Termination for medical reasons

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A termination for medical reasons (TFMR) is an induced abortion motivated by medical indications involving the fetus or mother. [1] In some countries, health risks are the only basis for obtaining a legal abortion. [2] Prenatal screening can allow early diagnosis, and abortion if desired or necessary. [3] Some medical organizations advocate the offer of diagnostic testing by chorionic villi sampling, and amniocentesis to all pregnant women, as a matter of course. [3]

Contents

Screening and diagnostic tests can provide the information needed to make a decision on whether or not to abort. TFMR is one of the least talked about types of pregnancy loss, but is more common than generally realised. [4] It is stressful, and the involved people need support during the pregnancy and after its termination. [5]

A number of factors may influence a person's decision to terminate the pregnancy, including the severity of a condition, and its impact on life expectancy and quality of life.

Medical reasons

Medical reasons for inducing or performing an abortion are usually due to concerns about fetal viability or disability. These reasons include chromosomal and genetic abnormalities, [6] structural abnormalities, [7] and fetal reduction. [8]

The medical reasons may also be about the ability of the mother to survive the pregnancy without injury.

Prenatal testing

During prenatal care if a pregnancy is considered to be at high risk for a genetic disorder, prenatal testing can be undertaken to determine the health of the embryo or fetus. Two such diagnostic tests are chorionic villus sampling (CVS) and amniocentesis. [3] [9]

Individual states and countries vary on their restrictions for termination of pregnancy.

In the UK, abortions after 24 weeks' gestational age are only legal to protect the mother's physical or mental health, or if the fetus is "seriously handicapped" due to "physical or mental abnormalities". [10] As of 2020, in the UK, about 1.5% of abortions were due to serious physical or mental disability in the fetus; about half of these were due to congenital malformation, and a quarter to chromosomal abnormalities. [11] About one in one thousand abortions in the UK involved late termination of pregnancy (performed after 24 weeks) due to fetal disability; most abortions involving fetal anomaly are performed earlier in pregnancy. [11] Relatively few abortions – 128 out of more than 200,000 abortions in the UK each year – are intended to save the life of the mother or to prevent grave permanent injury to the mother's physical or mental health. [11]

TFMR has been legal since 1927 in Germany. [12] In 1975, West German abortion law changed to permit abortions at any time if there was a serious danger to the mother's health and in case of fetal abnormalities through 22 weeks, in addition to permitting some abortions for non-medical reasons before 12 weeks. [12] The law changed again during German reunification. In 2013, 4% of legal abortions in Germany were due to either medical reasons or because the pregnancy was the result of a crime, and 96% were for personal or social reasons. [12]

Psychosocial considerations

Pregnancy termination is a stressful experience. In some respects, the aftermath of TFMR is similar to any other type of pregnancy loss, including the need to grieve the lost child. [13] Parents commonly experience distress, depression, and guilt for several months afterwards, or even longer. [14] [13] [2] In TFMR, the concept of abortion as a "choice" does not accurately capture the true complexities of deciding to end a wanted pregnancy. Approximately 72% of parents undergoing TFMR felt that their experience was not the same as other types of baby loss, and that they do not always feel they "fit in" with other types of baby loss support groups because of their specific experience. [15]

A number of factors may influence the decision to terminate. Some common reasons are medical, such as the severity of the condition, the life expectancy and quality of life for the affected person, and available treatment options for the condition. Other common reasons are non-medical, such as personal values and beliefs, financial and employment considerations, the general family situation, including other children, and the availability of social support.

