Termination For Fetal Abnormality Research Articles

The Landscape of Point Mutations in Human Protein Coding Genes Leading to Pregnancy Loss.

Pregnancy loss is the most frequent complication of a pregnancy which is devastating for affected families and poses a significant challenge for the health care system. Genetic factors are known to play an important role in the etiology of pregnancy loss; however, despite advances in diagnostics, the causes remain unexplained in more than 30% of cases. In this review, we aggregated the results of the decade-long studies into the genetic risk factors of pregnancy loss (including miscarriage, termination for fetal abnormality, and recurrent pregnancy loss) in euploid pregnancies, focusing on the spectrum of point mutations associated with these conditions. We reviewed the evolution of molecular genetics methods used for the genetic research into causes of pregnancy loss, and collected information about 270 individual genetic variants in 196 unique genes reported as genetic cause of pregnancy loss. Among these, variants in 18 genes have been reported by multiple studies, and two or more variants were reported as causing pregnancy loss for 57 genes. Further analysis of the properties of all known pregnancy loss genes showed that they correspond to broadly expressed, highly evolutionary conserved genes involved in crucial cell differentiation and developmental processes and related signaling pathways. Given the features of known genes, we made an effort to construct a list of candidate genes, variants in which may be expected to contribute to pregnancy loss. We believe that our results may be useful for prediction of pregnancy loss risk in couples, as well as for further investigation and revealing genetic etiology of pregnancy loss.

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.

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.

Expectant parents’ attitudes to termination of pregnancy in general and in cases of fetal abnormality

The aim of this article was to explore whether expectant parents’ attitudes to termination or continuation of pregnancy, both in general and in case of fetal abnormality, are affected by previous experiences of miscarriage and whether attitudes change after ultrasound screening with normal findings. It was also of interest to investigate differences in attitudes in relation to age, parity and gender. A prospective one-year cohort study was carried out. Questionnaires were administered before and after the ultrasound examination. Analyses included 1258 women and 925 men. A comparison between the results pre- and post-ultrasound showed that after the ultrasound examination, there were significant changes towards a more positive attitude to give birth to a baby with an abnormality. Men were significantly more willing to terminate for a fetal abnormality and significantly less hesitant towards abortion in general than women. Women aged 35 years or older were significantly less willing to give birth to a baby with an abnormality and significantly more positive to termination for fetal abnormality than younger women. Parents showed understanding attitudes towards other parents’ decisions no matter what these were. We conclude that parents need individualized information and support in connection with prenatal diagnosis, due to parental hesitancy. Midwives play an important role in this.

Women's experiences of termination for fetal abnormality in a United Kingdom hospital setting: a systematic review protocol.

REVIEW QUESTION / OBJECTIVE The objective of this review is to explore women's experiences of a termination of pregnancy for fetal abnormality in a United Kingdom hospital setting. INCLUSION CRITERIA Types of participants This review will consider studies that include women who have undergone a termination for fetal abnormality in a United Kingdom hospital setting. Types of intervention(s)/phenomena of interest The phenomena of interest for this review are the experiences of women undergoing a termination for a fetal abnormality. Context The studies that are included in this review will be United Kingdom-based and will cover women’s experiences of termination of fetal abnormality. Included will be any research which considers the following: Diagnosis of abnormality Experiences in hospital of termination Follow-up services provided by the hospital.

Termination of pregnancy for fetal abnormality

A small but important minority of pregnant women will be diagnosed with a fetal abnormality, and most women diagnosed with a serious fetal abnormality choose to terminate the pregnancy. Midwives have a key role to play in providing high quality care to women given a diagnosis of fetal anomaly. This includes provision of information about the option of and methods of termination, which may be discussed before women opt into screening. Both medical and surgical termination are safe and effective, but involve very different experiences for the patient and her support person. Therefore, both options should be available to all women having a termination for fetal abnormality up to 24 weeks gestation and health professionals should help women to choose the method which best suits their individual coping style. In addition to medical advice about future pregnancy planning, women may need ongoing emotional and psychological support after their termination.

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.

