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Purpose To explore whether epidemiological shifts regarding reproduction and pregnancy have influenced the spectrum of indications for late termination of singleton pregnancies (TOP) above 17 weeks of gestation and to evaluate temporal changes in maternal demographics and fetal indications over the last 16 years. Methods Retrospective single-center cohort study involving all late TOPs preceded by feticide between 1 January 2004 and 31 December 2019 at a tertiary referral hospital in Austria. Outcome variables were retrieved and a time trend assessed between two 8-year intervals (2004–2011 versus 2012–2019). Results Between January 2004 and December 2019, a total of 209 singleton pregnancies (50.7% male; 46.9% female fetuses, 2.4% no disclosed sex) were terminated medically at a median gestational age of 25+1 (17+3–37+1) weeks at our institution. Predominant conditions legally justifying the late medical abortion were abnormaltities of the brain/central nervous system (n = 83; 39.7%), chromosomal aberrations (n = 33; 15.8%), complex malformations (n = 31; 4.8%) and abnormaltities of the musculosceletal system including diaphragmatic hernias (n = 18; 8.6%), as reflected by the ICD-10-categories “Congenital malformation of the central nervous system”, “Other congenital malformations” and “Chromosomal abnormalities”. No changes were observed with regards to maternal age (30.1 ± 5.9 vs. 31.0 ± 6.0 years; p = 0.315) nor frequency of assisted reproductive technologies (7.0% vs. 8.5%; p = 0.550). Despite a 2.5-fold increase in incidence of late TOPs, no epidemiological changes in maternal or fetal characteristics were observed over the last 16 years. Conclusion Population profile and indications for late TOPs followed by feticide remain unchanged over time.

This paper provides a recent legal case which calls into discussion the women’s safe access to voluntary termination of pregnancy (VTP) after the first 90 days. On 15 January 2021, the Italian Supreme Court sentenced a physician to damage compensation because he did not correctly inform the patient, in her 22nd week of pregnancy, about the risks to the fetus relating to an infection from cytomegalovirus (CMV). The option for VTP was not offered since, at the time of the woman’s request, medical investigations did not show the evidence of fetal malformations, neither there were concrete risks for the life of the mother, as Italian law requires. The baby was born with severe brain injuries. The case is noteworthy because it offers a new precedent to extend legal requirements for late VTP. The impact of this decision must be tested in the clinical practice. Further studies are necessary to evaluate possible law amendments extending access conditions for this practice and new policies promoting the strengthening of informative and assistance procedures, including psychological help, to the pregnant woman are needed, as well.

Prenatal exome sequencing (pES) is a promising tool for diagnosing genetic disorders when structural anomalies are detected on prenatal ultrasound. The aim of this study was to investigate the diagnostic yield and clinical impact of pES as an additional modality for fetal neurologists who counsel parents in case of congenital anomalies of the central nervous system (CNS). We assessed 20 pregnancies of 19 couples who were consecutively referred to the fetal neurologist for CNS anomalies. pES had a diagnostic yield of 53% (10/19) with most diagnosed pregnancies having agenesis or hypoplasia of the corpus callosum (7/10). Overall clinical impact was 63% (12/19), of which the pES result aided parental decision making in 55% of cases (6/11), guided perinatal management in 75% of cases (3/4), and was helpful in approving a late termination of pregnancy request in 75% of cases (3/4). Our data suggest that pES had a high diagnostic yield when CNS anomalies are present, although this study is limited by its small sample size. Moreover, pES had substantial clinical impact, which warrants implementation of pES in the routine care of the fetal neurologist in close collaboration with gynecologists and clinical geneticists.

Micro-computed tomography (CT) is a non-invasive alternative to conventional macroscopic dissection for the evaluation of human fetal cardiac anatomy. This paper aims to systematically review the literature regarding the use of micro-CT to examine human fetal hearts, to illustrate its educational and research implications and to explain its possible directions for the future. A systematic literature review was conducted following the PRISMA statement to identify publications concerning micro-CT applications for the isolated human fetal heart. The search strategy identified nine eligible studies. Micro-CT is technically feasible for postmortem examination of the human fetal heart coming from early and late termination of pregnancy. It reaches high diagnostic accuracy, and it seems to perform better than autopsy in small samples or in the case of early termination of pregnancy. Applications derived from micro-CT allow multiple off-time evaluations and interdisciplinary comparisons for educational purposes and research perspectives in biological and bioengineering domains.