Religious beliefs can influence whether parents accept TFMR if recommended. Under Jewish laws, abortion to protect the mother's life or health is acceptable, and, to save the mother's life, abortion may be considered a requirement. [16] Some Jewish authorities support abortion to protect the mother's mental health. [16]

Support

When involved in psychotherapy for TFMR, the process may often include cognitive and behavioral approaches aimed at improving thoughts, feelings, and behaviors, to include positive coping strategies. According to Zareba et al. (2018), coping strategies most frequently mentioned in literature are: conversation (with the partner, family, friends, psychologist, physician), internalization of one's feelings, participation in support groups, psychotherapy, seeking information (in the literature, on the Internet, on television), denial and repression, concentrating on one's children, trying to conceive again quickly, seeking spiritual support, waiting, memorializing rituals, going on vacation or holiday with the partner or family. [17]

Disability rights concerns

TFMR due to expected fetal disability (as opposed to life-threatening medical conditions that could kill the mother or fetus) has been criticized by some in the disability rights movement. [18]

In the United Kingdom, a challenge based on Article 8 of the European Convention on Human Rights to the provisions in the Abortion Act 1967 that allowed the late-term abortion of fetuses with Down syndrome, failed in 2021. [19] Attempts have been made to remove the ability to perform late-term abortions for disability reasons through legislation. [20]

Related Research Articles

<span class="mw-page-title-main">Miscarriage</span> Natural death and expulsion of an embryo or fetus before its independent survival

Miscarriage, also known in medical terms as a spontaneous abortion, is the death and expulsion of an embryo or fetus before it can survive independently. The term miscarriage is sometimes used to refer to all forms of pregnancy loss and pregnancy with abortive outcomes before 20 weeks of gestation.

<span class="mw-page-title-main">Amniocentesis</span> Sampling of amniotic fluid done mainly to detect fetal chromosomal abnormalities

Amniocentesis is a medical procedure used primarily in the prenatal diagnosis of genetic conditions. It has other uses such as in the assessment of infection and fetal lung maturity. Prenatal diagnostic testing, which includes amniocentesis, is necessary to conclusively diagnose the majority of genetic disorders, with amniocentesis being the gold-standard procedure after 15 weeks' gestation.

Late termination of pregnancy, also referred to as third trimester abortion, describes the termination of pregnancy by induced abortion during a late stage of gestation. In this context, late is not precisely defined, and different medical publications use varying gestational age thresholds. As of 2015 in the United States, more than 90% of abortions occur before the 13th week, 1.3% of abortions in the United States took place after the 21st week, and less than 1% occur after 24 weeks.

<span class="mw-page-title-main">Obstetric ultrasonography</span> Use of medical ultrasonography in pregnancy

Obstetric ultrasonography, or prenatal ultrasound, is the use of medical ultrasonography in pregnancy, in which sound waves are used to create real-time visual images of the developing embryo or fetus in the uterus (womb). The procedure is a standard part of prenatal care in many countries, as it can provide a variety of information about the health of the mother, the timing and progress of the pregnancy, and the health and development of the embryo or fetus.

<span class="mw-page-title-main">Prenatal testing</span> Testing for diseases or conditions in a fetus

Prenatal testing is a tool that can be used to detect some birth defects at various stages prior to birth. Prenatal testing consists of prenatal screening and prenatal diagnosis, which are aspects of prenatal care that focus on detecting problems with the pregnancy as early as possible. These may be anatomic and physiologic problems with the health of the zygote, embryo, or fetus, either before gestation even starts or as early in gestation as practicable. Screening can detect problems such as neural tube defects, chromosome abnormalities, and gene mutations that would lead to genetic disorders and birth defects, such as spina bifida, cleft palate, Down syndrome, trisomy 18, Tay–Sachs disease, sickle cell anemia, thalassemia, cystic fibrosis, muscular dystrophy, and fragile X syndrome. Some tests are designed to discover problems which primarily affect the health of the mother, such as PAPP-A to detect pre-eclampsia or glucose tolerance tests to diagnose gestational diabetes. Screening can also detect anatomical defects such as hydrocephalus, anencephaly, heart defects, and amniotic band syndrome.

