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Late termination of pregnancy for lethal fetal anomalies: a national survey of maternal–fetal medicine specialists

  • Adam R. Jacobs
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Science, Mt. Sinai Medical Center, 1176 5th Avenue, Klingenstein Pavilion (9th floor), New York, NY 10029, USA
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  • Gillian Dean
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Science, Mt. Sinai Medical Center, 1176 5th Avenue, Klingenstein Pavilion (9th floor), New York, NY 10029, USA

    Planned Parenthood of New York City, 26 Bleecker Street, New York, NY 10012, USA
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  • Erika J. Wasenda
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Science, Mt. Sinai Medical Center, 1176 5th Avenue, Klingenstein Pavilion (9th floor), New York, NY 10029, USA
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  • Lauren M. Porsch
    Affiliations
    Planned Parenthood of New York City, 26 Bleecker Street, New York, NY 10012, USA
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  • Erin L. Moshier
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Science, Mt. Sinai Medical Center, 1176 5th Avenue, Klingenstein Pavilion (9th floor), New York, NY 10029, USA
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  • David A. Luthy
    Affiliations
    Obstetrix Medical Group of Washington, 1229 Madison Avenue, Suite 750, Seattle, WA 98104, USA
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  • Maureen E. Paul
    Correspondence
    Corresponding author at: Beth Israel Deaconess Medical Center, Department of Obstetrics & Gynecology, KS-3, 330 Brookline Av, Boston, MA. 02215. Tel.: +1 917 208 9521(cell), +1 617 667 4165 (office); fax: +1 617 667 4173.
    Affiliations
    Department of Obstetrics, Gynecology and Reproductive Science, Mt. Sinai Medical Center, 1176 5th Avenue, Klingenstein Pavilion (9th floor), New York, NY 10029, USA

    Planned Parenthood of New York City, 26 Bleecker Street, New York, NY 10012, USA
    Search for articles by this author

      Abstract

      Objective

      The objective was to ascertain the practices and opinions of US maternal–fetal medicine specialists regarding termination of pregnancy as a management option following late diagnosis of lethal fetal anomalies.

      Study design

      We conducted a cross-sectional mail survey of all US members of the Society of Maternal Fetal Medicine to ascertain how they manage pregnancies diagnosed with lethal fetal anomalies after 24 weeks of gestation. We analyzed the proportion of respondents that discuss termination of pregnancy as a management option, barriers to offering or accessing late termination services, and respondents’ opinions about what anomalies are lethal and when pregnancy termination should be permitted.

      Results

      The response rate was 41% (869/2119). Nearly all (93%) respondents discuss delivery near term or when complications arise, while 75% discuss the option of termination of pregnancy soon after the diagnosis of lethal fetal anomalies. Only 52% of the physicians indicated that their patients could obtain termination of pregnancy after 24 weeks at their affiliated medical centers or through providers within 50 miles. Real or perceived legal restrictions represented the most common reason for lack of local services. The proportion of respondents that felt strongly or very strongly that termination of pregnancy should be allowed was 76% for lethal anomalies and 58% for anomalies likely to result in significant long-term impairment.

      Conclusion

      Although limited by a modest response rate, our study found that physicians do not consistently discuss immediate termination of pregnancy as an option following late diagnosis of lethal fetal anomalies, and they face numerous barriers to providing these services.

      Implications

      This national survey supports the need for improved services for pregnant women who desire later termination of pregnancy following diagnosis of serious fetal anomalies. Helpful efforts might include educating physicians about the laws and regulations governing late termination of pregnancy, forging more consistent standards of care, and improving collaboration between MFM specialists and family planning providers to enhance access to care.

      Keywords

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