Advances in perinatal medicine, present increasing numbers of women with difficult decisions about their pregnancy. We explored the views of 5 parents and 5 perinatal healthcare professionals regarding late termination of pregnancy following the principles of qualitative content analysis. Parents deciding on whether to (dis)continue pregnancy needed more time and decisional support. Decentralized care and lacking continuity between caregivers led to negative experiences. No standardized bereavement services were offered after leaving the hospital. Integrating principles of perinatal palliative care to care might help to offer further decisional support and to overcome the fragmentation of care.

Performing a feticide as part of termination of late pregnancy is recommended in many countries. Feticide avoids a live birth of a severely affected premature newborn and prevents fetal pain. There are limited data on feticide procedures since only a few countries in the world authorize late termination of pregnancy. The objective of this review was to assess the most appropriate feticide procedure based on published data during the last thirty years. Administration of an initial fetal analgesia followed by a lethal lidocaine injection through the umbilical cord, under ultrasound guidance, appears to be the most effective, safe and ethical way to perform feticide. According to the current knowledge regarding the risk of fetal pain and survival of extremely preterm infants, a feticide should be discussed as early as 20-22 weeks of gestation.

Problem Hospital midwives are the main care givers for women undergoing termination of pregnancy after 20 weeks. Midwives’ role and potential impact of regular involvement in termination of pregnancy (TOP) are poorly understood. Setting New Zealand. Background TOP after 20 weeks may be performed to save a woman’s life or preserve her physical and mental health. Throughout the process midwives play a key role in supporting women’s complex psychological and clinical needs. Objective To gain a deeper understanding of the role of midwives in TOP care after 20 weeks, including the support they might need and the impacts caring for women who are having a TOP may have on them. Methods Eight midwives from two District Health Boards were interviewed about their experiences of caring for women having a TOP after 20 weeks. Transcripts were analysed by applying a hermeneutic-phenomenological lens. Findings Three themes emerged: “A different kind of midwife”, “Staying true to oneself” and “Melting an Iceberg”. TOP care is a different role within midwifery as midwives facilitate death in the space of birth. Immersing themselves in women’s emotional space they create meaningful connections to support their complex needs and provide a positive birth experience. Yet, midwives are unprepared for the emotional effects of repeatedly caring for women undergoing TOP. Lacking appropriate support they can experience increasing, lasting grief. Conclusion Midwives’ experiences of providing TOP care are complex, intense and have lifelong impact. Their role in the context of TOP is highly specialised and must be valued and supported.

Objective To study changes in the reasons for third-trimester termination of pregnancy (TOP) for fetal anomalies over a 20-year period in France. Study design We compared a consecutive series of third-trimester TOPs from a single centre in 2005–2014 to those performed by Dommergues et al. in a similar centre in 1986–1994, using the same criteria. Main outcome measures The process leading to late TOP, using the same categories in both studies. Results In the present series, 205 of 1409 TOPs were performed in the third trimester, vs. 305/956 in the historical series. There were 33 (16.1 %) diagnoses missed at the screening before the third trimester, 55 (26.8 %) cases in which the anomaly was impossible to diagnose until the third trimester, 86 (42 %) cases in which fetal prognosis could not be established until the third trimester despite earlier diagnosis, 31 (15.1 %) TOPs postponed to allow more time for the women/couples to contemplate, versus respectively 113 (37 %), 55 (18 %), 122 (40 %), and 15 (5%) in the historical series. Conclusion There was a significant drop in the rate of anomalies missed earlier. The increase in late TOP due to couples requiring additional time for contemplation might result from changes in counselling processes.