<span class="mw-page-title-main">Chorionic villus sampling</span> Type of prenatal diagnosis done to determine chromosomal or genetic disorders in the fetus

Chorionic villus sampling (CVS), sometimes called "chorionic villous sampling", is a form of prenatal diagnosis done to determine chromosomal or genetic disorders in the fetus. It entails sampling of the chorionic villus and testing it for chromosomal abnormalities, usually with FISH or PCR. CVS usually takes place at 10–12 weeks' gestation, earlier than amniocentesis or percutaneous umbilical cord blood sampling. It is the preferred technique before 15 weeks.

The triple test, also called triple screen, the Kettering test or the Bart's test, is an investigation performed during pregnancy in the second trimester to classify a patient as either high-risk or low-risk for chromosomal abnormalities.

<span class="mw-page-title-main">Fetal alcohol spectrum disorder</span> Group of conditions resulting from maternal alcohol consumption during pregnancy

Fetal alcohol spectrum disorders (FASDs) are a group of conditions that can occur in a person who is exposed to alcohol during gestation, as a result of their mother drinking alcohol during pregnancy. The several forms of the condition are: fetal alcohol syndrome (FAS), partial fetal alcohol syndrome (pFAS), alcohol-related neurodevelopmental disorder (ARND), and neurobehavioral disorder associated with prenatal alcohol exposure (ND-PAE). Other terms used are fetal alcohol effects (FAE), partial fetal alcohol effects (PFAE), alcohol-related birth defects (ARBD), and static encephalopathy, but these terms have fallen out of favor and are no longer considered part of the spectrum.

<span class="mw-page-title-main">Nuchal scan</span> Routine ultrasound done between 11 and 14 weeks pregnancy

A nuchal scan or nuchal translucency (NT) scan/procedure is a sonographic prenatal screening scan (ultrasound) to detect chromosomal abnormalities in a fetus, though altered extracellular matrix composition and limited lymphatic drainage can also be detected.

The genetics and abortion issue is an extension of the abortion debate and the disability rights movement. Since the advent of forms of prenatal diagnosis, such as amniocentesis and ultrasound, it has become possible to detect the presence of congenital disorders in the fetus before birth. Specifically, disability-selective abortion is the abortion of fetuses that are found to have non-fatal mental or physical defects detected through prenatal testing. Many prenatal tests are now considered routine, such as testing for Down syndrome. Women who are discovered to be carrying fetuses with disabilities are often faced with the decision of whether to abort or to prepare to parent a child with disabilities.

Confined placental mosaicism (CPM) represents a discrepancy between the chromosomal makeup of the cells in the placenta and the cells in the fetus. CPM was first described by Kalousek and Dill in 1983. CPM is diagnosed when some trisomic cells are detected on chorionic villus sampling and only normal cells are found on a subsequent prenatal test, such as amniocentesis or fetal blood sampling. In theory, CPM is when the trisomic cells are found only in the placenta. CPM is detected in approximately 1-2% of ongoing pregnancies that are studied by chorionic villus sampling (CVS) at 10 to 12 weeks of pregnancy. Chorionic villus sampling is a prenatal procedure which involves a placental biopsy. Most commonly when CPM is found it represents a trisomic cell line in the placenta and a normal diploid chromosome complement in the baby. However, the fetus is involved in about 10% of cases.

<span class="mw-page-title-main">Maternal–fetal medicine</span> Branch of medicine

Maternal–fetal medicine (MFM), also known as perinatology, is a branch of medicine that focuses on managing health concerns of the mother and fetus prior to, during, and shortly after pregnancy.

