Despite advances in prenatal imaging and screening, not all abnormalities can be detected early in pregnancy, making safe delayed termination services essential to equitable reproductive health care, according to the authors of research published today. australian medical journal.
Late termination of Pregnancy It occurs in some Queensland hospitals after 20 weeks, for reasons that can include fetal aneuploidy, genetic syndromes, late advanced skeletal abnormalities, or when the woman has a serious medical condition. However, data on Australian late termination is limited.
Professor Sailesh Kumar, Senior Specialist in Maternal, Fetal and Obstetrics at the Royal Brisbane and Women’s Hospital, and colleagues have reviewed the rates and indications for late termination of pregnancy requiring fetal killing at RBWH’s Advanced Prenatal Care Center over the past decade.
They report that “during 2010-2020, 305 late terminations were performed at or after 22 weeks of gestation”.
The annual number of late terminations increased from 20 in 2010 to 54 in 2020. The mean gestational age at late termination was constant over the decade (24 + 6 weeks; range, 17 + 0 to 37 + 1 weeks).
The most common fetal indicators of late termination were neurological abnormalities (110 out of 305, 36%), aneuploidy or genetic syndromes (67, 22%), and cardiac anomalies (59, 19%).
“Most of the women (78%) were seen for a maternal-fetal review within seven days of referral, and in 69% of the cases delayed termination was made within seven days of the initial review.”
Kumar and colleagues note that the annual number of late terminations performed at RBWH declined between 2010 and 2014, possibly because practitioners “may fear prosecution for pregnancy terminations after 2009.” criminal trial to terminate a pregnancy in Queensland”.
“Following an independent review of state legislation, the Termination of Pregnancy Act 2018 entered into force in Queensland in December 2018, ending the regulation of the termination of pregnancy under the state criminal law.
“Over the 2014-2020 period, the number of late terminations performed in RBWH has steadily increased,” Kumar and colleagues wrote.
“Since 2018, Queensland law requires specialists to review and support any request for late termination before it can be made. At RBWH there is clear institutional support for termination of pregnancy from Metro North Health’s Department of Women and Newborn Services. As a result, the number of referrals from Queensland hospitals Other (from inside and outside the RBWH pool area) and through general practitioners The number of ultrasound and obstetric care providers has increased.
“Women who may have previously been referred to private or interstate pregnancy termination providers are increasingly being referred to the RBWH maternal-fetal medicine service, likely explaining the rise in the annual number of late terminations in RBWH since 2014.”
Kumar and colleagues write that advances in prenatal imaging and genomics mean that women can now be given more information about their fetus and can make informed decisions about late termination.
“It is imperative that access to delayed termination be fair and not constrained by any perceived fear of litigation among medical practitioners,” they wrote.
“Collecting and disseminating data on late terminations of pregnancy…essential to inform decisions Resource allocation and provide service.
“Equal access to late termination of pregnancy has been restricted during the COVID-19 pandemic, and this situation may continue in the face of further infection, economic, conflict and policy challenges.
“It is a duty health care providers and legislators to ensure that the infrastructure for ending pregnancy care in Australia is safe.”
Shannyn Rosser et al, Late termination of pregnancy at a large third hospital in Queensland, 2010-2020, australian medical journal (2022). DOI: 10.5694 / mja2.51697.005
Submitted by the Australian Medical Journal
the quote: Experts say access to late terminations in Queensland is vital (2022, 12 September) Retrieved 12 September 2022 from https://medicalxpress.com/news/2022-09-experts-access-late-terminations-queensland.html
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