Elective Terminations Because of Fetal Abnormalities: Findings in A Tertiary Maternity Center Over 41 Years (1972–2012)

Finding abnormalities in a fetus by prenatal testing during pregnancy is a common reason why parents choose to terminate a pregnancy. A malformations surveillance program of all births at a tertiary center in Boston was used to identify each elective termination because of a malformation detected prenatally. A severity scale of malformations was used: lethal (anencephaly), severe-handicapping (Down syndrome; myelomeningocele), moderate-fixable (omphalocele) and mild (postaxial polydactyly, type B). Demographic characteristics and the findings in prenatal testing were recorded. Six hundred and sixty-nine elective terminations because of fetal abnormalities were identified. A destructive procedure (dilation and evacuation; D&E) was the primary method used to end the pregnancy. The gestational age at the time of termination was 18 to 19 weeks. The two most common sequences of events were: (1) imaging by ultrasound established the diagnosis; (2) imaging by ultrasound led to amniocentesis which established the diagnosis. Ninety-four percent of the abnormalities were either lethal or severe-handicapping. The discovery of a fetal abnormality was a surprise to 98% of the parents. Single women differed from married women in being younger, less well-educated, less likely to have health insurance, and more likely to terminate a pregnancy with moderate-fixable malformations.