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Rosser S, Sekar R, Laporte J, Duncombe GJ, Bendall A, Lehner C, Portmann C, McGrath P, Lust K, Ganter P, Kumar S. Late termination of pregnancy at a major Queensland tertiary hospital, 2010–2020. Med J Aust 2022; 217:410-414. [DOI: 10.5694/mja2.51697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Renuka Sekar
- Royal Brisbane and Woman's Hospital Brisbane QLD
| | | | - Gregory J Duncombe
- Centre for Advanced Prenatal Care Royal Brisbane and Woman's Hospital Brisbane QLD
| | | | | | | | | | - Karin Lust
- Royal Brisbane and Woman's Hospital Brisbane QLD
| | - Peter Ganter
- Royal Brisbane and Woman's Hospital Brisbane QLD
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Schoenborn C, De Spiegelaere M, Racape J. Measuring the invisible: perinatal health outcomes of unregistered women giving birth in Belgium, a population-based study. BMC Pregnancy Childbirth 2021; 21:733. [PMID: 34715815 PMCID: PMC8555314 DOI: 10.1186/s12884-021-04183-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022] Open
Abstract
Background The unregistered population remains under-researched because of its “invisible” status in statistics. Studies on perinatal health outcomes of unregistered women remains particularly limited. Our objectives were 1) to describe the sociodemographic profiles of women who are not legally residing in Belgium and 2) to analyze the associations of registration status with pregnancy outcomes according to socioeconomic status and nationality. Methods We analysed data from birth and death certificates taken from the Belgian civil registration system, linked with the National Population Registry (NPR). The data relates to all singleton babies born between 2010 and 2016 (n = 871,283), independent of their mother’s NPR registration status. We used logistic regression to estimate the odds ratios for the associations between perinatal outcomes (perinatal mortality, prematurity and low birth weight) and maternal NPR registration status according to socioeconomic status and maternal nationality. Results Over the study period, 1.9% of births were to mothers without NPR-registration. Unregistered women from newer EU member states and non-European countries were particularly disadvantaged from a socioeconomic point of view. Apart from women with a South American nationality, all other groups of unregistered women had higher rates of prematurity, low birth weight, and perinatal mortality, compared to registered mothers (p < 0.0001). Unregistered women from Belgium and EU15 nationalities had particularly higher rates of prematurity, low birth weight, and perinatal mortality, compared to registered mothers, even after adjustment for socioeconomic status (p < 0.0001). The excess of perinatal mortality for non-European unregistered mothers could partly be explained by their precarious socioeconomic situation. Conclusions This is the first study to include data on mothers who were not legally residing in Belgium. Unregistered women giving birth in Belgium are likely a heterogeneous socioeconomic group. Overall, unregistered women have increased risks of adverse perinatal outcomes, but it is likely that the causal mechanisms differ starkly between Belgian, European and non-European women. Further research is needed to understand the mechanisms behind these accrued rates. It is important to keep measuring the health outcomes of the populations which are “invisible” in national statistics, in order to identify the groups in most need of integration and access to services. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04183-9.
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Affiliation(s)
- Claudia Schoenborn
- Research centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Myriam De Spiegelaere
- Research centre in Social Approaches to Health, School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium
| | - Judith Racape
- Research centre in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles (ULB), Bruxelles, Belgium. .,Chair in Health and Precarity. Faculty of Medecine, Université libre de Bruxelles (ULB), Bruxelles, Belgium.
