Termination of pregnancy for maternal indications at the limits of fetal viability: a retrospective cohort study in the Dutch tertiary care centres

Abstract

ObjectiveMaternal morbidity, either pregnancy related or pre-existent, can become life threatening and of such severity as to warrant termination of pregnancy (TOP). In this situation, chances of fetal survival are usually poor, either because of low gestational age and/or because of the fetal effects of the maternal condition. Examples include severe growth restriction in pre-eclampsia and intrauterine infection due to the very early preterm prelabour rupture of membranes. There are very few reports on the prevalence of TOP for maternal indication at the limits of fetal viability. We investigated the prevalence of and indications for TOP on maternal indication in the 10 tertiary care centres in the Netherlands during the past decade.Study designWe conducted a retrospective review of the medical records of all women who underwent TOP for maternal indications between 22 and 27 completed weeks of gestation in all 10 tertiary care centres from 2000 to 2009.ResultsDuring the study period, there were 1 929 470 deliveries; 163 052 (8.4%) of these took place in one of the 10 tertiary care centres and 177 pregnancies were terminated for severe maternal disease, 131 for hypertensive disorders, 29 for intrauterine infection and 17 for other reasons. The mean gestational age at TOP was 171 days (243/7)±10 days. No maternal deaths were recorded. The overall perinatal mortality was 99.4%.ConclusionsOver a 10-year period, TOP for maternal indications was performed in 1 in 1000 deliveries in the 10 Dutch tertiary care centres. Hypertensive disorders comprised three-quarters of the cases.

Subsequent pregnancy outcome after mid‐trimester termination of pregnancy for preeclampsia

“…Termination of pregnancy was defined as termination of a vital pregnancy and intention of primary non‐intervention for fetal indications. In all cases the fetus was considered to be non‐viable, because of the periviable gestational age with concomitant severe growth restriction . Exclusion criteria for this study were TOP for other maternal indications, fetal congenital anomalies or intra‐uterine fetal demise prior to the decision to terminate the pregnancy.…”

Effects of Single-Nucleotide Polymorphisms in Cytokine, Toll-Like Receptor, and Progesterone Receptor Genes on Risk of Miscarriage

“…Even after conducting a thorough examination, in more than 50% of cases, the cause of pregnancy loss remains unknown, and therapeutic measures aimed at diagnosing the cause of miscarriage are not always effective [ 1 ]. Pregnancy loss is considered a multifactorial pathology [ 2 – 4 ], and study of the genetic factors that can act as prerequisites for miscarriage is a promising direction of personalized medicine aimed at prevention of various obstetric complications [ 5 ].…”

New Approaches for Managing Preeclampsia: Clues From Clinical and Basic Research

“…1 While better obstetrical care has lessened the maternal mortality associated with preeclampsia, it remains a leading cause of peripartum mobidity, and hypertensive disorders, primarily preeclampsia, are a major cause pregnancy termination prior to term due to life threatening symptoms in the mother. 2 A number of risk factors have been implicated as being significant for the development of preeclampsia including elevated BMI, primiparity, multiparity, and ethinicity. 3–5 However, despite the identification of these factors, the underlying cause of the disorder remains elusive.…”