Miremberg Hadas, Oduola Oladayo, Morrison John J, O'Donoghue Keelin
Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland (Drs Miremberg and O'Donoghue).
Department of Obstetrics and Gynaecology, Galway University Hospital, University of Galway, Galway, Ireland (Drs Oduola and Morrison).
Am J Obstet Gynecol MFM. 2023 Oct;5(10):101111. doi: 10.1016/j.ajogmf.2023.101111. Epub 2023 Jul 31.
Approximately 3% of pregnancies are diagnosed with a fetal anomaly, of which a proportion is fatal or life-limiting. The introduction of legislation for termination of pregnancy in Ireland in 2019 for conditions "likely to lead to the death of the fetus" made termination of pregnancy for "fatal fetal anomaly" an option for pregnant women in Ireland.
This study examined all cases of termination of pregnancy performed for major fetal anomaly over the first 3 years of service implementation, including cases that did not meet the legal criteria, resulting in women traveling outside Ireland for abortion care.
A retrospective service evaluation of tertiary fetal medicine clinics in 2 tertiary maternity hospitals between 2019 and 2021 was undertaken. We compared pregnancies of patients diagnosed with fatal fetal anomaly who underwent termination of pregnancy in Ireland with those of patients who did not meet the legal criteria and hence traveled outside Ireland for termination of pregnancy.
Overall, 139 pregnancies met the inclusion criteria; 83 (59.7%) patients had termination of pregnancy in the tertiary maternity hospital (local), and 56 (40.3%) traveled abroad, mainly to the United Kingdom. Demographic characteristics were similar between the 2 groups, as was gestation at diagnosis and delivery. All cases where termination of pregnancy was local were discussed at fetal medicine multidisciplinary meetings, as opposed to 34% of cases of patients who ultimately traveled outside Ireland for termination of pregnancy. The most common indication (25/83; 30.1%) for local termination of pregnancy was trisomy 18, followed by anencephaly. Traveling to obtain abortion care was mainly due to diagnosis of trisomy 21 (30/56; 53.6%), followed by other multiple structural anomalies/syndromes deemed locally as not meeting the legal criteria.
Legislation for termination of pregnancy for fetal anomaly, restricted to fatal diagnoses, is difficult to implement, requires significant multidisciplinary input, and can lead to limited services for pregnancies diagnosed with major fetal anomalies. Our findings emphasize the impact of legislative barriers to abortion care for fetal anomaly and the need for policies and services that support women's access to termination of pregnancy for fetal anomaly.
约3%的妊娠被诊断出胎儿异常，其中一部分是致命或危及生命的。2019年爱尔兰出台了关于因“可能导致胎儿死亡”的情况而终止妊娠的立法，这使得因“致命胎儿异常”而终止妊娠成为爱尔兰孕妇的一种选择。
本研究调查了服务实施的前3年中因严重胎儿异常而进行的所有终止妊娠病例，包括不符合法律标准的病例，这些病例导致妇女前往爱尔兰境外接受堕胎护理。
对2019年至2021年期间2家三级妇产医院的三级胎儿医学诊所进行了回顾性服务评估。我们将在爱尔兰接受终止妊娠的被诊断为致命胎儿异常的患者的妊娠情况与不符合法律标准并因此前往爱尔兰境外进行终止妊娠的患者的妊娠情况进行了比较。
总体而言，139例妊娠符合纳入标准；83例（59.7%）患者在三级妇产医院（当地）终止妊娠，56例（40.3%）出国，主要前往英国。两组的人口统计学特征相似，诊断时和分娩时的孕周也相似。所有在当地终止妊娠的病例都在胎儿医学多学科会议上进行了讨论，而最终前往爱尔兰境外终止妊娠的患者中，这一比例为34%。当地终止妊娠最常见的指征（25/83；30.1%）是18三体，其次是无脑儿。前往境外接受堕胎护理主要是因为诊断为21三体（30/56；53.6%），其次是其他多种结构异常/综合征，当地认为这些不符合法律标准。
仅限于致命诊断的胎儿异常终止妊娠立法难以实施，需要大量多学科投入，并且可能导致为被诊断出严重胎儿异常的妊娠提供的服务有限。我们的研究结果强调了堕胎护理的立法障碍对胎儿异常的影响，以及需要制定支持妇女因胎儿异常而获得终止妊娠服务的政策和服务。
