An investigation into the reporting and management of late terminations of pregnancy (between 22+0 and 26+6 weeks of gestation) within NHS Hospitals in England in 2006: the EPICure preterm cohort study

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 119; no. 6; pp. 710 - 715
• Main Authors: Draper, ES, Alfirevic, Z, Stacey, F, Hennessy, E, Costeloe, K
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-05-2012; Blackwell; Wiley Subscription Services, Inc
• Subjects: Abortion; Abortion, Therapeutic - statistics & numerical data; Biological and medical sciences; Birth control; Diseases of mother, fetus and pregnancy; England - epidemiology; Female; Fetal anomaly; feticide; Fetus - abnormalities; Gestational Age; Gynecology. Andrology. Obstetrics; Humans; Induced abortion. Therapeutic abortion; late termination of pregnancy; Medical sciences; Pregnancy; Pregnancy Outcome - epidemiology; Pregnancy. Fetus. Placenta; Prospective Studies; State Medicine; Time Factors; England; United Kingdom; Great Britain; Europe; Premature; Late; Clinical management; Treatment; Prematurity; Cohort study; Gynecology; Induced abortion; Hospital; Obstetrics; Gestational age
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2012.03285.x

Please cite this paper as: Draper E, Alfirevic Z, Stacey F, Hennessy E, Costeloe K, for the EPICure Study Group. An investigation into the reporting and management of late terminations of pregnancy (between 22+0 and 26+6 weeks of gestation) within NHS Hospitals in England in 2006: the EPICure preterm cohort study. BJOG 2012;119:710–715.
Objective  To review all late terminations of pregnancy, between 22+0 and 26+6 weeks of gestation, collected as part of the EPICure2 study.
Design  Prospective cohort study.
Setting  All National Health Service (NHS) hospitals providing perinatal services for extremely preterm infants.
Population  All births between 22+0 and 26+6 weeks of gestation in England during 2006.
Methods  Data were collected for the defined cohort of births, including terminations of pregnancy, by designated unit staff using a standardised questionnaire. Rigorous validation processes were established to ensure comprehensive data collection. Gestational age was validated using a hierarchical classification of scan dates, certain date of last menstrual period and working gestation. Data for terminations of pregnancy (TOPs) were categorised into two groups, terminations for fetal abnormality and for maternal or fetal compromise, and were analysed in terms of their reporting, management and outcomes.
Main outcome measures  Classification, rate of feticide and outcome following TOP.
Results  Of 3782 births between 22+0 and 26+6 weeks of gestation, 647 (17.1%) were TOPs; of these 584 (90.3%) were for fetal abnormality and 63 (9.7%) for maternal or fetal compromise. Feticide was carried out in 489 of 584 (83.7%) TOPs for fetal abnormality, and in 38 of 63 (60.3%) of the TOPs for maternal or fetal compromise. Live births resulted following 2.2% TOPs for fetal abnormality and 4.8% TOPs for maternal or fetal compromise.
Conclusion  Terminations of pregnancy represent a relatively large proportion of very preterm births. Fetal abnormalities are the main cause for these terminations, and most include feticide. Better screening strategies are required to avoid the need for late terminations of pregnancy for fetal abnormalities.