1
|
Terece C, Turan G, Uckan HH, Eser A, Ozler MR, Gunbay S, Taner MZ. The analysis of pregnancies terminated before and after the limit of viability: A medicolegal view. J Forensic Leg Med 2023; 95:102491. [PMID: 36758309 DOI: 10.1016/j.jflm.2023.102491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 01/30/2023] [Accepted: 02/02/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE In the present study, the purpose was to determine the indications of pregnancy termination procedures that are performed before and after the limit of viability (between 10 and 22 weeks) in a tertiary center and to investigate the characteristics of the cases in which fetocide procedure was offered after the limit of viability (22 weeks and later). It also aimed to discuss the legal deadline for the fetocide procedure and legal aspect of pregnancy termination. MATERIAL AND METHOD The present study was conducted as a result of the retrospective examination of 198 cases who underwent pregnancy termination after the 10th week of pregnancy (the legal limit for voluntary termination of pregnancy in our country) in our clinic and met the study criteria. The cases were divided into two main groups as Early Termination (10-22 weeks) and Late Termination (22 weeks and later). The characteristics of these groups (i.e. reason for termination, termination week) and the characteristics of the cases in which fetocide procedure was performed and the cases that were not (i.e. termination week, reasons for termination) were compared. RESULTS A total of 171 (86%) cases were under 22 weeks and 27 (14%) were 22 weeks or more. In the cases terminated early, the gestational week was found to be highest [20 + 1 (12+3-21 + 1)] in those with preterm premature rupture of membranes, and lowest in those with fetal gastrointestinal abnormalities. No statistically significant differences were detected between the termination reason and the gestational week in the late-terminated group, and also, although the termination week of 5 patients for whom the fetocide procedure was offered [median = 23 + 1 (22+4-26 + 0] was higher than the week of 22 patients for whom the fetocide procedure was not offered [median = 22 + 4 (22+1-25 + 4], the difference was not found to be statistically significant. CONCLUSION Since the majority of pregnancy terminations are performed before the viable period, the need for the fetocide procedure in pregnancy terminations is relatively low, and we think that this rate will decrease even more because the rate of early diagnosis of fetal anomalies increases as a result of developments in ultrasonographic imaging. Families who choose the termination of pregnancy search for other countries with appropriate legislation and the loss of time and the indecision of the family might cause the application of pregnancy termination after the viable period because of the limitations in the legal regulations of countries.
Collapse
Affiliation(s)
- Cem Terece
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Gokce Turan
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Hasan Hüseyin Uckan
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Ayla Eser
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Mustafa Rasit Ozler
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Suheda Gunbay
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| | - Mehmet Zeki Taner
- Gazi University, Faculty of Medicine, Department of Obstetrics and Gynecology, Ankara, Turkey.
| |
Collapse
|
2
|
Fisher SA, Miller ES, Yee LM, Grobman WA, Premkumar A. Universal First-Trimester Cytomegalovirus Screening and Valaciclovir Prophylaxis in Pregnant Persons: A Cost-Effectiveness Analysis. Am J Obstet Gynecol MFM 2022; 4:100676. [PMID: 35714861 DOI: 10.1016/j.ajogmf.2022.100676] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 06/10/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Recent studies suggest a possible benefit of valaciclovir prophylaxis to prevent vertical transmission after a positive serologic screen for primary maternal cytomegalovirus infection during pregnancy, although its cost-effectiveness remains uncertain. OBJECTIVE We sought to determine the circumstances under which universal first-trimester maternal serologic screening for maternal cytomegalovirus infection, with valaciclovir prophylaxis to prevent congenital cytomegalovirus, is cost-effective. STUDY DESIGN We performed a decision analysis from the perspective of the pregnant person to assess whether universal maternal screening in the first trimester, with subsequent valaciclovir prophylaxis (8g/day from time of positive serologic screen for primary maternal cytomegalovirus infection through 21 weeks' gestation) for those who are acutely infected, is cost-effective compared to usual care (i.e., no routine serologic screening, but amniocentesis if mid-trimester sonographic findings suggest cytomegalovirus). For baseline estimates, we assumed a 35% risk of congenital cytomegalovirus after primary maternal infection and a 71% risk reduction with valaciclovir. We varied valaciclovir's efficacy to identify whether and at what threshold universal screening would be estimated to be cost-effective, compared to usual care. Monte Carlo analyses were performed. A willingness-to-pay threshold of $100,000/quality-adjusted life year was used to define cost-effectiveness. RESULTS Under base-case estimates, first-trimester universal screening and valaciclovir prophylaxis for seropositive pregnant persons with acute cytomegalovirus infection is not cost-effective, with a cost of $137,854 per maternal QALY, but results in 14 fewer cytomegalovirus-affected children per 100,000 pregnancies compared to usual care. In one-way sensitivity analysis, universal screening and treatment is estimated to be the cost-effective strategy if the incidence of primary maternal cytomegalovirus infection exceeds 2.6%, baseline risk of vertical transmission of cytomegalovirus without prophylaxis is greater than 36.8%, and the risk reduction of vertical transmission of cytomegalovirus with valaciclovir prophylaxis exceeds 75.9%. In Monte Carlo analyses, first-trimester universal serologic screening with valaciclovir prophylaxis is estimated to be the cost-effective strategy in 46.8% of runs. CONCLUSION Universal first-trimester serologic screening with valaciclovir prophylaxis is not the cost-effective strategy for antenatal management of cytomegalovirus under the base-case estimates. Although universal screening is cost-effective in certain circumstances when the efficacy of valaciclovir exceeds the base case, that result is not robust to variation of estimates across their reasonable ranges. These data can inform future studies to evaluate screening and treatment to prevent congenital CMV.
