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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Article info
Publication history
Published online: October 10, 2014
Accepted:
October 7,
2014
Received in revised form:
October 7,
2014
Received:
July 2,
2014
Footnotes
☆Footnotes: Reprints will not be available.
☆☆Funding: Partial funding provided by Advancing New Standards in Reproductive Health, Bixby Center for Global Reproductive Health, University of California, San Francisco.
★Conflicts of interest: The authors report no conflicts of interest.
★★Disclaimer: The findings and conclusions in this article are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America, Inc.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