What parents say about disclosing the end of their pregnancy due to fetal abnormality

Objectiveto describe men's and women's experiences of deciding whether to tell people in their social network, including their children, about their pregnancy loss following a termination for fetal abnormality. Designsecondary analysis of qualitative narrative interview data informed by a critical realist approach. Settingrespondents were recruited throughout the United Kingdom and interviewed at home between 2004 and 2005. Participantstwenty-eight women and nine men who had ended a pregnancy diagnosed with a fetal abnormality and who talked about disclosing or not disclosing the termination to others. Findingsfew respondents reported having any advice or information about whether or how to disclose their termination. None said they completely concealed their decision from adults in their social network; most said they disclosed selectively, telling close friends and family they had terminated and acquaintances they had miscarried. Most respondents reported telling their young children that the baby had died but did not reveal that they had chosen to end the pregnancy. A minority had not told their existing offspring about the pregnancy loss. Common reasons given for (partially) concealing a termination were: guilt over the decision; to avoid being judged; and to protect other people's feelings. Common reasons for disclosure were: others knew of the pregnancy; needing time off work; needing practical help and/or emotional support during diagnosis and termination; and wanting recognition of their loss. Positive consequences of disclosure were said to be getting more support and less criticism than expected; negative consequences included not getting the anticipated support and empathy; and encountering disapproval. Some respondents felt that concealing their pregnancy loss from their children had resulted in their confusion over the cause of their parents' distress. Some men said they found it hard to access emotional support from their social networks because of expectations about how men 'should' deal with emotions. Key conclusions and implications for practicemidwives have to make difficult judgements about what, how and when to provide information when trying to support and advise parents who have ended a pregnancy due to fetal abnormality. Further education and training in this area could be of benefit. Midwives could signpost parents to existing sources of advice around disclosure, taking into account parents' individual preferences, help parents to consider the potential implications of disclosure and concealment and different ways of disclosing. They could also recommend alternative sources of emotional support, bearing in mind that men in particular may find it harder to access support from their social networks.

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.

An investigation into the reporting and management of late terminations of pregnancy (between 22+0 and 26+6 weeks of gestation) within NHS Hospitals in England in 2006: the EPICure preterm cohort study

To review all late terminations of pregnancy, between 22(+0) and 26(+6) weeks of gestation, collected as part of the EPICure2 study. Prospective cohort study. All National Health Service (NHS) hospitals providing perinatal services for extremely preterm infants. All births between 22(+0) and 26(+6) weeks of gestation in England during 2006. Data were collected for the defined cohort of births, including terminations of pregnancy, by designated unit staff using a standardised questionnaire. Rigorous validation processes were established to ensure comprehensive data collection. Gestational age was validated using a hierarchical classification of scan dates, certain date of last menstrual period and working gestation. Data for terminations of pregnancy (TOPs) were categorised into two groups, terminations for fetal abnormality and for maternal or fetal compromise, and were analysed in terms of their reporting, management and outcomes. Classification, rate of feticide and outcome following TOP. Of 3782 births between 22(+0) and 26(+6) weeks of gestation, 647 (17.1%) were TOPs; of these 584 (90.3%) were for fetal abnormality and 63 (9.7%) for maternal or fetal compromise. Feticide was carried out in 489 of 584 (83.7%) TOPs for fetal abnormality, and in 38 of 63 (60.3%) of the TOPs for maternal or fetal compromise. Live births resulted following 2.2% TOPs for fetal abnormality and 4.8% TOPs for maternal or fetal compromise. Terminations of pregnancy represent a relatively large proportion of very preterm births. Fetal abnormalities are the main cause for these terminations, and most include feticide. Better screening strategies are required to avoid the need for late terminations of pregnancy for fetal abnormalities.

Perinatal Postmortems: What Is Important to Parents and How Do They Decide?