Collapse
Affiliation(s)
- Stephanie A Fisher
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Emily S Miller
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - Lynn M Yee
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - William A Grobman
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, The Ohio State University College of Medicine, Cleveland, Ohio.
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
| |
Collapse
|
3
|
Deng L, Liu Y, Yuan M, Meng M, Yang Y, Sun L. Prenatal diagnosis and outcome of fetal hyperechogenic kidneys in the era of antenatal next-generation sequencing. Clin Chim Acta 2022; 528:16-28. [DOI: 10.1016/j.cca.2022.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 12/22/2021] [Accepted: 01/18/2022] [Indexed: 01/19/2023]
|
4
|
Igel CM, Rabin-Havt S, Estrada Trejo F, Doulaveris G, Eisenberg R, Fazzari M, Klugman S. Patient attitudes toward prenatal diagnostic testing during antenatal care in an urban population. Prenat Diagn 2021; 41:888-895. [PMID: 33470437 DOI: 10.1002/pd.5899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/22/2020] [Accepted: 12/25/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Investigate factors that influence the decision to accept or decline diagnostic testing for pregnant women referred for genetic counseling. METHODS Cross sectional anonymous survey of pregnant women undergoing genetic counseling at a tertiary care referral center. Subjects' perceived risk of procedure related loss and fetal chromosomal problem were obtained via survey where patients rated risk from 0 (no risk) to 10 (highest risk). RESULTS There were no differences in sociodemographic factors between women undergoing a diagnostic procedure compared to those not undergoing a procedure. As the perceived risk for having a baby with genetic problem increased by one point, the estimated odds of having the diagnostic procedure increased by 43% controlling for the perceived risk of procedure related loss (p < .0001). Similarly, as the perceived risk of miscarriage increased by one point, the odds of having the diagnostic procedure decreased by 40%, controlling for the perceived risk of having a baby with a genetic problem (p < .0001). The main reason women cited for not undergoing a procedure was fear of procedure related loss. CONCLUSIONS Pregnant women that decline diagnostic testing have a higher perceived risk of procedure related loss and lower perceived risk of fetal chromosomal abnormality than those who accept.
Collapse
Affiliation(s)
- Catherine M Igel
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Sara Rabin-Havt
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Fatima Estrada Trejo
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Georgios Doulaveris
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Ruth Eisenberg
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Melissa Fazzari
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA.,Department of Epidemiology & Population Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| | - Susan Klugman
- Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine/ Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
5
|
Trends in gestational age at time of surgical abortion for fetal aneuploidy and structural abnormalities. Am J Obstet Gynecol 2017; 216:278.e1-278.e5. [PMID: 27984035 DOI: 10.1016/j.ajog.2016.10.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/17/2016] [Accepted: 10/20/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Screening for fetal aneuploidy has evolved over the past 2 decades. Whether these advances impact gestational age at abortion has received little study. OBJECTIVE We sought to describe trends in the gestational age at the time of abortion by fetal diagnosis over an 11-year study period. We hypothesized that gestational age at time of abortion would decrease for fetal aneuploidy but remain unchanged for structural abnormalities. STUDY DESIGN We conducted a retrospective case series of all women undergoing surgical abortion for fetal aneuploidy or structural abnormalities up to 24 weeks' gestation from 2004 through 2014 in a hospital operating room setting at a single, urban medical center. We excluded labor induction abortions (<1% of abortions at our medical center) and suction aspirations performed in the office practice. We performed suction aspiration up to 14 weeks and dilation and evacuation after that gestational age. We describe the median gestational age at abortion by fetal indication and year. RESULTS For women undergoing abortion for fetal aneuploidy (n = 392), the median gestational age at time of abortion decreased from 19.0 weeks (interquartile range 18.0-21.0) in 2004 to 14.0 weeks (interquartile range 13.0-17.0) in 2014 (Kruskal-Wallis P < .0001). For women undergoing abortion for fetal structural abnormalities (n = 586), the median gestational age was ≥20 weeks for each year during the study interval (P = .1). As gestational age decreased in the fetal aneuploidy group, fewer women underwent dilation and evacuation and more became eligible for suction aspiration (<14 weeks). In 2004, >90% of women underwent dilation and evacuation for either indication. By 2014, 31% of women with fetal aneuploidy were eligible for suction aspiration compared to 11% of those with structural anomalies. CONCLUSION Gestational age at the time of abortion for fetal aneuploidy decreased substantially from 2004 through 2014; earlier abortion is safer for women. In contrast, women seeking abortion for fetal structural abnormalities did not experience a change in timing. Legislation restricting gestational age at the time of abortion could disproportionately affect women with fetal structural abnormalities.
