Therapeutic Termination Of Pregnancy Research Articles

Therapeutic Termination of Pregnancy and Paternal Mental Outcomes

Therapeutic Termination of Pregnancy and Paternal Mental Outcomes

Antenatal toxoplasmosis screening and treatment in Northern Italy: update on the clinical effectiveness.

Antenatal universal screening for toxoplasmosis is recommended in most affluent countries worldwide. Despite evidence is not robust, detected cases are typically treated during pregnancy. Affected newborns are also treated to temper clinical consequences. However, this established mode of management warrants careful and continuous re-evaluation. The epidemiology of the infection is changing and there is the need to monitor the clinical scenario. This is an observational retrospective study conducted at a referral hospital in Northern Italy. Every woman referred from January 2011 to December 2021 for suspected toxoplasmosis in pregnancy was eligible. All women were managed according to a local standardized protocol. Clinical and laboratory findings were obtained from patients' charts. Out of 347 women referred, 191 (55%) were discharged as false positive at initial assessment. We identified 141 women with suspected infection and 15 with confirmed infection. The number of women treated with antibiotics was 136 (96%) and 15 (100%), respectively. A total of 118 amniocenteses were performed, all of which were negative. There were two spontaneous miscarriages and five therapeutic terminations of pregnancy (of whom four were consequent to parental concerns related to the toxoplasmic infection), all among suspected cases. Vertical transmission occurred in a single case, a patient with confirmed infection diagnosed by seroconversion at 28 weeks' gestation. The course of this pregnancy was uneventful, and the infant is healthy at 7 years follow-up. Overall, the incidence of vertical transmission was 7% (95% CI: 1-30%) in confirmed cases and 0% (95% CI: 0-0.2%) in suspected cases. The current policy of universal screening and prompt management of toxoplasmosis infection is efficient. However, undue invasive procedures and terminations of pregnancy could occur. Future studies are warranted to improve clinical management.

Feasibility of Optical Genome Mapping from Placental and Umbilical Cord Sampled after Spontaneous or Therapeutic Pregnancy Termination

Optical genome mapping (OGM) is an alternative to classical cytogenetic techniques to improve the detection rate of clinically significant genomic abnormalities. The isolation of high-molecular-weight (HMW) DNA is critical for a successful OGM analysis. HMW DNA quality depends on tissue type, sample size, and storage conditions. We assessed the feasibility of OGM analysis of DNA from nine umbilical cord (UC) and six chorionic villus (CV) samples collected after the spontaneous or therapeutic termination of pregnancy. We analyzed quality control metrics provided by the Saphyr system (Bionano Genomics) and assessed the length of extracted DNA molecules using pulsed-field capillary electrophoresis. OMG data were successfully analyzed for all six CV samples. Five of the UC samples did not meet the Saphyr quality criteria, mainly due to poor DNA quality. In this regard, we found that DNA quality assessment with pulsed-field capillary electrophoresis can predict a successful OGM analysis. OGM data were fully concordant with the results of standard cytogenetic methods. Moreover, OGM detected an average of 14 additional structural variants involving OMIM genes per sample. On the basis of our results, we established the optimal conditions for sample storage and preparation required for a successful OGM analysis. We recommend checking DNA quality before analysis with pulsed-field capillary electrophoresis if the storage conditions were not ideal or if the quality of the sample is poor. OGM can therefore be performed on fetal tissue harvested after the termination of pregnancy, which opens up the perspective for improved diagnostic yield.

Fetal Presentation of Walker-Warburg Syndrome with Compound Heterozygous POMT2 Missense Mutations

Background: Walker-Warburg syndrome (WWS) (OMIM #236670) is an autosomal recessive disorder characterized by congenital muscular dystrophy, hydrocephalus, cobblestone lissencephaly, and retinal dysplasia. The main genes involved are: POMT1, POMT2, POMGNT1, FKTN, LARGE1, and FKRP. Case report: We present a fetus with WWS showing at ultrasound severe triventricular hydrocephalus. Pregnancy was legally terminated at 21 weeks +2 days of gestation. In vivo and postmortem magnetic resonance revealed corpus callosum agenesis and cerebellar hypoplasia. Cobblestone lissencephaly was observed at post-mortem. Next generation sequencing (NGS) of 193 genes, performed on fetal DNA extracted from amniocytes, detected two heterozygous mutations in the POMT2 gene. The c.1238G > C p.(Arg413Pro) mutation was paternally inherited and is known to be pathogenic. The c.553G > A p.(Gly185Arg) mutation was maternally inherited and has not been previously described. Conclusion: Compound heterozygous mutations in the POMT2 gene caused a severe cerebral fetal phenotype diagnosed prenatally at midgestation allowing therapeutic pregnancy termination.