Objective Vein of Galen aneurysmal malformation (VGAM) is a rare fetal anomaly, the neurological outcome of which can be good with appropriate perinatal management. However, most fetal series are too small to allow reliable statistical assessment of potential prognostic indicators. Our aim was to assess, in a two-center series of 49 cases, the prognostic value of several prenatal variables, in order to identify possible prenatal indicators of poor outcome, in terms of mortality and cerebral disability. Methods This was a retrospective study involving 49 cases of VGAM diagnosed prenatally and managed at two centers over a 17-year period (1999–2015). All cases had undergone detailed prenatal cerebral and cardiac assessment by grayscale ultrasound, color and pulsed-wave Doppler and magnetic resonance imaging (MRI). Ultrasound and MRI examination reports and images were reviewed and outcome information was obtained from medical reports. Volume of the VGAM (on ultrasound and MRI) was calculated and development of straight-sinus dilatation, ventriculomegaly and other major brain abnormalities was noted. Cardiothoracic ratio, tricuspid regurgitation and reversed blood flow across the aortic isthmus were evaluated on fetal echocardiography. Major brain lesions were considered by definition to be associated with poor outcome in all cases. Pregnancy and fetoneonatal outcome were known in all cases. Fetoneonatal outcome and brain damage were considered as dependent variables in the statistical evaluation. Poor outcome was defined as death, late termination of pregnancy due to association with related severe brain anomalies or severe neurological impairment. Results At a mean follow-up time of 20 (range, 0–72) months, 36.7% of the whole series and 52.9% of the cases which did not undergo late termination were alive and free of adverse sequelae. Five (10.2%) cases showed progression of the lesion between diagnosis and delivery. On univariate analysis, dilatation of the straight sinus, VGAM volume ≥ 20 000 mm3 and tricuspid regurgitation were all significantly related to poor outcome. However, on logistic regression analysis, the only variables associated significantly with poor outcome were tricuspid regurgitation and, to a lesser extent, VGAM volume ≥ 20 000 mm3. The former was also the only variable associated with brain damage. Conclusions Major brain lesions, tricuspid regurgitation and, to a lesser extent, VGAM volume ≥ 20 000 mm3 are the only prenatal variables associated with poor outcome in fetal VGAM. Prenatal multidisciplinary counseling should be based on these variables. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

AIMS OF THE STUDY Based on an incidental observation made in the context of the Swiss National Science Foundation (SNSF) Project 67 “End-of-life decision-making in extremely low birth weight infants in Switzerland”, this retrospective multicentre observational study aimed to analyse circumstances of delivery room deaths after late termination of pregnancy (LTOP) in Switzerland over a 3-year period. METHODS All delivery room deaths (including live and stillbirths) following LTOP among infants with a gestational age between 22 0/7 and 27 6/7 weeks at the nine Swiss level III perinatal centres between 1 July 2012 and 30 June 2015 were analysed. Indications for LTOP were classified as either (a) maternal emergencies or (b) fetal anomalies severe enough to cause significant maternal psychological distress. Whenever possible, specific diagnoses were recorded. Spontaneous intrapartum death and fetal death caused by injection of a cardioplegic drug were distinguished for stillborn infants. RESULTS A total of 465 delivery room deaths among extremely low gestational age newborns (ELGANs) were identified over the 3-year study period of the SNSF project. Of these, 195 (42%) occurred in the context of LTOP. Central nervous system malformations, chromosomal anomalies, severe congenital heart disease, multiple malformations and maternal emergencies accounted for 70% of all LTOPs. LTOPs resulted in live births in 76 (39%) cases. No correlation between gestational age and rate of live births was observed. Fetal death caused by injection of a cardioplegic drug was documented in only three cases. All infants born alive after LTOP died in the delivery room without resuscitation attempts. The use of drugs for palliative care in these patients was either rare or, alternatively, incompletely documented. CONCLUSION LTOPs contribute significantly to mortality rates among ELGANs and should therefore be included in perinatal registries. Uniform reporting of LTOPs should be established. Infants born alive after LTOP are entitled to comprehensive palliative care like any other infant born under different circumstances. Development of national guidelines for LTOPs (including the role of fetal death caused by injection of a cardioplegic drug and palliative birth as an alternative to induced abortion) would be highly desirable to guarantee acceptable standards of care.