Collapse
|
6
|
Reed AR, Berrier KL. A Qualitative Study of Factors Influencing Decision-Making after Prenatal Diagnosis of down Syndrome. J Genet Couns 2016; 26:814-828. [PMID: 28035593 DOI: 10.1007/s10897-016-0061-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 12/16/2016] [Indexed: 11/27/2022]
Abstract
Previous research has identified twenty-six factors that may affect pregnancy management decisions following prenatal diagnosis of DS; however, there is no consensus about the relative importance or effects of these factors. In order to better understand patient decision-making, we conducted expansive cognitive interviews with nine former patients who received a prenatal diagnosis of DS. Our results suggest that patients attached unique meanings to factors influencing decision-making regardless of the pregnancy outcome. Nineteen of the twenty-six factors previously studied and four novel factors (rationale for testing, information quality, pregnancy experience, and perception of parenting abilities and goals) were found to be important to decision-making. We argue that qualitative studies can help characterize the complexity of decision-making following prenatal diagnosis of DS.
Collapse
Affiliation(s)
- Amy R Reed
- Department of Writing Arts, Rowan University, 142 Bozorth Hall, Glassboro, NJ, 08028, USA.
| | - Kathryn L Berrier
- Division of Medical Genetics, Duke University Medical Center, Durham, NC, USA
| |
Collapse
|
7
|
Care provision during termination of pregnancy following diagnosis of a severe congenital anomaly – A qualitative study of what is important to parents. Midwifery 2016; 43:14-20. [DOI: 10.1016/j.midw.2016.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 10/05/2016] [Accepted: 10/08/2016] [Indexed: 11/24/2022]
|
8
|
Maguire M, Light A, Kuppermann M, Dalton VK, Steinauer JE, Kerns JL. Grief after second-trimester termination for fetal anomaly: a qualitative study. Contraception 2014; 91:234-9. [PMID: 25499590 DOI: 10.1016/j.contraception.2014.11.015] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 11/23/2014] [Accepted: 11/29/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES We aimed to qualitatively evaluate factors that contribute to and alleviate grief associated with termination of a pregnancy for a fetal anomaly and how that grief changes over time. STUDY DESIGN We conducted a longitudinal qualitative study of decision satisfaction, grief and coping among women undergoing termination (dilation and evacuation or induction termination) for fetal anomalies and other complications. We conducted three post-procedure interviews at 1-3 weeks, 3 months and 1 year. We used a generative thematic approach to analyze themes related to grief using NVivo software program. RESULTS Of the 19 women in the overall study, 13 women's interviews were eligible for analysis of the grief experience. Eleven women completed all three interviews, and two completed only the first interview. Themes that contributed to grief include self-blame for the diagnosis, guilt around the termination decision, social isolation related to discomfort with abortion and grief triggered by reminders of pregnancy. Social support and time are mechanisms that serve to alleviate grief. CONCLUSIONS Pregnancy termination in this context is experienced as a significant loss similar to other types of pregnancy loss and is also associated with real and perceived stigma. Women choosing termination for fetal anomalies may benefit from tailored counseling that includes dispelling misconceptions about cause of the anomaly. In addition, efforts to decrease abortion stigma and increase social support may improve women's experiences and lessen their grief response. IMPLICATIONS The nature and course of grief after second-trimester termination for fetal anomaly are, as of yet, poorly understood. With improved understanding of how women grieve over time, clinicians can better recognize the significance of their patients' suffering and offer tools to direct their grief toward positive coping.