Late diagnosis of Neural Tube Defects: About two uncommon cases

Background: Neural tube defects are pathologies of the central nervous system occurring between the 23rd and 27th day of embryonic life. Classified into two groups: cephalic pole anomaly (anencephaly) and spinal pole anomaly (spina bifida), these are uncommon anomalies representing one case per 1000 births, often resulting in therapeutic termination of pregnancy. The etiopathogenesis is not yet known but an interaction of genetic, environmental and drug factors is implicated. Folic acid supplementation is a means of prevention. Ultrasound is an essential and increasingly effective means of antenatal screening. Our objective is to report two uncommon cases of neural tube closure anomalies diagnosed at birth due to unmonitored pregnancies.

Therapeutic termination of pregnancy and major psychiatric outcomes in parents

ObjectivesTherapeutic termination of pregnancy (TToP) may have psychiatric outcomes like depression, anxiety and post-traumatic-stress disorder (PTSD). Material and methods45 couples had psychiatric evaluation before TToP and after one-year period. ResultsTToP is linked to acute development of depressive symptoms that recover with time and professional support. Twelve percent of women developed PTSD (but 29.5% refused one-year evaluation due to mental distress at recalling TToP). Fathers showed no psychiatric outcomes. ConclusionsAcute depressive symptoms after TToP improve with professional support but PTSD rate is concerning and stress importance of mental health implications and need for adequate related treatments.

The Caring Experience of Fetal Loss and Termination of Pregnancy Through the Eyes of Gynecological Medical and Surgical Nurses

Nurses care for women experiencing fetal loss as a result of elective or therapeutic termination of pregnancy or unexpected delivery of a nonviable infant. It is an emotional experience for the family and nurses. Investigators aimed to illuminate the experience of nurses caring for women experiencing a fetal loss and/or termination of pregnancy on a gynecological medical/surgical unit. The study used a qualitative, descriptive design approved by the Institutional Review Board. Semi-structured interviews were conducted with nine registered nurses, and transcripts were analyzed using constant comparison methods resulting in codes and themes by three investigators. The experience of nurses caring for women and infants during fetal loss and termination of pregnancy occurs throughout a continuum before, during, and after work. The experience is one of the layers, starting with emotions, sadness, and remorse in the center, followed by layers of attitude (respect and comfort) and action (communication). The foundation for these layers is teamwork, faith, and coping, surrounded by a box of uncomfortableness and distress. Nurses care for both the woman and infant during the termination of pregnancy and fetal loss, treating each with respect and comfort by communicating in both words and physical presence. Support between nurses with similar experiences provides a strong foundation that buffers the uncomfortable and distressing experience.

Rare Antenatal Fetal Malformations of the Anterior Abdominal Wall in Mali: About a Case

Abdominal wall malformations correspond to a wide spectrum of congenital anomalies that are due to a defect in the closure of the anterior abdominal wall and can be fatal. We report the case of laparoschisis associated with a poly malformation syndrome in the same fetus at the reference health center of commune III of the district of Bamako. The objective is to clarify the interest of antenatal ultrasound in the diagnosis and prognosis of these malformations. It was a 19-year-old prim gravid woman received as part of the prenatal check-up. Antenatal ultrasound had allowed the diagnosis of malformation of the anterior abdominal wall of the gastroschisis type associated with abnormalities of the neural tube, the urogenital system and the bone skeleton. The antenatal diagnosis of the malformations had motivated the realization of a therapeutic termination of pregnancy at 19 weeks of amenorrhea and 3 days by triggering and vaginal delivery, allowing the confirmation of the diagnosis of gastroschisis and the poly malformation syndrome which is extremely rare. Antenatal ultrasound remains an ideal means of imaging for monitoring pregnancy and had made it possible to make the prognosis and antenatal diagnosis of multiple malformations in association, and to indicate better therapeutic decision-making.

