Termination of Pregnancy for Medical Indications under Sec. 218a Para. 2 of the German Criminal Code – Real-life Data from the “Gießen Model”

Abstract

ABSTR ACTBackground Following the legal provisions on the termination of pregnancies in Art. 13 of the SFHG (Law on the Assistance for Pregnant Women and Families, passed on 27.07.1992, BGBl. I, p. 1398) the socalled embryopathic indication for termination was abandoned. Since then, sec. 218a para. 2 of the German Criminal Code (StGB) states that for late terminations, i.e., terminations after the 12th week of gestation post conception, the pregnant woman must be in exceptional distress "according to medical opinion".Method Between 01. 05.2012 and 25.07.2016, a total of 160 pregnancy terminations were carried out in Gießen University Hospital under sec. 218a para. 2 StGB. The following data were obtained from the patientsʼ files: age of the pregnant woman, number of pregnancies, type of fetal disease or malformation, time of diagnosis, medical and psychosocial counseling given to the pregnant woman, time of termination or delivery, type of termination, fetal gender.Results 160 pregnant women (mean age: 31.6 years) underwent termination of pregnancy between the 13th -37th week of gestation.Chromosomal anomalies were diagnosed prenatally in 60 cases, and anomalies were diagnosed on ultrasonography in 100 cases, with the preponderance of cases presenting with developmental disorders of the central nervous system and cardiovascular system. ConclusionIn addition to recording intrauterine fetal disorders, when pregnancies are terminated under sec. 218a para. 2 StGB, treating physicians are expected to give plausible reasons why "according to medical opinion" the pregnancy represents a danger to the life of the pregnant woman or of grave injury to her physical or mental health and enter these reasons in the patientʼs medical records.

Prenatal and Obstetric Parameters of Late Terminations: A Retrospective Analysis

“…In our study population, the mean time between the diagnosis and feticide was 20 days. In a review article from Gießen (n = 118) the reported interval between diagnosis and feticide was 17 days [21], which is comparable with our data. However, the mean age of gestation at Leipzig University Hospital was two weeks older (26.1 vs. 23.4 GW).…”

“…In general, administration of misoprostol resulted in delivery of the dead fetus within 17-24 hours, which corresponds to the results of our study (mean Δdelivery using misoprostol was 23.9 hours) [24 -26]. The review article from Gießen reported a mean time between the start of induction and delivery of 2.6 days, although this was after prior cervical priming with prostaglandin [21]. Use of the drug mifepristone for cervical ripening, which increases endogenous production of and sensitivity to prostaglandin, can lead to a significant reduction in the administered doses of misoprostol and ultimately to a reduction of the time between the induction of labor and the birth [3,27].…”

Klinische Angebote zum Schwangerschaftsabbruch im zweiten und dritten Trimenon – eine explorative Erhebung zur aktuellen Versorgungslage

“…Ausgestellt wurden die medizinischen Indikationen hauptsächlich von Pränatalmediziner*innen, aber auch von Humangenetiker*innen und teilweise auch Psychiater*innen (vgl. Dettmeyer et al 2017 ).…”