Collapse
Affiliation(s)
- Marguerite Maguire
- University of Rochester School of Medicine, 601 Elmwood Ave, Rochester, NY 14642.
| | - Alexis Light
- Washington Hospital Center Department of Obstetrics and Gynecology, 110 Irving Street, NW Suite 5B-63, Washington, DC 20010.
| | - Miriam Kuppermann
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110.
| | - Vanessa K Dalton
- University of Michigan Department of Obstetrics and Gynecology, 1500 E Medical Center Drive, Ann Arbor, MI 48109.
| | - Jody E Steinauer
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110.
| | - Jennifer L Kerns
- University of California, San Francisco, Department of Obstetrics, Gynecology and Reproductive Sciences, 1001 Potrero Avenue, Ward 6D, San Francisco, CA 94110.
| |
Collapse
|
9
|
Hawkins A, Stenzel A, Taylor J, Chock VY, Hudgins L. Variables influencing pregnancy termination following prenatal diagnosis of fetal chromosome abnormalities. J Genet Couns 2012; 22:238-48. [PMID: 23001505 DOI: 10.1007/s10897-012-9539-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 08/15/2012] [Indexed: 11/29/2022]
Abstract
The objective of this study was to identify variables that may influence the decision to terminate or continue a pregnancy affected by a chromosome abnormality. We performed a retrospective cohort analysis of 286 pregnancies diagnosed with a chromosome abnormality following genetic counseling and prenatal diagnosis. Data obtained included procedure type, chromosome results, ethnicity, maternal age, use of fertility treatments, and uptake of genetic counseling after results, among other factors. Wilcoxon rank sum test, Fisher's exact test, and univariate and multivariate logistic regression models were used for data analysis. The overall termination rate in this study was 82.9 %. A lower likelihood to terminate was found in pregnancies with a diagnosis of a sex chromosome abnormality (OR 0.05, p < .0001), Filipina race (OR 0.10, p = .03), and uptake of second genetic counseling session (OR 0.05, p < .0001). Prior history of termination was associated with increased likelihood to terminate (OR 8.6, p = .02). Factors revealing no statistically significant association with termination included maternal age, gestational age, clinic site, fetal gender, ultrasound anomalies, reason for referral and who informed the patient. Our data affirm the complexity of the decision making process and reinforce that providers should refrain from making assumptions regarding a patient's likelihood to terminate based on factors such as maternal age, gestational age, type of procedure, or ultrasound.
Collapse
Affiliation(s)
- Anne Hawkins
- Stanford University Perinatal Genetics, Stanford, CA, USA.
| | | | | | | | | |
Collapse
|
10
|
Pergament E, Pergament D. Reproductive decisions after fetal genetic counselling. Best Pract Res Clin Obstet Gynaecol 2012; 26:517-29. [PMID: 22809468 DOI: 10.1016/j.bpobgyn.2012.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 04/12/2012] [Indexed: 11/25/2022]
Abstract
A broad range of testing modalities for fetal genetic disease has been established. These include carrier screening for single-gene mutations, first-trimester and second-trimester screening for chromosome abnormalities and open neural-tube defects, prenatal diagnosis by means of chorionic villus sampling and amniocentesis, and preimplantation genetic diagnosis. Reproductive decisions before and after fetal genetic counselling represent the culmination of a dynamic interaction between prospective parents, obstetrician and genetic counsellor. The decision to undergo genetic testing before and after genetic counselling is influenced by a host of interrelated factors, including patient-partner and family relationships, patient-physician communication, societal mores, religious beliefs, and the media. Because of the complexity of personal and societal factors involved, it is not surprising that genetic counselling concerning reproductive decision-making must be individualised. A limited number of principles, guidelines and standards apply when counselling about testing for fetal genetic disease. These principles are that genetic counselling should be non-directive and unbiased and that parental decisions should be supported regardless of the reproductive choice. A critical responsibility of the obstetrician and genetic counsellor is to provide accurate and objective information about the implications, advantages, disadvantages and consequences of any genetic testing applied to prospective parents and their fetuses. These principles and responsibilities will be tested as newer technologies, such as array comparative genome hybridisation, non-invasive prenatal diagnosis and sequencing of the entire genome are introduced into the field of reproductive genetics and become routine practice.
Collapse
Affiliation(s)
- Eugene Pergament
- Northwestern Reproductive Genetics, Inc., Chicago, IL 60611, USA.
| | | |
Collapse
|
11
|
Hahn S, Hösli I, Lapaire O. Non-invasive prenatal diagnostics using next generation sequencing: technical, legal and social challenges. ACTA ACUST UNITED AC 2012; 6:517-28. [PMID: 23480834 DOI: 10.1517/17530059.2012.703650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION Newly developed non-invasive prenatal diagnostic techniques, using maternal blood samples, have the potential to reduce or obviate the need for invasive prenatal diagnostic practices such as amniocentesis or chorionic villous sampling. This will lead to a change in how obstetric care is extended by health care providers to pregnant women at-risk of bearing an aneuploid child. AREAS COVERED The process leading to the development of fetal aneuploidy detection via the analysis of cell-free DNA in maternal plasma by massive parallel sequencing. Optimization of these strategies and approaches used in the recent or up-coming commercial launches. In addition, this review provides insight into legal implications, potential patent disputes, ethical and societal concerns raised by this development, such as whole genome data storage, retrieval and access. EXPERT OPINION There is a need for engagement by professional societies, to ensure correct usage of these newly emerging technologies and their restriction to high-risk pregnancies. National agencies need to ensure the necessary degree of high quality required for prenatal diagnosis.
