense of the different uses of this technology. Professionals commonly delineate their work (as providing information) from women’s autonomous choices. Emphasising “women’s choice” can obscure consideration of different collective ways of valuing foetuses with anomalies. It can also deflect consideration of the fundamentally ambiguous information that ultrasound can produce. Distinguishing information from choice is underpinned by a questionable fact–value distinction. We describe alternate professional practices which involve questioning these binaries and foregrounding clinicians’ responsibilities for women’s current and future experience. Public discussion of ultrasound’s different roles in valuing foetuses would be enriched if the discourses and practices shaping professionals’ attempts to facilitate ethical decision-making were included for collective consideration.

The expression of DNA methyltransferases3A is specifically downregulated in chorionic villi of early embryo growth arrest cases.

The aim of the present study was to investigate the expression pattern of four DNA methyltransferases (DNMT1, DNMT3A, DNMT3B and DNMT3L) in placenta chorionic villi of early embryo growth arrest patients. Chorionic villous specimens were obtained from 40 pregnant patients diagnosed with early embryo growth arrest and 40 healthy women who underwent selective pregnancy termination. Reverse transcription-quantitative polymerase chain reaction, immunohistochemistry and western blot analysis were performed to characterize the mRNA and protein expression of DNMTs in chorionic villous cells. It was identified, among the four DNMTs, DNMT3B presented the highest level of protein expression in both patient groups. Although the mRNA expressions of the four DNMTs were comparable, the DNMT3A protein was specifically downregulated in patients with early embryo growth arrest. Therefore, the current study suggests that an abnormal decrease in DNMT3A protein levels may be involved in the pathogenesis of early embryo growth arrest.

Comparison of perinatal outcomes of selective termination in dichorionic twin pregnancies performed at different gestational ages

Objective: To determine the perinatal outcomes of selective termination in dichorionic twin pregnancies discordant for major but non-lethal fetal anomalies performed at different gestational ages.Methods: Thirty-one dichorionic twin pregnancies that underwent selective termination for discordant major but non-lethal fetal anomalies between January 2004 and February 2015 were retrospectively reviewed. The patients were grouped into three, according to the gestational age at which selective termination of pregnancies was performed; Group 1 (15–19 weeks), Group 2 (20–24 weeks) and Group 3 (30–33 weeks). Perinatal outcomes in all the three groups were reviewed and analyzed.Results: The overall live birth, term birth and pregnancy loss rate were 93.6%, 54.8% and 9.6%, respectively. The overall live birth rate was 66.6% in Group 1, this rate was 100% in Group 2 and Group 3 (p = 0.01). The rate of pregnancy loss was significantly higher in Group 1 (p = 0.01). The overall preterm delivery rate was 38.7%. While the overall preterm delivery rate was significantly higher in Group 3 (p = 0.04), the rate of extremely and very preterm birth was significantly lower (p = 0.03).Conclusion: Late selective feticide performed during the third trimester of pregnancy seems to be a safe approach and can be offered as an alternative method to reduce the total pregnancy loss and extremely and early pre-term birth rates.

Abortion Practices in Nepal: What does Evidence Show?

Twenty-five years have passed since the global community agreed in Nairobi to address the high maternal mortality by implementing the Safe Motherhood Initiative. However, every year around 22 million women seek unsafe abortion in developing countries. Globally, the unsafe abortion accounts for 13% maternal deaths. Out of the total aborted women, around five million women were admitted to hospitals as a result of unsafe abortion. Similarly, more than three million women suffer from severe complications from unsafe abortion every year. In 2002, responding to the public voices and high attribution of unsafe abortion on maternal mortality, Nepal granted legal access to safe abortion introducing safe abortion act. Women can seek abortion up to 12 weeks of gestation for any indication. However, sex selective pregnancy termination is prohibited in Nepal. This study aimed to assess the results of various studies on abortion practices in Nepal. Literature published in PubMed, Lancet, Medline, WHO and Google Scholar web pages from 1990 to 2014 were used to prepare this paper. From 2004 to 2014, more than half a million women sought safe abortion care in Nepal. Despite the considerable progress, unsafe abortion is still a major issue in Nepal as it has been estimated that it constitutes half of all abortions undertaken every year. Published literature further showed that still an unmet need of safe abortion services exists in Nepal. However, the overall awareness of legal abortion was found to be high among Nepalese women. We found negative attitude of most people towards women who sought abortion care. Similarly, a large number of unmarried women were found at risk for seeking abortion care due to socio-cultural norms, values and stigmas in Nepal.

Periconceptional Multivitamin Supplementation Containing Folic Acid and Sex Ratio at Birth in a Chinese Population: a Prospective Cohort Study.

To determine whether periconceptional use of multivitamin supplements containing folic acid increases the occurrence of male births in a Chinese population. A prospective cohort study was carried out in 18 counties in four provinces of China. Participants were naturally and voluntarily divided into an intervention group (who took a multivitamin pill containing folic acid, n = 25,418) and a control group (who did not take any multivitamin, n = 26,580). Multivitamin supplements containing folic acid was ascertained before pregnancy. Pregnant women were followed through the first trimester of pregnancy and the outcome of pregnancy (i.e. livebirth, stillbirth, or fetal death; sex at birth) was recorded. A total of 52,043 pregnancies and 51,998 births were recorded between September 2000 and August 2002. The proportion of males born to women who did and did not take the multivitamin were 54.8% (n = 13,935) and 54.0% (n = 11,483), respectively. The male to female sex ratios at birth among women who did and did not take the multivitamin were 117:100 and 121:100, respectively. The risk ratio was 1.03 [95% confidence interval 0.99, 1.06] after adjusting for confounding factors. These findings suggest that periconceptional multivitamin supplementation containing folic acid is not associated with an increased likelihood of male births in a Chinese population. However, these results may have been affected by induced abortion or selective termination of pregnancy, and the findings must therefore be cautiously interpreted.