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3
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Temporal changes in epidemiological profile and fetal indications for late termination of pregnancy: a retrospective single-center study. Arch Gynecol Obstet 2021; 304:935-942. [PMID: 33797606 PMCID: PMC8429401 DOI: 10.1007/s00404-021-06042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/18/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE To explore whether epidemiological shifts regarding reproduction and pregnancy have influenced the spectrum of indications for late termination of singleton pregnancies (TOP) above 17 weeks of gestation and to evaluate temporal changes in maternal demographics and fetal indications over the last 16 years. METHODS Retrospective single-center cohort study involving all late TOPs preceded by feticide between 1 January 2004 and 31 December 2019 at a tertiary referral hospital in Austria. Outcome variables were retrieved and a time trend assessed between two 8-year intervals (2004-2011 versus 2012-2019). RESULTS Between January 2004 and December 2019, a total of 209 singleton pregnancies (50.7% male; 46.9% female fetuses, 2.4% no disclosed sex) were terminated medically at a median gestational age of 25+1 (17+3-37+1) weeks at our institution. Predominant conditions legally justifying the late medical abortion were abnormaltities of the brain/central nervous system (n = 83; 39.7%), chromosomal aberrations (n = 33; 15.8%), complex malformations (n = 31; 4.8%) and abnormaltities of the musculosceletal system including diaphragmatic hernias (n = 18; 8.6%), as reflected by the ICD-10-categories "Congenital malformation of the central nervous system", "Other congenital malformations" and "Chromosomal abnormalities". No changes were observed with regards to maternal age (30.1 ± 5.9 vs. 31.0 ± 6.0 years; p = 0.315) nor frequency of assisted reproductive technologies (7.0% vs. 8.5%; p = 0.550). Despite a 2.5-fold increase in incidence of late TOPs, no epidemiological changes in maternal or fetal characteristics were observed over the last 16 years. CONCLUSION Population profile and indications for late TOPs followed by feticide remain unchanged over time.
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Power S, Meaney S, O'Donoghue K. Fetal medicine specialist experiences of providing a new service of termination of pregnancy for fatal fetal anomaly: a qualitative study. BJOG 2020; 128:676-684. [PMID: 32935467 DOI: 10.1111/1471-0528.16502] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore fetal medicine specialists' experiences of caring for parents following a diagnosis of fatal fetal anomaly (FFA) during the implementation of termination of pregnancy (TOP) for FFA for the first time. DESIGN Qualitative study. SETTING Fetal medicine units in the Republic of Ireland. POPULATION Ten fetal medicine specialists from five of the six fetal medicine units. METHODS nvivo 12 assisted in the thematic analysis of semi-structured in-depth face-to-face interviews. MAIN OUTCOME MEASURES Fetal medicine specialists' experiences of prenatal diagnosis and holistic management of pregnancies complicated by FFA. RESULTS Four themes were identified: 'not fatal enough', 'interactions with colleagues', 'supporting pregnant women' and 'internal conflict and emotional challenges'. Fetal medicine specialists feared getting an FFA diagnosis incorrect because of media scrutiny and criminal liability associated with the TOP for FFA legislation. Challenges with the ambiguous and 'restrictive' legislation were identified that 'ostracised' severe anomalies. Teamwork was essential to facilitate opportunities for learning and peer support; however, conflict with colleagues was experienced regarding the diagnosis of FFA, the provision of feticide and palliative care to infants born alive following TOP for FFA. Participants reported challenges implementing TOP for FFA, including the absence of institutional support and 'stretched' resources. Fetal medicine specialists experienced internal conflict and a psychological burden providing TOP for FFA, but did so to 'provide full care for women'. CONCLUSIONS Our study identified challenges regarding the suitability of the Irish legislation for TOP for FFA and its rapid introduction into clinical practice. It illustrates the importance of institutional and peer support, as well as the need for supportive management, in the provision of a new service. TWEETABLE ABSTRACT The implementation of termination services for fatal fetal anomaly is complex and requires institutional support.
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Affiliation(s)
- S Power
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - S Meaney
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.,National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - K O'Donoghue
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.,Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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Houdayer C, Ziegler A, Boussion F, Blesson S, Bris C, Toutain A, Biquard F, Guichet A, Bonneau D, Colin E. Prenatal diagnosis of Desbuquois dysplasia type 1 by whole exome sequencing before the occurrence of specific ultrasound signs. J Matern Fetal Neonatal Med 2019; 34:2217-2220. [PMID: 31510824 DOI: 10.1080/14767058.2019.1657084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Desbuquois dysplasia is a very severe and sometimes lethal form of osteochondrodysplasia characterized by prenatal onset of severe micromelic short stature, joint laxity with multiple joint dislocations, specific radiographic features, and facial dysmorphism. Here, we report a case for which whole exome sequencing allowed early prenatal diagnosis of Desbuquois dysplasia before the detection of characteristic ultrasound signs of the disease.