Collapse
Affiliation(s)
- Sinuhe Hahn
- University Hospital Basel, Department of Biomedicine/ Department of Obstetrics and Gynecology, Lab. Prenatal Medicine , Basel , Switzerland
| | | | | |
Collapse
|
12
|
Kerns JL, Swanson M, Pena S, Wu D, Shaffer BL, Tran SH, Steinauer JE. Characteristics of women who undergo second-trimester abortion in the setting of a fetal anomaly. Contraception 2012; 85:63-8. [DOI: 10.1016/j.contraception.2011.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 04/13/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
|
13
|
Kerns J, Vanjani R, Freedman L, Meckstroth K, Drey EA, Steinauer J. Women's decision making regarding choice of second trimester termination method for pregnancy complications. Int J Gynaecol Obstet 2011; 116:244-8. [DOI: 10.1016/j.ijgo.2011.10.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 10/12/2011] [Accepted: 11/21/2011] [Indexed: 10/14/2022]
|
14
|
Lakovschek IC, Streubel B, Ulm B. Natural outcome of trisomy 13, trisomy 18, and triploidy after prenatal diagnosis. Am J Med Genet A 2011; 155A:2626-33. [PMID: 21990236 DOI: 10.1002/ajmg.a.34284] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 07/29/2011] [Indexed: 11/10/2022]
Abstract
Trisomy 13, trisomy 18, and triploidy belong to the chromosomal abnormalities which are compatible with life, but which are also associated with a high rate of spontaneous abortion, intrauterine death, and a short life span. This study was conducted to analyze natural outcome after prenatal diagnosis of these disorders. Between January 1, 1999 and December 31, 2009, we investigated all amniocenteses and chorionic villus biopsies carried out at our department. All cases with fetal diagnosis of triploidy, trisomy 13, and 18 were analyzed, with a focus on cases with natural outcome. Overall, 83 (78%) cases of pregnancy termination and 24 (22%) patients with natural outcome (NO) were identified. The NO group included 15 cases of trisomy 18, six cases of triploidy, and three cases of trisomy 13. No case of triploidy was born alive. The live birth rate was 13% for trisomy 18 and 33% for trisomy 13. The three live-born infants with trisomy 13 and 18 died early after a maximum of 87 hr postpartum. Our data are consistent with the literature concerning outcome of triploidy, with none or only a few live births. Analyzes of trisomy 13 and 18 indicate a very short postnatal life span. Different study designs and diverse treatment strategies greatly affect the fetal and neonatal outcome of fetuses with triploidy, trisomy 13, and 18. More studies analyzing natural outcome after prenatal diagnosis of these chromosomal abnormalities are needed. Non-termination of these pregnancies remains an option, and specialists advising parents need accurate data for counseling.
Collapse
|
15
|
Scurti V, Romero M, Tognoni G. A plea for a more epidemiological and patient-oriented pharmacovigilance. Eur J Clin Pharmacol 2011; 68:11-9. [PMID: 21773732 DOI: 10.1007/s00228-011-1096-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/29/2011] [Indexed: 11/30/2022]
Abstract
The present work has the main objective of summarizing the history of pharmacovigilance and the associated methods and legislation and of showing how it could/should be reformulated in terms of a transition from a drug-centered to a patient/population-centered approach. The recurrent emergencies associated with new drug molecules raise many questions about the efficacy and efficiency of methodological tools as well as the role of regulatory systems. Drugs cannot be considered as an independent variable: the evaluation of all their effects must take into account the real contexts in which they are used and which affect not only their efficacy but also their tolerability and safety. Specific emphasis is given to recent and promising developments focused on the participation of patients and populations as key actors in producing knowledge that could technically integrate what has been produced so far and allow the evolution of surveillance from a role of controlling severe adverse reactions attributable to individual molecules to one of promoting a comprehensive assessment of the benefit/risk profile of drugs as they are utilized in society.
Collapse
Affiliation(s)
- Veronica Scurti
- Department of Clinical Pharmacology and Epidemiology, Centro Studi SIFO, Consorzio Mario Negri Sud, Via Nazionale 8/a, 66030, S. Maria Imbaro, Italy.
