Dommergues Marc
Maternité, Hôpital Necker Enfants Malades, AP-HP, 149 rue de Sèvres, 75743 Paris Cedex 15, France.
Childs Nerv Syst. 2003 Aug;19(7-8):600-4. doi: 10.1007/s00381-003-0780-7. Epub 2003 Aug 14.
Prenatal screening for fetal abnormalities may identify conditions likely to result in perinatal death or in survival with a risk of handicap, for which termination of pregnancy is legal in many countries.
When considering termination of pregnancy, it is crucial that prenatal diagnosis be as accurate as possible and that the prognosis of the condition diagnosed in utero is thoroughly understood by the parents. Our ability to predict postnatal outcome in borderline cases should not be overestimated. Parents should not precipitate their decision, and in some European countries, the absence of a gestational age limit at which a termination may be performed is viewed as a guarantee against hasty terminations. Maternal morbidity potentially associated with termination should be kept as low as possible. This includes maternal analgesia, and avoiding uterine trauma to preserve fertility and to prevent obstetrical complications in subsequent pregnancies. Bereavement should also be taken into account. Tests that could contribute to confirming the diagnosis or to establishing the aetiology of the abnormality, such as fetal karyotype or platelet count, should be implemented when appropriate, since post-termination genetic counselling relies on such data. Post-mortem examination is often crucial for genetic counselling and should include X-rays and gross examination of the fetus as well as brain and spine examination by a neuropathologist with expertise in the field of fetal medicine. Specific post-mortem procedures sometimes need to be planned before termination, for instance, in fetal akinesia sequence. First trimester surgical techniques and second or third trimester medical techniques of termination of pregnancy are reviewed.
胎儿异常的产前筛查可能会识别出可能导致围产期死亡或存活但有残疾风险的情况，在许多国家，针对这些情况终止妊娠是合法的。
在考虑终止妊娠时，至关重要的是产前诊断要尽可能准确，并且父母要充分了解子宫内诊断出的疾病的预后。我们在临界病例中预测产后结局的能力不应被高估。父母不应仓促做出决定，在一些欧洲国家，没有可进行终止妊娠的孕周限制被视为防止仓促终止妊娠的保障。与终止妊娠潜在相关的母体发病率应尽可能降低。这包括母体镇痛，并避免子宫创伤以保留生育能力并预防后续妊娠中的产科并发症。还应考虑丧亲之痛。在适当的时候应进行有助于确诊或确定异常病因的检查，例如胎儿核型或血小板计数，因为终止妊娠后的遗传咨询依赖于此类数据。尸检对于遗传咨询通常至关重要，应包括对胎儿进行X射线和大体检查，以及由胎儿医学领域的神经病理学家进行脑和脊柱检查。有时在终止妊娠前需要规划特定的尸检程序，例如在胎儿运动不能序列中。本文综述了妊娠早期终止妊娠的手术技术以及妊娠中期或晚期终止妊娠的医学技术。
