Edling Agnes, Lindström Linda, Bergman Eva
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Acta Obstet Gynecol Scand. 2021 Dec;100(12):2202-2208. doi: 10.1111/aogs.14230. Epub 2021 Jul 23.
Two-thirds of induced abortions after gestational week (gw) 18 are performed due to fetal anomalies. The potential of the fetus to survive outside the uterus after birth is the upper limit for induced abortions in Sweden. Due to advances in neonatal medicine, fetal viability and the upper limit of late induced abortions have been converging over the last few decades. The aim of the study was to examine clinical management of fetal anomalies, including time frames, leading to second trimester abortions.
All induced abortions due to fetal anomalies after gw 11+6 in Uppsala county, Sweden, from 2010 to 2017, were reviewed from electronic medical records in a retrospective descriptive study. In total, 180 women underwent 185 abortions divided into 107 (57.8%) in an early group (gw 12+0 to 18+0), and 78 (42.2%) in a late group (≥ gw 18+1). Examinations performed were genetic testing, fetal echocardiography, magnetic resonance imaging (MRI) and pediatric counseling. Time frames from suspicion of fetal anomaly to abortion were reviewed.
Anomalies were subdivided into groups of diagnosis: chromosomal (n = 104), central nervous system (n = 22), heart (n = 12), urinary tract (n = 10) and others (n = 37). Chromosomal anomaly was present in 82 (76.6%) in the early group and 22 (28.2%) in the late group. In the early group, examinations performed preceding a conclusive diagnosis were mainly QF-PCR for trisomies (n = 97), microarray (n = 13), and genetic counseling (n = 14). In the late group, trisomy test was performed in 68, microarray in 31, MRI in 24, fetal echocardiography in 28, and pediatric or genetic counseling in 43 and six cases, respectively. Mean time interval from suspicion of fetal anomaly to the woman's decision was 5 days before gw 18+1, 7 days in gw 18, and 13 days in gw 21. More than two examinations before reaching the decision to terminate the pregnancy were needed in two abortions (25.0%) in gw 18, increasing to 16 (80.0%) in gw 21.
Increasing complexity and diversity in fetal diagnoses require time-consuming examinations in late-induced abortions compared with earlier gestational weeks. A structured expedient process is necessary to allow for decision time and minimize terminations approaching the legal limit.
妊娠18周（gw）后进行的人工流产中有三分之二是由于胎儿畸形。胎儿出生后在子宫外存活的可能性是瑞典人工流产的上限。由于新生儿医学的进步，在过去几十年中，胎儿的生存能力和晚期人工流产的上限一直在趋同。本研究的目的是检查导致孕中期流产的胎儿畸形的临床管理，包括时间框架。
在一项回顾性描述性研究中，从电子病历中回顾了2010年至2017年瑞典乌普萨拉郡妊娠11 + 6周后因胎儿畸形而进行的所有人工流产。共有180名妇女进行了185次流产，分为早期组（妊娠12 + 0至18 + 0周）107例（57.8%）和晚期组（≥妊娠18 + 1周）78例（42.2%）。进行的检查包括基因检测、胎儿超声心动图、磁共振成像（MRI）和儿科咨询。回顾了从怀疑胎儿畸形到流产的时间框架。
畸形被细分为诊断组：染色体异常（n = 104）、中枢神经系统（n = 22）、心脏（n = 12）、泌尿系统（n = 10）和其他（n = 37）。早期组中82例（76.6%）存在染色体异常，晚期组中22例（28.2%）存在染色体异常。在早期组中，在最终诊断之前进行的检查主要是用于三体检测的QF-PCR（n = 97）、微阵列分析（n = 13）和遗传咨询（n = 14）。在晚期组中，分别有68例进行了三体检测，31例进行了微阵列分析，24例进行了MRI检查，28例进行了胎儿超声心动图检查，43例和6例分别进行了儿科或遗传咨询。从怀疑胎儿畸形到妇女做出决定的平均时间间隔在妊娠18 + 1周之前为5天，妊娠18周时为7天，妊娠21周时为13天。在妊娠18周的两次流产（25.0%）中，在做出终止妊娠的决定之前需要进行两次以上的检查，在妊娠21周时这一比例增加到16例（80.0%）。
与妊娠早期相比，胎儿诊断的复杂性和多样性增加，导致晚期人工流产需要进行耗时的检查。需要一个结构化的便捷流程，以便有决策时间，并尽量减少接近法定极限的终止妊娠情况。