<span class="mw-page-title-main">Percutaneous umbilical cord blood sampling</span>

Percutaneous umbilical cord blood sampling (PUBS), also called cordocentesis, fetal blood sampling, or umbilical vein sampling is a diagnostic genetic test that examines blood from the fetal umbilical cord to detect fetal abnormalities. Fetal and maternal blood supply are typically connected in utero with one vein and two arteries to the fetus. The umbilical vein is responsible for delivering oxygen rich blood to the fetus from the mother; the umbilical arteries are responsible for removing oxygen poor blood from the fetus. This allows for the fetus’ tissues to properly perfuse. PUBS provides a means of rapid chromosome analysis and is useful when information cannot be obtained through amniocentesis, chorionic villus sampling, or ultrasound ; this test carries a significant risk of complication and is typically reserved for pregnancies determined to be at high risk for genetic defect. It has been used with mothers with immune thrombocytopenic purpura.

<span class="mw-page-title-main">Circumvallate placenta</span> Medical condition

Circumvallate placenta is a rare condition affecting about 1-2% of pregnancies, in which the amnion and chorion fetal membranes essentially "double back" on the fetal side around the edges of the placenta. After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface. Circumvallate placenta is a placental morphological abnormality associated with increased fetal morbidity and mortality due to the restricted availability of nutrients and oxygen to the developing fetus.

Prenatal sex discernment is the prenatal testing for discerning the sex of a fetus before birth.

Ravinder (Rav) Dhallan is the chairman and chief executive officer of Ravgen.

<span class="mw-page-title-main">L1 syndrome</span> Medical condition

L1 syndrome is a group of mild to severe X-linked recessive disorders that share a common genetic basis. The spectrum of L1 syndrome disorders includes X-linked complicated corpus callosum dysgenesis, spastic paraplegia 1, MASA syndrome, and X-linked hydrocephalus with stenosis of the aqueduct of Sylvius (HSAS). It is also called L1CAM syndrome and CRASH syndrome, an acronym for its primary clinical features: corpus callosum hypoplasia, retardation, adducted thumbs, spasticity, and hydrocephalus.

Testing Women, Testing the Fetus by Rayna Rapp is a book, published in 1999, about analysis of the social repercussions of prenatal genetic testing. Rapp combines the data she collected herself with historical context of amniocentesis and genetic counseling to argue that amniocentesis and those abortions following positive test results is a social decision as much as an individual one.

The anomaly scan, also sometimes called the anatomy scan, 20-week ultrasound, or level 2 ultrasound, evaluates anatomic structures of the fetus, placenta, and maternal pelvic organs. This scan is an important and common component of routine prenatal care. The function of the ultrasound is to measure the fetus so that growth abnormalities can be recognized quickly later in pregnancy, to assess for congenital malformations and multiple pregnancies, and to plan method of delivery.

Rh factor testing, also known as Rhesus factor testing, is the procedure of determining the Rhesus D status of an individual.