Objectives This study aimed to explore maternal-fetal medicine specialists' experiences of conducting feticide in late termination of pregnancy. Methods Participants were recruited via email. Purposeful sampling resulted in ten maternal-fetal specialists. Semistructured interviews were used to examine their experiences of conducting feticide. Interviews occurred across four English National Health Service hospitals. Interpretative phenomenological analysis was used. Results An ongoing doctor-patient relationship when conducting feticide facilitated participants' self-image as clinicians rather than technicians. Coping involved rationalisation, with feticide viewed as 'part of the job'. Supportive team relationships helped keep emotional expression within control. Participants were not distressed if they felt, through relationship-based decision-making, that the feticide aligned with their values and legal interpretation. To avoid negative judgements, they disclosed selectively, only telling trusted individuals that they conducted feticides. Conclusions Participants experienced conducting feticides as difficult but necessary, eliciting pride from the skills involved. Some noted management of personal distress. Optimal conditions were involvement in the process from the initial decision-making and team support. Providing feticides was deemed as potentially stigmatising, with selective disclosure employed. Training in managing feticides and guidance on providing optimal service conditions may decrease selectivity of disclosures and enhance staff well-being and the quality of feticide provisions. © 2015 John Wiley & Sons, Ltd.

Objective. To examine the opinions of a perinatal health team regarding decisions related to late termination of pregnancy and severely ill newborns. Materials and Methods. An anonymous questionnaire was administered to physicians, social workers, and nurses in perinatal care. Differences were evaluated using the chi square and Student’s t tests. Results. When considering severely ill fetuses and newborns, 82% and 93% of participants, respectively, opted for providing palliative care, whereas 18% considered feticide as an alter- native. Those who opted for palliative care aimed to diminish suffering and those who opted for intensive care intended to protect life or sanctity of life. There was poor knowledge about the laws that regulate these decisions. Conclusions. Although there is no consensus on what decisions should be taken with severely ill fetuses or neonates, most participants considered palliative care as the first option, but feticide or induced neonatal death was not ruled out.

Geç dönemde gebeliğin sonlandırılması tüm dünyada önemli tıbbi ve etik sorunlar oluşturmaktadır. Bu dönemde gebeliğin sonlandırılması için ciddi tıbbi ve ya sosyal endikasyonların bulunması gerekmektedir. Burada antenatal hidronefroza bağlı annenin isteği ile gebeliğin geç dönemde sonlandırılmasına dair bir olgu sunulmuştur. Antenatal hidronefroz, postnatal dönemde spontan gerileme göstermesi ve tedavi olanaklarının bulunması nedeni ile gebeliğin sonlandırılması için ciddi bir endikasyon oluşturmamaktadır. Özellikle kürtaj komplikasyonlarının sık rastlandığı geç dönem gebeliklerde bu gibi nedenlere dayanarak gebeliğin sonlandırılması risklidir. Bu bakımdan sağlık çalışanlarının anne adayına ve ailesine mevcut hastalık, hastalığın seyri ve tedavisi konusunda yeterli bilgi vermesi önem arz etmektedir.Anahtar kelimeler: Antenatal hidronefroz, fetüs, otopsi, ultrasonografi.

Over an 8-year period, a male patient presented three times to an endocrinologist with strikingly similar presentations, including palpitations, anxiety, and tremors. Each of his presentations occurred following either the birth of one of his two children or his wife’s late termination of pregnancy. This patient’s illness followed the typical time course of silent thyroiditis: hyperthyroidism, followed by euthyroidism, a late hypothyroid phase, and then a complete resolution of symptoms and normalization of thyroid function tests over a period of several months. We discuss the curious clinical presentation, diagnostic evaluation, and a literature review of alternate explanations for this patient’s condition, including a discussion of the impact of seasonal shift, spousal’s autoimmune disease, stress, and evolutionary changes in males postpartum. Although the differential diagnosis is broad in this case and the thyrotoxicosis could have coincidentally followed pregnancies of the patient’s wife, documented hormonal changes in men during postpartum period in conjunction with the timeline of the patient’s condition are suggestive of recurrent “sympathetic” postpartum thyroiditis. To our knowledge, this is the first case report of recurrent painless thyroiditis in a man following pregnancies of his wife with Hashimoto’s thyroiditis.

