Fetal indications for selective termination to a singleton pregnancy over 10 years – A retrospective single-center cohort study

Main Question:

Is there a trend in time regarding fetal indications leading to selective termination of a singleton pregnancy (feticide) over the last 10 years?

Methods:

Retrospective cohort study.

Results:

Between 2007 and 2017, 146 elective terminations to singleton pregnancies were performed at our institution. Due to lacking information 40 cases were excluded, hence the eligible study cohort comprised in total 104 cases of feticides, 52 (50%) of which were performed between 2007 – 2012 (time period 1) and another 52 (50%) were performed in 2013 – 2017 (time period 2). Between 2007 – 2012, the three most common Indications for feticide were complex fetal malformations involving two or more independent organ systems or syndromes (n = 28; 53.8%), isolated brain malformations (n = 7, 13.5%) and isolated heart malformations (n = 7; 13.5%). Further indications were respiratory abnormalities (n = 5; 9.6%), urogenital malformations (n = 2; 3.8%), gastrointestinal abnormalities (n = 1; 1.9%), skeletal disorders (n = 1; 1.9%) and spina bifida (n = 1; 1.9%). Between 2013 – 2017, the most common Indications for feticide were isolated brain malformations (n = 27, 51.9%), complex malformations or syndromes (n = 10; 19.2%) and isolated heart malformations (n = 9; 17.3%), followed by musculoskeletal disorders (n = 5; 9.6%) and isolated malformation of the extremities (n = 1; 1.9%). Within time period 1 and 2, mean age of mothers was 31 ± 0.93 years and 30.04 ± 0.77 years, respectively (p = 0.43). Mean gestational age at time of feticide was 26.08 ± 0.55 gestational weeks and 25.18 ± 0.42 gestational weeks (p = 0.19). No prevalence of fetal sex was seen in time (p = 0.71), nor a trend of fetal weight (980.8 ± 74.7 versus 895.4 ± 63.08; p = 0.38).

Conclusion:

While isolated heart malformations have remained the third most common indication for feticide at our department over the last ten years, selective termination of a singleton pregnancy has become significantly more frequent for isolated brain malformations.