Termination of pregnancy due to fetal central nervous system abnormalities performed after 24 weeks’ gestation: survey of 57 fetuses from a single medical center

Melcer, Yaakov; Maymon, Ron; Haratz, K.K.; Goldrat, Ittai; Shavit, Maya; Ben‐Ami, Ido; Vaknin, Zvi

doi:10.1007/s00404-018-4836-z

Cited by 8 publications

(13 citation statements)

References 30 publications

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“…The medical files and pathological reports, of all pregnancy's terminations because of fetal congenital malformations, from January 2009 to December 2017, in the Obstetrics and Gynecology department, at Edith Wolfson Medical Center, in Holon, Israel, were reviewed. All TOPs were conducted based on a medical indication according to Israel law . The group with fetal cardiac defects (CHD group) included only isolated CHDs cases with the following malformations: hypoplastic left heart, transposition of great arteries, A‐V canal, tetralogy of Fallot, double outlet right ventricle (RV), and coractation of aorta.…”

Section: Methodsmentioning

confidence: 99%

The association between severe fetal congenital heart defects and placental vascular malperfusion lesions

et al. 2019

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Objective:Studies have shown an association between infant with congenital heart defects (CHD) and the risk of preeclampsia. We aimed to characterize placental histopathology from pregnancies who underwent termination of pregnancy (TOP) because of severe CHD. Methods:This was a case control study. The medical files of all TOPs due to fetal congenital malformations were reviewed. Cases with CHD included hypoplastic left heart, transposition of great arteries, AV canal, tetralogy of Fallot, double outlet RV, and coractation of aorta. The controls included TOPs due to congenital central nervous system defects (CNS group) that were matched in a 1:1 ratio, by gestational age and maternal age. Placental lesions were classified to maternal and fetal vascular malperfusion (MVM and FVM) and inflammatory lesions. Results:Higher rates of any MVM or FVM lesion were observed in placentas from the CHD group (n = 32) as compared with the CNS group (n = 32), 40.6% versus 12.5% respectively, p = .02. As compared with the CNS group, the CHD group had more abnormal coiling of umbilical cord (p = .01). Conclusion:Placental vascular malperfusion lesions are more common in pregnancies complicated with CHD as compared with CNS malformations. These findings support the hypothesis of similar etiopathogenetic factors, contributing to the development of preeclampsia and CHD.Note. Data presented as mean ± standard deviation, median (range), or number (rate) as appropriate.

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Section: Methodsmentioning

confidence: 99%

The association between severe fetal congenital heart defects and placental vascular malperfusion lesions

et al. 2019

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“…2,56,[60][61][62] Cooperation between ultrasonographers and pathologists is of great value. However, studies show that autopsy rates are low, 28,29 and according to Boyd et al, 63 the percentage of fetuses that underwent autopsy fell from 84% to 67% throughout the 90s. We found in our study an average autopsy rate of 88.8% during the 30-year period, in which 1029 of 1157 fetuses with congenital anomalies were examined postmortem after TOP.…”

Section: Discussionmentioning

confidence: 99%

“…26 The gestational age (GA) at TOP is often related to the type of anomaly, such as earlier terminations in cases of NTDs compared to later terminations of vermian anomalies as Dandy-Walker malformation (DWM). [27][28][29] There are few studies focusing on CNS anomalies in perinatal autopsy populations. [2][3][4][28][29][30][31] In this study, the aim was to investigate the distribution of CNS anomalies with associated anomalies and karyotype in an autopsy material of terminated fetuses over a 30-year period and to correlate the prenatal ultrasonographic diagnoses of CNS anomalies with autopsy findings.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…There are few studies focusing on CNS anomalies in perinatal autopsy populations. 2–4,28–31 In this study, the aim was to investigate the distribution of CNS anomalies with associated anomalies and karyotype in an autopsy material of terminated fetuses over a 30-year period and to correlate the prenatal ultrasonographic diagnoses of CNS anomalies with autopsy findings.…”

Section: Introductionmentioning

confidence: 99%

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Autopsy Findings of Central Nervous System Anomalies in Intact Fetuses Following Termination of Pregnancy After Prenatal Ultrasound Diagnosis

