Guillem P, Fabre B, Cans C, Robert-Gnansia E, Jouk P S
Registre des Handicaps de l'Enfant et Observatoire Périnatal, Grenoble, Cedex, France.
Prenat Diagn. 2003 Nov;23(11):877-83. doi: 10.1002/pd.711.
This study was performed in order to provide a description of indications for induced elective terminations of pregnancy (ETOP), their characteristics (e.g. gestational age), and their evolution over time.
This is an epidemiological study. The geographic area covered is the French county of 'Isère', which represents a mean of 14 000 births per year over the study period.
Data on ETOPs were collected actively from medical records by a register of childhood deficiencies and adverse perinatal events in this county. Between 1989 and 2000, 996 ETOPs were notified.
Four main grounds for ETOPs were identified: (1) morphological anomalies with normal karyotype (39%), (2) chromosomal anomalies (35%), (3) other fetal grounds (16%), and (4) maternal indications (10%). Prevalence rates for the first two grounds increased significantly over the study period respectively from 2.0 to 2.9 and from 1.4 to 2.7 per 1000. Among the ETOPs carried out because of fetal indications, the percentage of late ETOPs (from 24 weeks of gestation) was 34.6%, and remained stable over the studied period. In some cases, a medical consensus was not reached with respect to indications for termination (sex chromosome anomalies, limb defects). We estimated the percentage of these cases as being 2.7% of the figure for fetal indications, without any variation in prevalence over the whole period (p = 0.59). The increasing number of ETOPs that occurred in the chromosomal aberrations group during the study period is thought to be due to an increase in diagnostic sensitivity. The increase that occurred in the morphological anomalies group is thought to be due both to an increase in sensitivity and to a widening of the field with respect to indications, some of which have an uncertain prognosis (e.g. agenesis of the corpus callosum).
This study provides useful data for monitoring medical practice consistency within the field of prenatal diagnosis, and for the drive to keep medical practice within ethically acceptable limits.
开展本研究以描述选择性引产（ETOP）的指征、其特征（如孕周）以及随时间的演变情况。
这是一项流行病学研究。所涵盖的地理区域为法国伊泽尔省，在研究期间该地区平均每年有14000例分娩。
通过该省儿童缺陷和围产期不良事件登记册，从医疗记录中主动收集ETOP的数据。1989年至2000年期间，共通报了996例ETOP。
确定了ETOP的四个主要原因：（1）核型正常的形态学异常（39%），（2）染色体异常（35%），（3）其他胎儿原因（16%），以及（4）母亲指征（10%）。在前两个原因中，患病率在研究期间显著增加，分别从每1000例中的2.0例增至2.9例，以及从1.4例增至2.7例。在因胎儿指征进行的ETOP中，晚期ETOP（妊娠24周起）的比例为34.6%，在研究期间保持稳定。在某些情况下，对于终止妊娠的指征（性染色体异常、肢体缺陷）未达成医学共识。我们估计这些病例占胎儿指征病例数的2.7%，在整个期间患病率无变化（p = 0.59）。研究期间染色体畸变组中ETOP数量的增加被认为是由于诊断敏感性的提高。形态学异常组中出现的增加被认为是由于敏感性的提高以及指征范围的扩大，其中一些指征预后不确定（如胼胝体发育不全）。
本研究为监测产前诊断领域内医疗实践的一致性以及推动将医疗实践保持在道德可接受范围内提供了有用数据。