Therapeutic termination of pregnancy and women's mental health: Determinants and consequences.

The therapeutic termination of pregnancy (TToP) is an induced abortion following a diagnosis of medical necessity. TToP is applied to avoid the risk of substantial harm to the mother or in cases of fetal unviability. This type of induced abortion is provided after the second semester of gestation if fetal illness or the pregnancy cause physical danger or pathological mental distress to the mother. Socio-cultural and economic determinants could influence the desire for children and family planning in couples, as well as the use of effective contraception and the choice to perform an induced abortion. Also, pre-existing mental health problems could affect the decision between carrying on a problematic pregnancy or having TToP. Furthermore, the TToP is a reproductive event with an important traumatic burden, but also with an intrinsic therapeutic effect and it can produce different psychological and psychopathological effects on women and couples. The aim of this review is to evaluate what demographic, reproductive and psychopathological determinants are involved in the choice of undergoing a TToP in women. Also, we will examine both positive and negative consequences of this procedure on women’s mental health, underlying which factors are related to a worse outcome in order to provide the best clinical support to vulnerable groups.

Étude longitudinale sur le trouble stress post-traumatique du post-partum chez la primipare en Tunisie

ObjectivesThe aims of this study were to estimate the incidence of the post-partum post-traumatic stress disorder (PP-PTSD) in primiparous women, and to determine the profile of women at risk of developing this disorder. MethodsWe conducted a descriptive, prospective and longitudinal study carried out at the maternity department of the Hedi Chaker Hospital, Sfax-Tunisia over a period of 15 months. At the first stage of the study, the Saint-Antoine pain questionnaire, the peri-traumatic dissociative experiences questionnaire and the peri-traumatic distress inventory were used respectively to assess the pain of delivery, the peri-traumatic dissociation and distress. At the second stage of the study, the questionnaires, perinatal post-traumatic stress disorder (PPQ), hospital anxiety and depression scale and the Edinburgh postnatal depression scale were used respectively for the PP-PTSD screening and the assessment of the post-partum anxious and depressive symptomatology. ResultsThe study population consisted of 183 parturients at the first stage of the study and 150 parturients at the second stage of the study. The incidence of the PP-PTSD was 9.3 %. In the multivariate study, some factors studied were significantly associated with the development of PTSD-PP, including a history of therapeutic termination of pregnancy, a history of miscarriage, exposure to a stressful event during pregnancy, prenatal hospitalization of the mother, instrumental delivery, pain intensity especially in the affective component, peri-traumatic dissociation and avoidance of sexual intercourse for fear of a new pregnancy. However the skin to skin contact with the new-born immediately after delivery was a significant protective factor. ConclusionThe psychological consequences associated with the first birth, particularly the PP-PTSD, are common. The Identification of women at risk and a systematic screening of postpartum post-traumatic stress symptoms are desirable.

Congenital heart disease with neonatal revelation in Tunisia: Epidemiological, clinical and evolutionary aspects

Congenital heart diseases include all heart and vascular malformations; they represent around third of congenital malformations and constitute an important public health issue in Tunisia. The aim of this study is to describe the epidemiological and clinical profile of these malformations and to emphasize on the results encountered through the disease treatment. We propose a retrospective study of 165 congenital heart disease observations collected in the neonatology department of the maternity and neonatology center of Tunis over a period of 2 years from January 2018 to December 2019. The hospital prevalence of congenital heart disease was equal to 3.5%. The sex ratio was equal to 1.11 (52.7% male, 47.2% female). Inbreeding was found in 10.9% of patients. The average maternal age was equal to 33 years; the follow-up of the pregnancy was noted in 60.2% of mothers. Chronic diseases were found in 13.3% (type 1 diabetes 6%); 61.2% of heart diseases were diagnosed in antenatal care. Respiratory distress was the most common symptom (86.6%). Hypotrophy was objectified in 11.5% of newborns however the rate of association of heart murmur and congenital heart disease was 45.4%. Among the patients, 28.4% had associated congenital malformations. Non-cyanogenic congenital heart disease represented 63.3%, however, it represented 36.3% for the cyanogenic ones. Among the patients, 67.6% received medical treatment, 12.7% benefited from surgery or interventional surgery and 86.7% of them received treatment in an intensive care setting. The mortality rate was 64.8%. Congenital heart disease is still shown a significant rate of mortality and morbidity. Improving the prognosis is based on prenatal screening in women at risk in order to be able to develop genetic counselling and to practice a therapeutic termination of pregnancy when it is necessary.