2019

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Objectives Central nervous system (CNS) anomalies are the second most frequent category of congenital anomalies after congenital heart defects (CHDs). In this study, the aim was to investigate the distribution of different CNS anomalies with associated anomalies and karyotype in a fetal autopsy population of terminated pregnancies over a 30-year period and to correlate the ultrasonographic diagnoses of CNS anomalies with autopsy findings. Materials and Methods This study includes 420 intact fetuses with CNS anomalies terminated at gestational ages 11+ 0 to 33+ 6 over a 30-year period from 1985 to 2014. An ultrasound (US) examination was performed at the National Centre for Fetal Medicine, St. Olavs Hospital, Trondheim. The autopsies were performed at the Department of Pathology at the same hospital or a collaborating hospital. The anomalies were subcategorized according to the classification by the World Health Organization. Results Neural tube defects such as anencephaly (22.4%, 107/477) and spina bifida (22.2%, 106/477) constituted the most common CNS anomalies, followed by congenital hydrocephalus (17.8%, 85/477). In total, the karyotype was abnormal in 21.0% of all termination of pregnancies (TOPs), with trisomy 18 as the most frequent abnormal karyotype. CHDs, skeletal anomalies, and urinary anomalies were the most common associated organ anomalies. Throughout the study period, there was full agreement between US and postmortem findings of CNS anomalies in 96.9% (407/420) of TOPs. Conclusion In this study of autopsy findings of CNS anomalies in intact fetuses terminated after prenatal US diagnosis, neural tube defects were most common. About half of the fetuses had isolated serious CNS anomalies, while the other half were CNS anomalies associated with structural and/or chromosomal anomalies. The prenatal US diagnoses were in good concordance with autopsy findings. In particular, due to challenges of diagnoses made early in pregnancy, it is necessary to continue the validation practice.

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The influence of the introduction of a national prenatal screening program on late termination of pregnancy, a retrospective cohort study

et al. 2023

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Objective: To assess the influence of a national prenatal screening program on category 1 (lethal anomalies) late terminations of pregnancy (LTOP). Methods:In this population-based retrospective cohort study, we included all category 1 LTOPs from 2004 to 2015 in the Netherlands. The number of LTOPs before and after the introduction of the program was compared as well as the diagnostic process and factors contributing to LTOP. Results:In total, 97 LTOPs were reported. After the introduction of the program, the number of LTOPs decreased from 17 per year to 5 per year on average. The number of cases in which the diagnostic process started with obstetric indications decreased from 55% to 17% (p < 0.01) and the number of cases detected by routine screening increased from 11% to 52% (p < 0.01). Four factors still contributed to LTOP after the introduction of the screening program: diagnostic or parental delay (40%), absence of screening (24%), false negative results of prior screening (14%) and late onset of disease (12%). Conclusion:The number of LTOPs decreased after the introduction of the screening program. At present, the diagnostic process is mostly screening driven. Parentaland diagnostic delay is still an important factor that contributes to LTOP. Key points What's already known about this topic?� Prenatal detection of structural anomalies by fetal ultrasound has increased tremendously.� Early termination of pregnancy (TOP) is associated with lower levels of grief and less maternal mortality.� Termination of pregnancy has been accepted in the Netherlands since 1984 up to the gestational age (GA), where a newborn can be expected to independently survive outside the uterus. This is currently up to 23 weeks and 6 days of gestation.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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Termination of pregnancy due to fetal central nervous system abnormalities performed after 24 weeks’ gestation: survey of 57 fetuses from a single medical center

Cited by 8 publications

References 30 publications

The association between severe fetal congenital heart defects and placental vascular malperfusion lesions

The association between severe fetal congenital heart defects and placental vascular malperfusion lesions

Autopsy Findings of Central Nervous System Anomalies in Intact Fetuses Following Termination of Pregnancy After Prenatal Ultrasound Diagnosis

The influence of the introduction of a national prenatal screening program on late termination of pregnancy, a retrospective cohort study

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