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Affiliation(s)
- Clara Houdayer
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France
| | - Alban Ziegler
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France
| | - Françoise Boussion
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Sophie Blesson
- Department of Genetics, Tours University Hospital, Tours, France
| | - Céline Bris
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France
| | - Annick Toutain
- Department of Genetics, Tours University Hospital, Tours, France
| | - Florence Biquard
- Department of Obstetrics and Gynecology, Angers University Hospital, Angers, France
| | - Agnès Guichet
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France
| | - Dominique Bonneau
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France.,Mitovasc, UMR CNRS 6015, INSERM U1083, Angers University, Angers, France
| | - Estelle Colin
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France.,Mitovasc, UMR CNRS 6015, INSERM U1083, Angers University, Angers, France
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Fujiogi M, Michihata N, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Clinical features and practice patterns of gastroschisis: a retrospective analysis using a Japanese national inpatient database. Pediatr Surg Int 2018; 34:727-733. [PMID: 29770842 DOI: 10.1007/s00383-018-4277-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE The number of infants with gastroschisis is increasing worldwide, but advances in neonatal intensive care and parenteral nutrition have reduced gastroschisis mortality. Recent clinical data on gastroschisis are often from Western nations. This study aimed to examine clinical features and practice patterns of gastroschisis in Japan. METHODS We examined treatment options, outcomes, and discharge status among inpatients with simple gastroschisis (SG) and complex gastroschisis (CG), 2010-2016, using a national inpatient database in Japan. RESULTS The 247 eligible patients (222 with SG) had average birth weight of 2102 g and average gestational age of 34 weeks; 30% had other congenital anomalies. Digestive anomalies were most common, followed by circulatory anomalies. In-hospital mortality was 8.1%. The median age at start of full enteral feeding was 30 days. The median length of stay was 46 days. There were no significant differences in outcomes except for length of stay, starting full enteral feeding and total hospitalization costs between the SG and CG groups. About 80% of patients were discharged to home without home medical care. The readmission rate was 28%. CONCLUSION This study's findings on the clinical characteristics and outcomes of gastroschisis are useful for the clinical management of gastroschisis.
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Affiliation(s)
- Michimasa Fujiogi
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Graduate School of Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 112-0002, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
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Anesthesia for Medical Termination of Pregnancy. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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8
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Gerdts C, DeZordo S, Mishtal J, Barr-Walker J, Lohr PA. Experiences of women who travel to England for abortions: an exploratory pilot study. EUR J CONTRACEP REPR 2016; 21:401-7. [DOI: 10.1080/13625187.2016.1217325] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | - Silvia DeZordo
- Department of Anthropology, University of Sussex, Brighton, UK
| | - Joanna Mishtal
- Department of Anthropology, University of Central Florida, Orlando, FL, USA
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Fay V, Thomas S, Slade P. Maternal-fetal medicine specialists' experiences of conducting feticide as part of termination of pregnancy: a qualitative study. Prenat Diagn 2015; 36:92-9. [DOI: 10.1002/pd.4720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/16/2015] [Accepted: 10/29/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Vanessa Fay
- Department of Clinical Psychology (Complex Cases, Central); Gaskell House; Manchester UK
| | - Sophie Thomas
- Department of Clinical Psychology and Neuropsychology; Queens Medical Centre; Nottingham UK
| | - Pauline Slade
- Department of Clinical Psychology - Ground Floor Whelan Building; University of Liverpool; Liverpool UK
- Department of Psychological Sciences, Institute of Psychology, Health and Society; University of Liverpool; Liverpool UK
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Howe D. Ethics of prenatal ultrasound. Best Pract Res Clin Obstet Gynaecol 2013; 28:443-51. [PMID: 24374013 DOI: 10.1016/j.bpobgyn.2013.10.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 09/23/2013] [Accepted: 10/15/2013] [Indexed: 11/16/2022]
Abstract
Prenatal ultrasound has opened new opportunities to examine, diagnose and treat the fetus, but these advances bring with them ethical dilemmas. In this chapter, I address the ethical principles that need to be considered when treating both mother and fetus as patients, and how these can be applied in practice. In particular, ultrasound practitioners have an ethical duty to maintain their theoretical knowledge and practical skills to ensure they advise parents correctly. I also discuss the ethical issues in carrying out intrauterine therapy, ultrasound-related research, and termination of pregnancy for fetal abnormality.