| | | | | |
Collapse
|
16
|
Arif MO, Fatmi Z, Pardeep B, Ali T, Iqbal H, Bangash HK, Pervaiz R, Altaf H, Baba JA. Attitudes and perceptions about prenatal diagnosis and induced abortion among adults of Pakistani population. Prenat Diagn 2008; 28:1149-55. [DOI: 10.1002/pd.2144] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
17
|
McCoyd JLM. "I'm not a saint": burden assessment as an unrecognized factor in prenatal decision making. QUALITATIVE HEALTH RESEARCH 2008; 18:1489-1500. [PMID: 18849510 DOI: 10.1177/1049732308325642] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Prenatal testing is widely utilized, yet few studies have explored decision-making processes about diagnosis from the pregnant woman's standpoint. This qualitative, exploratory study reveals a factor not accounted for in prior research geared toward associations between demographic categories and decisions. The 30 women in this study demonstrated a three-part decisional trajectory that included an effort to collect information about the challenges a potential child with their particular diagnosis might experience. They then assessed their social context, familial supports, and resilience as a couple. A final yet crucial step was an assessment of the woman's own capacity to provide this level of care within her unique context. Few genetics teams have a member with biopsychosocial expertise and time who can help the woman/couple reflect on the situated context of the decision and its impact. Better care strategies to support women and couples through this experience are warranted.
Collapse
Affiliation(s)
- Judith L M McCoyd
- Rutgers University, The State University of New Jersey, New Brunswick, New Jersey, USA
| |
Collapse
|
18
|
Korenromp MJ, Page-Christiaens GCML, van den Bout J, Mulder EJH, Visser GHA. Maternal decision to terminate pregnancy in case of Down syndrome. Am J Obstet Gynecol 2007; 196:149.e1-11. [PMID: 17306660 DOI: 10.1016/j.ajog.2006.09.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2006] [Revised: 07/14/2006] [Accepted: 09/18/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study explores decisional processes regarding termination of pregnancy because of Down syndrome and aims to identify possibilities for improving counseling. STUDY DESIGN Seventy-one women completed questionnaires 4 months after termination of pregnancy for Down syndrome, including motivations for the decision, reasons for doubt, perceived influence and/or pressure at decision-making, and satisfaction with the received health care. RESULTS Child-related motivations to the termination were the most frequently mentioned, but almost all women indicated also motives of self-interest. Twenty-one percent of women reported much doubt. Perceived influence of the medical staff was substantial, but most women felt that they had not been put under pressure. Satisfaction with the caregivers was high. CONCLUSION Women acknowledge that self-interested motives play an important role. Medical caregivers are among the most important persons for women who decide to terminate pregnancy because of Down syndrome.
Collapse
Affiliation(s)
- Marijke J Korenromp
- Department of Perinatology and Gynecology, University Medical Center, Utrecht, The Netherlands.
| | | | | | | | | |
Collapse
|
19
|
Khoshnood B, De Vigan C, Vodovar V, Bréart G, Goffinet F, Blondel B. Advances in medical technology and creation of disparities: the case of Down syndrome. Am J Public Health 2006; 96:2139-44. [PMID: 17077393 PMCID: PMC1698165 DOI: 10.2105/ajph.2005.069377] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed socioeconomic differences in probabilities of prenatal diagnoses of Down syndrome and continuation of pregnancies after such diagnoses, along with the effects of these differences on disparities in live-birth prevalences of Down syndrome. METHODS Using population-based data derived from 1433 cases of Down syndrome and 3731 control births, we assessed age-adjusted effects of maternal occupation and geographic origin on prenatal diagnoses, as well as overall and live-birth odds, of Down syndrome. RESULTS Maternal occupation and geographic origin had significant effects on the probability of a prenatal diagnosis of Down syndrome and on continuation of pregnancy after such a diagnosis. Women in lower-status occupational categories had higher odds of delivering a live-born infant with Down syndrome. In comparison with women in the highest-status occupational category, the age-adjusted odds ratio for a Down syndrome live birth among women without an occupation was 2.4 (95% confidence interval [CI] = 1.7, 3.3). By contrast, there were no disparities in age-adjusted overall likelihood of Down syndrome. CONCLUSIONS Socioeconomic differences in use of prenatal testing have created disparities in the live-birth prevalence of Down syndrome. Overall Down syndrome risk does not vary according to socioeconomic status.
Collapse
Affiliation(s)
- Babak Khoshnood
- Unit on Perinatal and Women's Health, Institut National de la Santé et de la Recherche Médicale (INSERM), U149, Paris, France.
| | | | | | | | | | | |
Collapse
|
20
|
Chen M, Shih JC, Wang BT, Chen CP, Yu CL. Fetal OK-432 pleurodesis: complete or incomplete? ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2005; 26:791-3. [PMID: 16273598 DOI: 10.1002/uog.2634] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
|
21
|
Khoshnood B, Blondel B, De Vigan C, Bréart G. Effects of maternal age and education on the pattern of prenatal testing: Implications for the use of antenatal screening as a solution to the growing number of amniocenteses. Am J Obstet Gynecol 2003; 189:1336-42. [PMID: 14634565 DOI: 10.1067/s0002-9378(03)00643-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was undertaken to assess age-specific effects of maternal education on patterns of prenatal testing. STUDY DESIGN We used data from a sample of all births in France in 1998. Statistical analysis included logistic regression and likelihood ratio tests. RESULTS The rate of amniocentesis of women without serum screening was 7.3% for those with 12 years or less, and 16.7% for those with more than 12 years of education. Women with lower levels of education were about 50% more likely to have an amniocentesis if they had serum screening (odds ratio [OR], 1.5; 95% CI, 1.2-1.8). In contrast, women with higher levels of education were less likely to have an amniocentesis with screening (OR, 0.7; 95% CI, 0.6-0.8); the education effect persisted across maternal age groups. CONCLUSION Many women eligible for reimbursed serum screening, in particular those with higher levels of education, obtain amniocentesis without serum screening. This might limit the use of antenatal screening as a solution to the growing number of amniocenteses.
