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Objective: To compare diagnoses in patients undergoing abortion for fetal indications at 15-0/7 to 21-6/7 vs. ≥22-0/7 weeks' gestation.Study Design: This retrospective cohort study included women undergoing abortion at ≥15-0/7 weeks' gestation for fetal indications from 2012 to 2018 at our institution. We compared indications (genetic vs. structural only) between groups by gestational age (15-0/7 to 21-6/7 vs. ≥22-0/7 weeks). We performed statistical analysis using Fisher's exact and Mann-Whitney U tests.Results: The 158 women identified included 97 (61.4%) at 15-0/7 to 21-6/7 and 61 (38.6%) at ≥22-0/7 weeks' gestation. Women at an earlier gestational age more commonly had an initial diagnosis of a genetic disorder (41 [42.3%)] vs.10 [16.4%], respectively, p < .001). In 69 cases with initial or subsequent diagnosis of a genetic disorder, there were differences in the types of genetic abnormalities, with common chromosomal abnormalities (including Trisomies 13, 18, and 21) the most frequent diagnosis in those who underwent abortion at 15-0/7 to 21-6/7 weeks and microarray abnormalities more common at ≥22-0/7 weeks (22 [44.9%] vs. 4 [18.2%]) and 7 [14.9%] vs. 11 [50.0%], respectively, p = .01). Routine ultrasonography for fetal anomaly surveillance occurred one week earlier in women undergoing abortion for structural anomalies at 15-0/7 to 21-6/7weeks (median 19-2/7 weeks [interquartile range (IQR) 19 0/7 to 19-5/7 weeks]) compared to ≥22-0/7 weeks (median 20-2/7 weeks [IQR 19 6/7 to 20 4/7 weeks]), p < .001.Conclusion: Abortions for genetic indications are performed earlier in gestation compared to those performed for structural abnormalities. Timing of fetal anatomy ultrasound examination correlated with gestational age at abortion for structural abnormalities.Implications: Many states impose gestational-age based abortion bans, with 20-weeks post-fertilization the most common. However, we may not identify fetal abnormalities until close to 22 weeks gestation (20-weeks post-fertilization). Optimizing timing of prenatal diagnosis might mitigate the impact of gestational-age based abortion bans. [ABSTRACT FROM AUTHOR]

Abstract: Background: A significant proportion of second-trimester abortions are done for fetal anomalies. Our objective was to evaluate the impact of ultrasound at <14 weeks on the gestational age at abortion for structural fetal abnormalities. Study Design: Retrospective review identified all patients undergoing abortion following sonographic diagnosis of structural fetal anomalies at a single institution from 2004–2011. First-trimester ultrasound findings were reviewed, and abnormalities were categorized as “diagnostic” or “nondiagnostic.” Chi-square analysis and Mann–Whitney U test were used for statistical comparison. Results: One hundred thirty-two patients who underwent abortion due to structural fetal abnormalities were included, 109 of whom underwent ultrasound at 11–13 weeks. In those scanned at <14 weeks, there were diagnostic findings in 36 cases (33.0%) and abnormal nuchal translucency or other nondiagnostic finding leading to early second-trimester ultrasound in 16 cases (14.7%). In those scanned at <14 weeks, median gestational age at abortion was earlier compared to those who underwent initial anatomic evaluation in the second trimester, 19 weeks (13.5–21) versus 21 weeks (19–22), p=.001. Conclusion: Ultrasound at <14 weeks was associated with an earlier gestational age at abortion in pregnancies with structural fetal abnormalities. [Copyright &y& Elsevier]