Late termination of pregnancy for congenital anomalies: a tertiary care center experience in South Africa.
Most lethal and non-lethal congenital anomalies can be diagnosed early in pregnancy and this can help prevent neonatal morbidity and mortality by appropriate antenatal management. Termination of pregnancy for severe congenital anomalies is permitted under South African law. Early termination is associated with less medical and psychological complications.
Medical records of 57 women who had opted for late termination of pregnancy for fetal anomalies over a period of 10 years were analyzed. Women’s demographics, interval from referral to feticide, gestational age at first scan and diagnosis, type of anomaly, methods and agents used for feticide were assessed.
Forty five (78.9%) of the women were less than 35 years old, 40 (70%) had no chronic medical conditions or risk factors. Thirty women (52.6%) had booked early in their pregnancy but only3 (5.2%) had a first trimester scan. Forty two (73.7%) had a clinically indicated third trimester scan and a late diagnosis. Mean time to referral between late (LTOP) and very late termination (VLTOP) groups was not significantly different 8 (1 – 41) and 6.5 (1 – 70) p value 0.671 for the two groups respectively. In 35 (62%) of the women potassium chloride was used for feticide. No procedure related complications were noted.
All pregnant women should have a basic ultrasound in second trimester. Task shifting should be used to provide this facility in primary and secondary health centers. A national registry should be established to document all late terminations for fetal anomalies.
Fauzia Shahid, University of Pretoria
Priya Soma-Pillay, University of Pretoria
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Date published: 2019-10-28
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