Falling consent rates for postmortems, regardless of age of death, have been widely reported in recent years. The aim of this study was to explore parental attitudes to, and decision-making about, a perinatal postmortem after termination for fetal abnormality, late miscarriage, or stillbirth. A prospective self-completion questionnaire was given to 35 women and their partners. The participants had experienced second or third trimester pregnancy loss in a single fetal medicine and delivery unit in the United Kingdom and were making decisions about having a postmortem. They were asked to complete a questionnaire about their attitudes to, and expectations of, a perinatal postmortem. Thirty-one questionnaires were received from parents of 17 babies (49% of those asked; 16 from mothers, 15 from fathers). Parents of nine babies (53%) said they would agree to a full postmortem, of three babies to a limited postmortem, and of four babies to an external examination only; one couple were undecided. The most important issues for the parents in this study that related to their decisions about a postmortem centered on the need for information, both for future planning and about what had happened. Moderately important issues related to altruism, which is, improving medical knowledge and helping other parents experiencing similar bereavement. Among the lowest scoring issues were potential barriers, such as concerns about cultural or religious acceptability of a postmortem, funeral delays, and what would happen to the baby's body. Bereaved parents who participated in this study, where postmortem consent rates were relatively high, thought that their need for knowledge eclipsed assumed barriers when deciding whether or not to have a postmortem for their baby.

Minimally‐invasive fetal autopsy using magnetic resonance imaging and percutaneous organ biopsies: clinical value and comparison to conventional autopsy

Autopsy is an important investigation following fetal death or termination for fetal abnormality. Postmortem magnetic resonance imaging (MRI) can provide macroscopic information of comparable quality to that of conventional autopsy in the event of perinatal death. It does not provide tissue for histological examination, which may limit the quality of counseling for recurrence risks and elucidation of the cause of death. We sought to examine the comparability and clinical value of a combination of postmortem MRI and percutaneous fetal organ biopsies (minimally invasive autopsy (MIA)) with conventional fetal autopsy. Forty-four fetuses underwent postmortem MRI and attempted percutaneous biopsy (using surface landmarks) of major fetal organs (liver, lung, heart, spleen, kidney, adrenal and thymus) following fetal death or termination for abnormality, prior to conventional autopsy, which was considered the 'gold standard'. We compared significant findings of the two examinations for both diagnostic information and clinical significance. Ancillary investigations (such as radiographs and placental histology) were regarded as common to the two forms of autopsy. In 21 cases conventional autopsy provided superior diagnostic information to that of MIA. In two cases the MIA provided superior diagnostic information to that of conventional autopsy, when autolysis prevented detailed examination of the fetal brain. In the remaining 21 cases, conventional autopsy and MIA provided equivalent diagnostic information. With regard to clinical significance, however, in 32 (72.7%) cases, the MIA provided information of at least equivalent clinical significance to that of conventional autopsy. In no case did the addition of percutaneous biopsies reveal information of additional clinical significance. Although in some cases MRI may provide additional information, conventional perinatal autopsy remains the gold standard for the investigation of fetal death. The utility of adding percutaneous organ biopsies, without imaging guidance, to an MRI-based fetal autopsy remains unproven. Postmortem MRI, combined with ancillary investigations such as placental histology, external examination by a pathologist, cytogenetics and plain radiography provided information of equivalent clinical significance in the majority of cases.

Investigations after stillbirth: a criterion based clinical audit in the Grampian region of Scotland (1998–2008)

ObjectiveTo audit the clinical investigations undertaken after stillbirth against a local protocol in a tertiary hospital in Scotland.MethodsA locally developed protocol for investigating causes of stillbirth was identified. All cases...

P02.15: Should medical termination of pregnancy be a better option than surgical termination for fetal abnormality diagnosed in 1sttrimester?

P02.15: Should medical termination of pregnancy be a better option than surgical termination for fetal abnormality diagnosed in 1^sttrimester?

Termination for fetal abnormality

Termination for fetal abnormality

Termination of Pregnancy for Fetal Abnormality: The Perspective of a Parent Support Organisation

Antenatal Results and Choices (ARC) celebrates its 20th anniversary as a UK registered charity in 2008. ARC's remit is to provide information and non-directive support to parents before, during and after antenatal screening. Much of its core work is supporting parents who are considering or who have already undergone a termination after a diagnosis of fetal abnormality. This paper describes ARC's history and how its work has changed over the 20 years, and looks at terminations, mostly in the second trimester, in the UK from ARC's experience as a parent support organisation. It summarises the law on when terminations for fetal abnormality can be offered and explores some of the issues that have affected the parental experience of termination after an antenatal diagnosis. It describes how standards of care have changed for the better, partly due to the training and information they provide widely, and parents' experience and perspectives on the importance of having contact with others with the same experience.