Different Policies on Prenatal Ultrasound Screening Programmes and Induced Abortions Explain Regional Variations in Infant Mortality with Congenital Malformations

Garne, Ester; Berghold, Andrea; Johnson, Z.; Stoll, Claude

doi:10.1159/000053901

Cited by 12 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…We described differences in policies about screening and TOP for each region using existing EUROCAT publications 1,[5][6][7]12 and information provided by the MOSAIC regional teams. Information collected included whether TOP were carried out for fetal anomalies, the presence of universal ultrasound screening for structural anomalies, the timing of the structural anomaly scan, the limit for carrying out TOP and whether or not TOP were registered in similar ways as other births in national birth registers.…”

Section: Methodsmentioning

confidence: 99%

“…National policies relating to antenatal screening and terminations of pregnancy (TOP) are one source of variation between populations of very preterm births and are known to affect overall perinatal and neonatal mortality. [1][2][3][4] European countries have varied policies and practices related to screening for congenital anomalies (CAs) during the second trimester of pregnancy. [5][6][7] In some countries without legal TOP for fetal anomalies, no routine ultrasound screening is carried out.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population‐based cohorts in the MOSAIC study

Papiernik

Zeitlin

Delmas

et al. 2008

BJOG

View full text Add to dashboard Cite

Objective To study the impact of terminations of pregnancy (TOP) on very preterm mortality in Europe.Design European prospective population-based cohort study.Setting Ten regions from nine European countries participating in the MOSAIC (Models of OrganiSing Access to Intensive Care for very preterm babies) study. These regions had different policies on screening for congenital anomalies (CAs) and on pregnancy termination.Population or sample Births 22-31 weeks gestational age.Methods The analysis compares the proportion of TOP among very preterm births and assesses differences in mortality between the regions.Main outcome measures Pregnancy outcomes (termination, antepartum death, intrapartum death and live birth) and reasons for termination, presence of CAs and causes of death for stillbirths and live births in 2003.Results Pregnancy terminations constituted between 1 and 21.5% of all very preterm births and between 4 and 53% of stillbirths. Most terminations were for CAs, although some were for obstetric indications (severe pre-eclampsia, growth restriction, premature rupture of membranes). TOP contributed substantially to overall fetal mortality rates in the two regions with late second-trimester screening. There was no clear association between policies governing screening and pregnancy termination and the proportion of CAs among stillbirths and live births, except in Poland, where neonatal deaths associated with CAs were more frequent, reflecting restrictive pregnancy termination policies.Conclusion Proportions of TOP among very preterm births varied widely between European regions. Information on terminations should be reported when very preterm live births and stillbirths are compared internationally since national policies related to screening for CAs and the legality and timing of medical terminations differ.

show abstract

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population‐based cohorts in the MOSAIC study

Papiernik

Zeitlin

Delmas

et al. 2008

BJOG

View full text Add to dashboard Cite

show abstract

“…Terminations of pregnancy for congenital anomalies were excluded because it is known that “late” terminations of this type are more common in France 10. Although this practice clearly influences perinatal mortality rates,11 we wished to focus on the care of the normally formed baby born preterm. Therefore, we also excluded live born infants with lethal congenital anomalies.…”

Section: Methodsmentioning

confidence: 99%

Mortality patterns among very preterm babies: a comparative analysis of two European regions in France and England

Draper

Zeitlin

Field

et al. 2007

Archives of Disease in Childhood - Fetal and Neonatal Edition

View full text Add to dashboard Cite

The high rate of very preterm deliveries and the larger proportion of these infants recorded as live born in Trent appear to be the cause of the excess neonatal mortality seen in the routine statistics. Information about very preterm babies (not usually included in routine statistics) is vital to avoid inappropriate interpretation of international perinatal and infant data. This study highlights the importance of including deaths before transfer to neonatal care and emphasises the need to include the outcome of all pregnancies in a population in any comparative analysis.

show abstract

“…More recent European data has confirmed major differences in detection rates between different European countries and emphasized the importance of noncardiac malformations and karyotypic abnormalities in prenatal detection rates and parental decision-making. [6–8]…”

Section: Impact Of Fetal Echocardiography On Prevalence Of Congenitalmentioning

confidence: 99%

Impact of fetal echocardiography

Simpson

2009

Ann Pediatr Card

View full text Add to dashboard Cite

Prenatal diagnosis of congenital heart disease is now well established for a wide range of cardiac anomalies. Diagnosis of congenital heart disease during fetal life not only identifies the cardiac lesion but may also lead to detection of associated abnormalities. This information allows a detailed discussion of the prognosis with parents. For continuing pregnancies, appropriate preparation can be made to optimize the postnatal outcome. Reduced morbidity and mortality, following antenatal diagnosis, has been reported for coarctation of the aorta, hypoplastic left heart syndrome, and transposition of the great arteries. With regard to screening policy, most affected fetuses are in the “low risk” population, emphasizing the importance of appropriate training for those who undertake such obstetric anomaly scans. As a minimum, the four chamber view of the fetal heart should be incorporated into midtrimester anomaly scans, and where feasible, views of the outflow tracts should also be included, to increase the diagnostic yield. Newer screening techniques, such as measurement of nuchal translucency, may contribute to identification of fetuses at high risk for congenital heart disease and prompt referral for detailed cardiac assessment.

show abstract

Different Policies on Prenatal Ultrasound Screening Programmes and Induced Abortions Explain Regional Variations in Infant Mortality with Congenital Malformations

Cited by 12 publications

References 19 publications

Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population‐based cohorts in the MOSAIC study

Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population‐based cohorts in the MOSAIC study

Mortality patterns among very preterm babies: a comparative analysis of two European regions in France and England

Impact of fetal echocardiography

Contact Info

Product

Resources

About