Weill Cornell Medical College, 525 East 68th Street, Room J130, New York, NY 10065, United States.
Weill Cornell Medical College, 525 East 68th Street, Room J130, New York, NY 10065, United States.
Contraception. 2020 May;101(5):293-295. doi: 10.1016/j.contraception.2020.02.002. Epub 2020 Feb 13.
To compare diagnoses in patients undergoing abortion for fetal indications at 15-0/7 to 21-6/7 vs. ≥22-0/7 weeks' gestation.
This retrospective cohort study included women undergoing abortion at ≥15-0/7 weeks' gestation for fetal indications from 2012 to 2018 at our institution. We compared indications (genetic vs. structural only) between groups by gestational age (15-0/7 to 21-6/7 vs. ≥22-0/7 weeks). We performed statistical analysis using Fisher's exact and Mann-Whitney U tests.
The 158 women identified included 97 (61.4%) at 15-0/7 to 21-6/7 and 61 (38.6%) at ≥22-0/7 weeks' gestation. Women at an earlier gestational age more commonly had an initial diagnosis of a genetic disorder (41 [42.3%)] vs.10 [16.4%], respectively, p < .001). In 69 cases with initial or subsequent diagnosis of a genetic disorder, there were differences in the types of genetic abnormalities, with common chromosomal abnormalities (including Trisomies 13, 18, and 21) the most frequent diagnosis in those who underwent abortion at 15-0/7 to 21-6/7 weeks and microarray abnormalities more common at ≥22-0/7 weeks (22 [44.9%] vs. 4 [18.2%]) and 7 [14.9%] vs. 11 [50.0%], respectively, p = .01). Routine ultrasonography for fetal anomaly surveillance occurred one week earlier in women undergoing abortion for structural anomalies at 15-0/7 to 21-6/7weeks (median 19-2/7 weeks [interquartile range (IQR) 19 0/7 to 19-5/7 weeks]) compared to ≥22-0/7 weeks (median 20-2/7 weeks [IQR 19 6/7 to 20 4/7 weeks]), p < .001.
Abortions for genetic indications are performed earlier in gestation compared to those performed for structural abnormalities. Timing of fetal anatomy ultrasound examination correlated with gestational age at abortion for structural abnormalities.
Many states impose gestational-age based abortion bans, with 20-weeks post-fertilization the most common. However, we may not identify fetal abnormalities until close to 22 weeks gestation (20-weeks post-fertilization). Optimizing timing of prenatal diagnosis might mitigate the impact of gestational-age based abortion bans.
比较因胎儿指征在 15-0/7 至 21-6/7 周与≥22-0/7 周行人工流产术的患者的诊断结果。
本回顾性队列研究纳入了 2012 年至 2018 年在我院因胎儿指征行≥15-0/7 周人工流产术的患者。我们比较了不同胎龄组（15-0/7 至 21-6/7 周与≥22-0/7 周）之间的指征（仅遗传异常与结构异常）。我们使用 Fisher 确切检验和 Mann-Whitney U 检验进行统计学分析。
共纳入 158 例患者，其中 97 例（61.4%）在 15-0/7 至 21-6/7 周，61 例（38.6%）在≥22-0/7 周。胎龄较早的患者更常见初始诊断为遗传疾病（41 例[42.3%] vs. 10 例[16.4%]，p<0.001）。在 69 例初始或后续诊断为遗传疾病的患者中，遗传异常的类型存在差异，常见染色体异常（包括 13、18 和 21 三体）在 15-0/7 至 21-6/7 周行人工流产术的患者中最常见，而微阵列异常在≥22-0/7 周更常见（22 例[44.9%] vs. 4 例[18.2%]）和 7 例[14.9%] vs. 11 例[50.0%]，p=0.01）。因结构异常在 15-0/7 至 21-6/7 周行人工流产术的患者比因结构异常在≥22-0/7 周行人工流产术的患者更早进行胎儿畸形超声筛查（中位数 19-2/7 周[四分位距（IQR）19 0/7 至 19-5/7 周] vs. 20-2/7 周[IQR 19 6/7 至 20 4/7 周]），p<0.001。
与因结构异常行人工流产术相比，因遗传指征行人工流产术的胎龄更早。胎儿结构异常行人工流产术的胎儿解剖超声检查时间与胎龄相关。
许多州都基于胎龄制定了堕胎禁令，最常见的是受精后 20 周。然而，我们可能要到接近 22 周妊娠（受精后 20 周）时才能发现胎儿异常。优化产前诊断的时机可能会减轻基于胎龄的堕胎禁令的影响。
