Late termination of pregnancy for fetal anomalies: Experience at a tertiary-care hospital in South Africa

Abstract

 Background. Early diagnosis and appropriate management of congenital anomalies can help prevent neonatal morbidity and mortality. Termination of pregnancy for severe congenital anomalies is permitted under South African law. 

Objective. To determine factors causing delayed diagnosis of lethal congenital abnormalities requiring late termination of pregnancy at Steve Biko Academic Hospital in Pretoria, South Africa. 

Methods. Medical records of pregnant women who presented with lethal fetal anomalies over a period of 7.5 years were analysed. Patients’ demographic profile, the interval from referral to feticide, gestational age at first scan and diagnosis, type of anomaly and feticide methods were considered. The cohort was divided in two groups based on timing of termination (i.e. earlier than 28 weeks and later than 28 weeks’ gestation) for statistical comparison. 

Results. The majority of women (n=45; 78.9%) were younger than 35 years and had no chronic medical conditions or risk factors (n=40; 70%). Although 30 women (52.6%) had been booked for antenatal examination early in their pregnancy, only three (5.2%) had a first-trimester scan. Mean time to referral was not significantly different between the women whose pregnancies terminated earlier than 28 weeks and those with a termination after 28 weeks (p=0.671). 

Conclusion. A basic ultrasound scan in the second trimester is recommended for all pregnant women. Task shifting can be a viable option to provide this facility at primary and secondary health centres. A national registry should be established to document all late terminations for fetal anomalies.