Termination of pregnancy for fetal abnormality in a portuguese tertiary care hospital: Two-year retrospective study

Introduction: The termination of pregnancy for fetal abnormality is based on a multidisciplinary clinical practice with an individually adapted intervention. Aims of the study: The objective of this study was to determine the major indications for pregnancy termination (PT), demographic and pregnancy details and effectiveness of medical management. Methods: This descriptive retrospective study examined all cases of PT due to prenatal diagnosis of fetal abnormality at Centro Materno-Infantil do Norte from January 2019 to December 2020. Analysed data included: maternal age, method of conception, obstetrical past history, gestational age at termination decision, fetal abnormalities categorization, PT procedure, waiting time to initiation and duration of termination process and complications associated. Results: In the two years span during which this study was conducted, a total of 111 cases of PT for fetal abnormality were performed. The mean maternal age was 34,25 years. The majority resulted from spontaneous pregnancy (93,69%) and 27,07% had prior poor obstetrical outcome. The mean gestational age at termination decision was 19 weeks with 97,80% less than 25 weeks. The most frequent group of anomalies were genetic disorders observed in 50 cases (45,04%): trisomy 21 in 48,0% and trisomy 18 in 24,0%. Central nervous system and cardiovascular system abnormalities were the next indications to PT (24,32% and 9,01%, respectively). The mean time interval between the couple request and the beginning of medical PT process was 4,41 days. The PT process was accomplished by usage of mifepristone and misoprostol in more than 90% of cases and only 16,35% of cases have required surgical evacuation of retained tissue. Conclusions: Genetic disorders were the principal indication for PT. Medical management had high rates of success with few cases requiring further surgical intervention. Regular retrospective evaluation of this clinical activity represents a source of valuable information for audit of PT procedures.