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Affiliation(s)
- David Howe
- Wessex Fetal Medicine Unit, Princess Anne Hospital, Southampton SO16 5YA, UK.
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Kumar M, Sharma S, Bhagat M, Gupta U, Anand R, Puri A, Singh A, Singh A. Postnatal outcome of congenital anomalies in low resource setting. Prenat Diagn 2013; 33:983-9. [DOI: 10.1002/pd.4179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 06/02/2013] [Accepted: 06/11/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Manisha Kumar
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Sumedha Sharma
- Department of Obstetrics & Gynaecology; All India Institute of Medical sciences; New Delhi India
| | - Manisha Bhagat
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Usha Gupta
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Rama Anand
- Department of Radiology; Lady Hardinge Medical College; New Delhi India
| | - Archana Puri
- Department of Paediatric Surgery; Lady Hardinge Medical College; New Delhi India
| | - Anuradha Singh
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
| | - Abha Singh
- Department of Obstetrics & Gynaecology; Lady Hardinge Medical College; New Delhi India
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12
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Cochrane RA, Cameron ST. Attitudes of Scottish abortion care providers towards provision of abortion after 16 weeks’ gestation within Scotland. EUR J CONTRACEP REPR 2013; 18:215-20. [DOI: 10.3109/13625187.2013.775240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Legendre CM, Moutel G, Drouin R, Favre R, Bouffard C. Differences between selective termination of pregnancy and fetal reduction in multiple pregnancy: a narrative review. Reprod Biomed Online 2013; 26:542-54. [PMID: 23518032 DOI: 10.1016/j.rbmo.2013.02.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 01/31/2013] [Accepted: 02/05/2013] [Indexed: 10/27/2022]
Abstract
Although selective termination of pregnancy and fetal reduction in multiple pregnancy both involve the termination in utero of the development of live fetuses, these two procedures are different in several aspects. Nevertheless, several authors tend to amalgamate and confuse their psychosocial consequences and the ethical issues they raise. Therefore, this narrative review, derived from a comparative analysis of 91 articles, shines a light on these amalgamations and confusions, as well as on the medical, contextual, experiential and ethical differences specific to selective termination and fetal reduction.
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Affiliation(s)
- Claire-Marie Legendre
- Division of Genetics, Department of Pediatrics, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, Québec, Canada
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Late termination of pregnancy for fetal abnormalities: The perspective of Indian lay persons and medical practitioners. Prenat Diagn 2011; 31:1286-91. [DOI: 10.1002/pd.2887] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 05/11/2011] [Accepted: 09/06/2011] [Indexed: 11/07/2022]
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Usui N, Kanagawa T, Kamiyama M, Tani G, Kinugasa-Taniguchi Y, Kimura T, Fukuzawa M. Current status of negative treatment decision-making for fetuses with a prenatal diagnosis of neonatal surgical disease at a single Japanese institution. J Pediatr Surg 2010; 45:2328-33. [PMID: 21129539 DOI: 10.1016/j.jpedsurg.2010.08.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 08/12/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND/PURPOSE The termination of pregnancy because of fetal abnormalities in Japan has not been described. The aim of the present study was to analyze the current status and to evaluate the medical and ethical relevance in our institution for negative treatment decision-making for fetuses demonstrating neonatal surgical disease with a prenatal diagnosis. MATERIALS AND METHODS The medical records of 209 fetuses with a prenatal diagnosis from 1999 to 2008 were retrospectively reviewed. The cases with a negative treatment policy were analyzed according to the potential for survival. The negative treatment policies were defined as those in which the pregnancy was not actively continued, including elective termination of pregnancy and palliative or limited treatment that are primarily provided after birth. RESULTS The selected treatment policies were active in 162 cases and negative in 46 cases. Thirty-three cases with negative policies were in the second-half period of pregnancy. The potential for survival was high in 5 cases, moderate in 11 cases, and nonviable in 30 cases. Eight of the nonviable cases underwent either limited or palliative treatment, whereas the remaining 38 fetuses were aborted. CONCLUSIONS The negative treatment policies in the nonviable fetuses were considered to be medically and ethically relevant. However, the number of cases with negative policies increased over the last 5 years and is therefore associated with complex ethical issues.
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Affiliation(s)
- Noriaki Usui
- Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan.
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