Evaluation of post-mortem high-field MRI at 7T compared to conventional autopsy: a morphometric study

Objective. The aim of our study was to establish if high-field post-mortem MRI at 7T can perform three-dimensional measurements of the fetal heart, and retrieve results comparable to post-mortem macroscopic measurements performed at autopsy, in fetuses with whole body weight below 500 g. Methodology. Twelve second-trimester fetuses with gestational ages ranging from 13 to 19 weeks of gestation were considered. All fetuses resulted from therapeutic termination of pregnancy (TOP) due to plurimalformative syndromes or chromosomal anomalies. All cases were immersed in 10% formalin solution, and after proper fixation they were examined using high-field MRI at 7T. After post-mortem imagistic examination, all cases were submitted to conventional autopsy. Three-axis cardiac measurements were performed by both examination methods, using the same landmarks. Results. We observed a strong correlation between post-mortem MRI measurements at 7T and post-mortem macroscopic measurements at autopsy, with p<0.001. The coefficient of correlation (r) for all three axes was above or equal to 0.90. Bland Altman plots showed overall good agreement between measurements performed by both methods. Conclusions. Using 7T post-mortem MRI for three-dimensional morphometric evaluation of the fetal heart in the second-trimester fetuses with a body weight less than 500 g, the obtained results are comparable to the macroscopic measurements performed during conventional autopsy.

Therapeutic termination of pregnancy with complete placenta praevia in the second and third trimesters

Background: Placenta previa is one of the complications of pregnancy. Complete placenta previa is the most serious type of placenta previa. It means that the placental tissue completely covers the internal orifice of the cervix. With the rising use of caesarean section (CS) and the increase in maternal age, the incidence of placenta praevia, placenta increta, and their associated complications have continued to increase. Since the early 20th century, the incidence of placenta increta has increased 13-fold. Complete placenta praevia and placenta increta are associated with a higher risk of maternal and fetal complications, especially postpartum hemorrhage. Because of fetal death, lethal anomalies, and maternal complications, the number of patients who are in the second and third trimesters of pregnancy needing to undergo therapeutic abortion is rising. Moreover, in present-day China, many patients with placenta praevia have a history of CS and the condition may be further complicated by placenta increta. Nevertheless, there is a lack of evidence relating to the management of patients with complete placenta praevia who seek therapeutic abortion in the second and third trimesters, and much less regarding placenta increta. The experience with these patients is limited and debate still surrounds the clinical management. So, the aim of this article is to study the delivery mode of therapeutic abortion complicated with complete placenta praevia in the second and third trimesters.

Occurrence of Congenital Anomalies in Iran and Implications of Osr-o-Haraj "Denegation of Intolerable Hardship Rule" in Shia Fiqh

Background and Objectives: The aim of this study was to explain the examples of "the Jurisprudential Rule of "Osr o- Haraj" or Denegation of Intolerable Hardship in the occurrence of congenital anomalies and genetic disorders and show that according to the current laws of the country, more of these diseases can be prevented. Material and Methods: Data for occurrence of congenital anomalies were derived from two major regional and national epidemiological studies based on 6,465,849 births in the country. A comprehensive review of literature was carried out on the details of ‘Denegation of Intolerable Hardship Rule. The details of medical termination of pregnancies diagnosed for congenital anomalies and the role of ‘Denegation of Intolerable Hardship’ principle in the prevention of birth defects were explored in several Focused Group Discussions formed by peditricians, geneticists, psychiatrists, neotatalogists and expert jurisprudents. Results: The statistical estimates indicate that there are now nearly 100,000 births with one of the birth defects occurring every year in Iran. The total prevalence of the anomalies has more than tripled in the last 18 years. Conclusion: The occurrence of congenital anomalies and genetic disorders will undermine the gene pool of the population if preventive measures are not properly implemented in the community genetics services to control those disorders. According to the current law on therapeutic abortion, disorders that lead to the hardships of father, mother, family, community, as well as future generations may be diagnosed by the three specialists (before the 16th week of pregnancy, the time of onsetting the soul). They can then be referred for medical abortion. A minimum of 70,000 birth defects may be avoided using the therapeutic termination of pregnancies diagnosed for congenital anomalies if the ‘no hardship and negation of distress and constriction’ principle is suitably explored in maternal, pediatric, neonatal settings and for public health authorities.