Collapse
Affiliation(s)
- Babak Khoshnood
- Epidemiological Research Unit on Perinatal and Women's Health, INSERM U149, 16 Avenue Paul Vaillant Couturier, 94807 Villejuif Cedex, France.
| | | | | | | |
Collapse
|
22
|
Redlinger-Grosse K, Bernhardt BA, Berg K, Muenke M, Biesecker BB. The decision to continue: the experiences and needs of parents who receive a prenatal diagnosis of holoprosencephaly. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 112:369-78. [PMID: 12376939 DOI: 10.1002/ajmg.10657] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Holoprosencephaly (HPE) is a condition characterized by a defect in the development of the midline embryonic forebrain. When detected prenatally, the diagnosis of HPE offers parents a poor but often uncertain prognosis. Since the majority of parents receiving a prenatal diagnosis of an abnormality terminate their pregnancies, few studies have examined parents' experiences and needs surrounding the decision to continue a pregnancy. We present a descriptive study of in-depth interviews with 24 parents who chose to continue their pregnancy after receiving a prenatal diagnosis of HPE. Parents were asked about their decision-making process to continue the pregnancy. Qualitative analysis was used to identify common themes that emerged from these parents' experiences. The results suggest that most parents did not make an active decision about continuing the pregnancy. Rather, they described a more subtle decision-making process that evolved over time and consisted of several factors. These factors included the parents' religious and personal beliefs, past experiences, and the uncertainty involved in the diagnosis of HPE. Throughout the decision-making process, they described informational, emotional, and supportive needs from family, friends, and health professionals. All of these factors contributed to the evolution of the parents' decision to continue the pregnancy and the acceptance of their decision. Results of this exploratory study suggest health care professionals need to work with parents as they make their decision to continue an affected pregnancy. The results also provide the groundwork for prospective investigation into parents' decision-making process as they receive and adjust to prenatal diagnoses of an abnormality.
Collapse
Affiliation(s)
- Krista Redlinger-Grosse
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA.
| | | | | | | | | |
Collapse
|
23
|
Tercyak KP, Johnson SB, Roberts SF, Cruz AC. Psychological response to prenatal genetic counseling and amniocentesis. PATIENT EDUCATION AND COUNSELING 2001; 43:73-84. [PMID: 11311841 DOI: 10.1016/s0738-3991(00)00146-4] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The purpose of the present study was to characterize the psychological status (attitudes toward selective abortion, perceived risk, comprehension, patient satisfaction, coping, and state anxiety) of pregnant women at increased risk for fetal genetic anomalies who were referred for prenatal genetic counseling and amniocentesis; to determine which of these factors would predict amniocentesis use; and to identify patient outcomes associated with counseling and testing. Participants were 129 women aged 18 years and older who had one or more fetal genetic risk factors. All were recruited from an urban women's health clinic. The results revealed elevated perceptions of risk and moderate state anxiety despite adequate comprehension of, and patient satisfaction with, the process and content of genetic counseling. Approximately 78% agreed to testing; those who consented were more likely to hold favorable attitudes toward abortion than those who refused. Post-counseling, women experienced decrease in their perceived risk of having a baby born with a birth defect although perceived risk estimates remained higher than actual risks. Anxiety was clinically elevated and highest at the pre-counseling stage, though it dissipated to normal levels over time. Previous experience with prenatal diagnostic testing, increased perceived risk of a birth anomaly, and favorable attitudes toward abortion were independently associated with increased pre-counseling anxiety. Women who were more anxious pre-counseling remained more anxious post-counseling. Coping (high versus low monitoring) was unrelated to anxiety. These findings suggest that women who participate in prenatal counseling and testing may be subject to experience distress and unrealistic perceptions of their risk and may benefit from interventions designed to lessen these states.