References

  1. ↑ "The Pink Elephants Support Network - Diagnostic Testing". The Pink Elephants Support Network. Retrieved 26 April 2022.
  2. 1 2 González-Ramos, Z; Zuriguel-Pérez, E; Albacar-Riobóo, N; Casadó-Marín, L (December 2021). "The emotional responses of women when terminating a pregnancy for medical reasons: A scoping review". Midwifery. 103: 103095. doi: 10.1016/j.midw.2021.103095 . PMID   34320417.
  3. 1 2 3 Grossman, TB; Chasen, ST (January 2020). "Abortion for Fetal Genetic Abnormalities: Type of Abnormality and Gestational Age at Diagnosis". AJP Reports. 10 (1): e87–e92. doi:10.1055/s-0040-1705173. PMC   7075712 . PMID   32190411.
  4. ↑ "Break the silence around TFMR". Antenatal Results and Choices (ARC). Retrieved 26 April 2022.
  5. ↑ "TFMR survey". Antenatal Results and Choices (ARC). Retrieved 26 April 2022.
  6. ↑ Dungan, Jeffrey S. (2015). "Medical Reasons for Pregnancy Interruption: Chromosomal and Genetic Abnormalities". In Paley Galst, Joann; Verp, Marion S. (eds.). Prenatal and Preimplantation Diagnosis: The Burden of Choice. Springer International Publishing. pp. 49–66. ISBN   978-3-319-18911-6. OCLC   919317956.
  7. ↑ Otaño, Lucas; Meller, César H.; Aiello, Horacio A. (2015). "Medical Reasons for Pregnancy Interruption: Structural Abnormalities". In Paley Galst, Joann; Verp, Marion S. (eds.). Prenatal and Preimplantation Diagnosis: The Burden of Choice. Springer International Publishing. pp. 67–96. ISBN   978-3-319-18911-6. OCLC   919317956.
  8. ↑ Evans, Mark I.; Andriole, Stephanie; Evans, Shara M.; Britt, David W. (2015). "Medical Reasons for Pregnancy Interruption: Fetal Reduction". In Paley Galst, Joann; Verp, Marion S. (eds.). Prenatal and Preimplantation Diagnosis: The Burden of Choice. Springer International Publishing. pp. 97–118. ISBN   978-3-319-18911-6. OCLC   919317956.
  9. ↑ Alfirevic, Z; Navaratnam, K; Mujezinovic, F (4 September 2017). "Amniocentesis and chorionic villus sampling for prenatal diagnosis". The Cochrane Database of Systematic Reviews. 2017 (9): CD003252. doi:10.1002/14651858.CD003252.pub2. PMC   6483702 . PMID   28869276.
  10. ↑ Gordon, Olivia (13 June 2019). The First Breath: How Modern Medicine Saves the Most Fragile Lives. Pan Macmillan. ISBN   978-1-5098-7121-6.
  11. 1 2 3 "Abortion statistics, England and Wales: 2020". Department of Health & Social Care. 4 May 2022. Retrieved 5 May 2022.
  12. 1 2 3 Lewis, Derek; Zitzlsperger, Ulrike (18 October 2016). Historical Dictionary of Contemporary Germany. Rowman & Littlefield. ISBN   978-1-4422-6957-6.
  13. 1 2 Henn, Fritz; Sartorius, Norman; Helmchen, Hanfried; Lauter, Hans (11 November 2013). Contemporary Psychiatry. Springer Science & Business Media. p. 196. ISBN   978-3-642-59519-6.
  14. ↑ Geddes, John; Price, Jonathan; McKnight, Rebecca (5 January 2012). Psychiatry. OUP Oxford. p. 215. ISBN   978-0-19-100301-1.
  15. ↑ "A spotlight on Termination for Medical Reasons (TFMR) | Tommy's". www.tommys.org. Retrieved 26 April 2022.
  16. 1 2 Bergman, Kim; Petok, William D. (21 October 2021). Psychological and Medical Perspectives on Fertility Care and Sexual Health. Elsevier. p. 248. ISBN   978-0-12-823275-0.
  17. ↑ Zaręba, Kornelia; Makara-Studzińska, Marta; Ciebiera, Michał; Gierus, Jacek; Jakiel, Grzegorz (December 2018). "Role of Social and Informational Support while Deciding on Pregnancy Termination for Medical Reasons". International Journal of Environmental Research and Public Health. 15 (12): 2854. doi: 10.3390/ijerph15122854 . ISSN   1660-4601. PMC   6313640 . PMID   30558123.
  18. ↑ Ehrenreich, Barbara (27 April 2009). This Land Is Their Land: Reports from a Divided Nation. Henry Holt and Company. ISBN   978-0-8050-9015-4. Medically informed "terminations" are already catching heat from disability rights groups, and, indeed, some of the conditions for which people are currently choosing abortion—like deafness or dwarfism—seem a little sketchy to me.
  19. ↑ "Woman with Down's syndrome loses UK abortion law case". the Guardian. 23 September 2021. Retrieved 5 May 2022.
  20. ↑ "ABORTION (DISABILITY EQUALITY) BILL". Abortion Rights. 1 March 2017. Retrieved 5 May 2022.

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