Guillain-Barré and Acute Transverse Myelitis Overlap Syndrome Following Obstetric Surgery.

IntroductionThere are rare reports of the occurrence of acute transverse myelitis and Guillain–Barré syndrome after various surgical procedures and general/epidural anaesthesia. The concomitant occurrence of these pathologies is very rare and is called Guillain–Barré and acute transverse myelitis overlap syndrome. In this article, we present the case of a second trimester pregnant patient who developed Guillain–Barré and acute transverse myelitis overlap syndrome.Case presentationWe report the case of a 16-year-old female patient who underwent a therapeutic termination of pregnancy two weeks prior to the onset of the disease with gradual development of a motor deficit with walking and sensitivity disorders, fecal incontinence. The diagnosis was based on clinical exam, electroneurography and spinal magnetic resonance imaging. Endocrinopathies, infectious diseases, autoimmune and inflammatory diseases, neoplastic diseases and vitamin deficiencies were ruled out. Our patient attended five sessions of therapeutic plasma exchange, followed by steroid treatment, intravenous immunoglobulin with minimum recovery of the motor deficit in the upper limbs, but without significant evolution of the motor deficit in the lower limbs. The patient was discharged on maintenance corticotherapy and immunosuppressive treatment with azathioprine.ConclusionsWe report a very rare association between Guillain–Barré syndrome and acute transverse myelitis triggered by a surgical intervention with general anaesthesia. The overlap of Guillain–Barré syndrome and acute transverse myelitis makes the prognosis for recovery worse, and further studies are needed to establish the first-line therapy in these cases.

Expectant Management of Cesarean Scar Ectopic Pregnancy: A Case Report

Cesarean scar pregnancy (CSP) is a very rare form of ectopic pregnancy. It complicates approximately 1 in 2226 pregnancies. However, it is becoming increasingly more frequent with the increasing number of cesarean sections performed each year. The recommended approach to treatment is therapeutic termination of pregnancy at the time of recognition. Couples occasionally make the choice to continue with expectant management. There are as few as ten documented cases of CSP and were expectantly managed that resulted in the delivery of a viable neonate. In this article, we present a case of CSP managed expectantly ending in emergency cesarean delivery at 27 weeks gestation. Delivery was complicated by severe postpartum hemorrhage with the need for cesarean hysterectomy. This report suggests the ability to expectantly manage appropriate cesarean scar ectopic pregnancies. However, it also raises several ethical questions whether or not we should manage these patients expectantly merely because we can.

Antenatal and postnatal diagnoses of visible congenital malformations in a sub-Saharan African setting: a prospective multicenter cohort\xa0study