Collapse
Affiliation(s)
- K P Tercyak
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.
| | | | | | | |
Collapse
|
24
|
Khoshnood B, Pryde P, Wall S, Singh J, Mittendorf R, Lee KS. Ethnic differences in the impact of advanced maternal age on birth prevalence of Down syndrome. Am J Public Health 2000; 90:1778-81. [PMID: 11076250 PMCID: PMC1446403 DOI: 10.2105/ajph.90.11.1778] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study explored whether ethnic differences in the impact of advanced maternal age on the risk of Down syndrome might reflect differences in use of prenatal diagnostic technologies. METHODS Maternal age-specific odds of Down syndrome and amniocentesis use were compared among African Americans, Mexican Americans, and non-Hispanic Whites via birth data for the years 1989 to 1991. RESULTS The odds ratio and population attributable risk of Down syndrome due to maternal age of 35 years or older were highest for Mexican Americans, intermediate for African Americans, and lowest for non-Hispanic Whites. CONCLUSIONS Advanced maternal age has a greater impact on the risk of Down syndrome for African American and, particularly, Mexican American women than for non-Hispanic White women. This difference in impact might reflect lower availability or use of prenatal diagnostic technologies.
Collapse
Affiliation(s)
- B Khoshnood
- Department of Pediatrics, University of Chicago, Ill., USA
| | | | | | | | | | | |
Collapse
|
25
|
Britt DW, Risinger ST, Miller V, Mans MK, Krivchenia EL, Evans MI. Determinants of parental decisions after the prenatal diagnosis of Down syndrome: Bringing in context. ACTA ACUST UNITED AC 2000. [DOI: 10.1002/1096-8628(20000828)93:5<410::aid-ajmg12>3.0.co;2-f] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
26
|
Abstract
Women who receive abnormal prenatal diagnosis results potentially face two emotionally difficult decisions. In this article, the first decision--whether or not to terminate the pregnancy--is presented with a discussion of the factors that may influence a women's choice. Women who choose to terminate the pregnancy face a second decision when more than one type of abortion procedure is available. Two second trimester abortion procedures--dilation and evacuation and labor induction--are compared and contrasted to delineate potential advantages and disadvantages of each. The decision-making process is examined, emphasizing the individual ways in which women may weigh this information to make a fully informed decision. In addition, a number of recommendations are offered to health care providers in the role of discussing options and supporting women in their choices.
Collapse
|
27
|
Figueiras M, Price H, Marteau TM. Effects of Textual and Pictorial Information Upon Perceptions of Down Syndrome: An Analogue Study. Psychol Health 1999. [DOI: 10.1080/08870449908410763] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
28
|
Mansfield C, Hopfer S, Marteau TM. Termination rates after prenatal diagnosis of Down syndrome, spina bifida, anencephaly, and Turner and Klinefelter syndromes: a systematic literature review. Prenat Diagn 1999. [DOI: 10.1002/(sici)1097-0223(199909)19:9<808::aid-pd637>3.0.co;2-b] [Citation(s) in RCA: 166] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
29
|
Abstract
The incidence of significant birth defects or genetic disorders in pregnancy is approximately 3%. Some will be found to have a congenital or genetic defect during childhood or early adulthood. The demands of modern society are for a healthy 'perfect' baby. Recent technological advances have enabled the development of techniques aimed at early diagnosis of the abnormal fetus, at a point where parents who wish to do so may terminate the pregnancy. Some of these techniques render the woman and fetus at risk of harm, whereas in others, efficacy has not yet been established. The implementation of these techniques raises several ethical questions which will be discussed in this article. We will also give a concise scientific background to the available techniques.
Collapse
Affiliation(s)
- V H Eisenberg
- Department of Obstetrics and Gynecology, Hadassah University Medical Center, Eim-Karem, Jerusalem, Israel
| | | |
Collapse
|
30
|
Abstract
There are now several well-documented psychological problems associated with prenatal testing programmes. These include poor understanding of tests undergone or declined, anxiety following false positive results, and false reassurance in those receiving negative test results. There is, as yet, little evidence concerning how to provide services to circumvent these. The focus of this review is upon just one of these problems: how best to inform women about prenatal testing and their reproductive options following the diagnosis of a fetal abnormality. Possible methods of improving informed decision-making either about whether to undergo testing or whether to terminate an affected pregnancy are described drawing upon research from antenatal and other health care areas. Future challenges for clinical practice and research in this area concern the range of conditions and predispositions for which prenatal testing with the option of termination should be offered.
Collapse
Affiliation(s)
- T M Marteau
- Psychology and Genetics Research Group, United Medical and Dental School of Guy's, London, U.K
| |
Collapse
|
31
|
Evans ML, Holzgreve W, Johnson MP, Gänshirt D, Sokol RJ. Fetal cell testing: societal and ethical speculations. Ann N Y Acad Sci 1994; 731:257-61. [PMID: 7944131 DOI: 10.1111/j.1749-6632.1994.tb55780.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- M L Evans
- Department of Obstetrics/Gynecology, Hutzel Hospital/Wayne State University School of Medicine, Detroit, Michigan 48201
| | | | | | | | | |
Collapse
|