Late Termination of Pregnancy: A Retrospective Evaluation of 243 Pregnancies In A Tertiary Medical Center

Abstract

Objective: This study aims to assess changes in the indications for late termination of pregnancy performed after 24 weeks of gestation over the years. Material and Methods: We performed a retrospective analysis of a cohort who requested late termination of pregnancy after a diagnosis of fetal abnormality at the Department of Obstetrics and Gynecology, Akdeniz University Faculty of Medicine, between January 2007 and December 2022. The cases were divided into two groups with 8-year time intervals: Group 1 spanning from January 2007 to December 2014, and Group 2 spanning from January 2015 to December 2022. Results: A total of 243 cases were evaluated in the analysis, with 127 (52.3%) cases in Group 1 and 116 (47.7%) cases in Group 2. Over the past sixteen years, the most frequent reasons for late termination of pregnancy involving fetuses were central nervous system malformations (43.2%), cardiovascular system anomalies (17.3%), and chromosomal abnormalities (11.1%). A significant increase was noted over the course of time in the percentage of instances presenting cardiovascular system anomalies and chromosomal abnormalities (p<0.05). Conclusion: This analysis provides insight into the causes of late termination of pregnancy. Especially in the third trimester, central nervous system anomalies are an important cause of late termination of pregnancy. In addition to standard second-trimester anatomical scanning, limited first-trimester anatomical scanning and third-trimester neurosonogram will contribute to the diagnosis of fetal anomalies. In conclusion, expanding screening strategies will also reduce the need for late termination of pregnancy due to fetal abnormalities.

Keywords

• Congenital malformation
• fetal death
• feticide
• termination of pregnancy

Gebeliğin Geç Sonlandırılması: Üçüncü Basamak Bir Tıp Merkezinde 243 Gebeliğin Retrospektif Olarak Değerlendirilmesi

Öz

ÖZ Amaç: Bu çalışma, 24. gebelik haftasından sonra yapılan geç gebelik terminasyonu endikasyonlarının yıllar içindeki değişimini değerlendirmeyi amaçlamıştır. Gereç ve Yöntemler: Akdeniz Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Anabilim Dalı'nda Ocak 2007 ile Aralık 2022 tarihleri arasında fetal anormallik tanısı sonrası geç gebelik terminasyonu talep eden bir kohort retrospektif olarak değerlendirildi. Olgular 8 yıllık zaman aralıklarındaki vakaları içeren iki gruba ayrıldı: Ocak 2007'den Aralık 2014'e kadar olan olgular Grup 1 ve Ocak 2015'ten Aralık 2022'ye kadar olan olgular Grup 2 olarak tanımlandı. Bulgular: Analizde Grup 1'de 127 (%52,3) ve Grup 2'de 116 (%47,7) olmak üzere toplam 243 vaka değerlendirildi. Son on altı yılda geç gebelik terminasyonun en sık nedenleri MSS (merkezi sinir sistemi) anomalileri (%43,2), kardiyovasküler sistem anomalileri (%17,3) ve kromozomal anormalliklerdi (%11,1). Yıllar içinde kardiyovasküler sistem anomalileri ve kromozomal anormallikleri olan vakaların yüzdesinde dikkate değer bir artış gözlendi (p<0.05). Sonuç: Bu çalışma, gebeliğin geç terminasyon endikasyonlarının yıllar içindeki değişimine ilişkin bilgiler vermektedir. Özellikle üçüncü trimesterde, MSS anomalileri geç gebelik terminasyonunun önemli bir nedenidir. Standart ikinci trimester anatomik taramaya ilave olarak kısıtlı birinci trimester anatomik tarama ve üçüncü trimester nörosonogramı fetal anomalilerin tanısına katkı sağlayacaktır. Sonuç olarak; tarama stratejilerinin yaygınlaştırılması fetal anormallikler nedeniyle gebeliğin geç sonlandırılmasına olan ihtiyacı da azaltacaktır.

Anahtar Kelimeler

• Konjenital malformasyon
• fetal ölüm
• fetisit
• gebeliğin sonlandırılması

Kaynakça

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