BackgroundVisible congenital malformations (VCMs) are one of the principal causes of disability in the world. Prenatal diagnosis is a paramount mandatory integral part of the follow up of pregnancies with VCM of the foetus in high-income setting. We aimed to determine the incidence of prenatal diagnosis of VCMs in a low-resource setting with no policy on antenatal diagnosis of VCMs.MethodsWe carried out a prospective cohort multicenter study from July 2015 to June 2016 in 10 randomly selected maternity units of Yaoundé, Cameroon. We enrolled all newborns with one or more detectable VCMs at birth. Variables studied were findings of the 1st, 2nd and 3rd trimesters’ obstetrical ultrasound scans, in order to establish a concordance between the clinical and sonographic diagnoses of the VCMs and determine the frequency of antenatal diagnosis as well as the rate of medical abortion.ResultsThe incidence of VCMs was 9 per 1000 births. The main VCMs were malformations of the skeletal (4.3%), neurological (2.2%), and gastrointestinal (2.1%) systems. The sex ratio was 1.1. Among the malformed newborns, 37% were premature and in 18.5% the diagnosis of a VCM was confirmed after a therapeutic termination of pregnancy (following suggestive findings of a malformation on antenatal ultrasound scan). The prevalence of sonographic antenatal diagnosis of VCMs was 21%. Hydrocephalus was the most diagnosed VCM antenatally. The mean gestational age at which antenatal clinics were initiated was 15 ± 5 weeks. The mean number of obstetrical ultrasound scans performed was two.ConclusionThe incidence of VCMs in our resource-limited setting is high and antenatal diagnosis rates are very low. Overall, our study emphasizes on the importance antenatal diagnosis of VCMs, often overlooked in our setting. The goal being to reduce maternal and foetal morbidity in a setting already burdened by a high maternal and neonatal mortality.

Therapeutic Termination of Pregnancy and Psychiatric Implications

Therapeutic Termination of Pregnancy and Psychiatric Implications

A guide to the management of hepatitis E infection during pregnancy

ABSTRACTIntroduction: Hepatitis E virus (HEV) infection has distinct features, depending upon the genotype and geographical area. HEV genotypes 1 and 2 are endemic to various developing countries causing epidemics of acute viral hepatitis with human to human transmission. On the other hand, HEV genotypes 3 and 4 prevalent in developed countries commonly lead to subclinical infection and are transmitted zoonotically. HEV infection typically causes acute self-limiting illness associated with low morbidity and mortality. Infection with HEV genotype 1 or 2 in pregnancy, especially in the third trimester may lead to severe illness and fulminant liver failure. Poor maternal and fetal outcomes have been reported.Areas covered: This review highlights the various aspects of HEV infection in pregnancy including diagnosis, management, and prevention.Expert commentary: Treatment is mainly supportive with diligent monitoring and intensive care. Therapeutic termination of pregnancy cannot be recommended based to the available literature. Early liver transplantation (LT) should be considered in these patients although the indications and timing of LT are still controversial. Prevention of HEV infection or illness by improved sanitation and active/passive immunization needs further research.

Intrauterine fetal MR versus postmortem MR imaging after therapeutic termination of pregnancy: evaluation of the concordance in the detection of brain abnormalities at early gestational stage.

Fetal postmortem MR Imaging (pmMRI) has been recently used as an adjuvant tool to conventional brain autopsy after termination of pregnancy (TOP). Our purpose was to compare the diagnostic performance of intrauterine MRI (iuMRI) and pmMRI in the detection of brain anomalies in fetuses at early gestational age (GA). We retrospectively collected 53 fetuses who had undergone iuMRI and pmMRI for suspected brain anomalies. Two pediatric neuroradiologists reviewed iuMRI and pmMRI examinations separately and then together. We used Cohen's K to assess the agreement between pmMRI and iuMRI. Using the combined evaluation iuMRI+pMRI as the reference standard, we calculated the "correctness ratio." We used Somers' D to assess the cograduation between postmortem image quality and time elapsed after fetus expulsion. Our data showed high agreement between iuMRI and pmMRI considering all the categories together, for both observers (K1 0.84; K2 0.86). The correctness ratio of iuMRI and pmMRI was 79% and 45% respectively. The major disagreements between iuMRI and pmMRI were related to postmortem changes as the collapse of liquoral structures and distorting phenomena. We also found a significant cograduation between the time elapsed from expulsion and pmMRI contrast resolution and distortive phenomena (both p < 0.001). Our study demonstrates an overall high concordance between iuMRI and pmMRI in detecting fetal brain abnormalities at early GA. Nevertheless, for the correct interpretation of pmMRI, the revision of fetal examination seems to be crucial, in particular when time elapsed from expulsion is longer than 24h. • IuMRI and pmMRI showed overall high concordance in detecting fetal brain abnormalities at early GA. • PmMRI corroborated the antemortem diagnosis and it could be a valid alternative to conventional brain autopsy, only when the latter cannot be performed. • Some caution should be taken in interpreting pmMR images when performed after 24h from fetal death.