Background. Progress in prenatal diagnosis and prenatal screening in the past 2 decades has facilitated improved diagnostic methods for fetal abnormalities. Objectives . To assess the indications for late termination of pregnancy, gestational ages and to discuss ethical and legal considerations. Methods. A retrospective study compiling and analysing data from justified medical terminations of pregnancies, reported between January 2001 and June 2012 at Charles Nicolle Hospital. Congenital infectious embryofetopathies were excluded. Results . Over this period, there were 77 cases of clinically justified medical terminations of pregnancies – a rate of 1.9 per 1 000 total births. The mean gestational age was 27 weeks. In 33 cases, the medical abortion was performed beyond 26 weeks (42.8%). Fetal malformations were predominantly of the central nervous system. Conclusion. Medical terminations of pregnancy for fetal indications are relatively rare. However, they raise ethical, medical and legal issues, due in part to a late prenatal diagnosis. Such decisions should be taken through a multidisciplinary committee.

To assess fetal abnormalities leading to very late termination of pregnancy (VLTOP) performed after 32 weeks' gestation.The study population included all pregnant women with singleton pregnancy that underwent VLTOP in our institute because of fetal indications between the years 1998 and 2015.Fifty-seven cases (2.0%) were at ≥32 weeks' gestation and are the subjects of the current study. Our VLTOP cases were subdivided into four categories according to the sequence of events that led to the decision for VLTOP: (1) No routine prenatal screening with an incidental fetal finding discovered after 32 weeks' gestation (9 fetuses ∼16%); (2) Routine early prenatal care raised suspicion of abnormalities, and the final diagnosis was established by additional tests (8 fetuses, ∼14%); (3) Developmental findings detected during the third trimester (21 fetuses; ∼37%), and (4) fetal abnormalities that could have been detected earlier during pregnancy (19 fetuses; ∼33%).The two categories in which the pregnant women did not underwent any fetal evaluation (i.e. group 1) or those that could have been detected earlier (i.e. group 4) consists ∼49% from our cohort in which VLTOP could have been avoided.

In this phenomenological-hermeneutic study, we explored how midwives perceive the burden of care, while assisting termination of pregnancy after 16 weeks' gestation. Between February and April 2013, 17 Italian midwives from three different units were interviewed. Data were collected using semistructured interviews. Four themes emerged from the interviews: influences, supports, empathy, and emotions. At the end of the study, researchers observed that midwives assert conscientious objection to the termination of pregnancy, which does not influence their experiences and memories. The midwives felt that it was important to share experiences with colleagues, discussing cases together and with the rest of the team. The midwives also suggested some strategies to improve this type of care: organize shifts in a way that could lead to improved and personalized care for women, continuous development, involvement of relatives, and special measures for these women's rooms. Moreover, they considered help from other professionals as fundamental in order to manage the clinical and emotional complexities related to these terminations.

Background In exceptional cases of severe and life-theatening maternal conditions in the periviable period, professionals may consider immediate delivery the only option to prevent deterioration of the maternal illness. Fetal demise is then the inevitable consequence of the treatment of the mother. We sought the opinion of involved medical specialists on management, reporting and auditing in these difficult cases. Methods All registered fetal-maternal medicine specialists (MFM-specialists) (n = 197) and neonatologists (n = 282) were invited to participate in an online survey. The survey presented to hypothetical cases of severe early-onset preeclampsia at periviable gestational age. Two management-options were presented: immediate delivery and expectant management directed towards newborn survival. During expectant management two epsiodes with eclamptic seizures occured. Findings In the case managed by immediate termination, 62% answered that fetal demise resulting from induction of labor for severe maternal illness should be audited within the medical profession only. In the case managed expectantly, 17% agreed with this management. 75% of MFM-specialists answered that an eclamptic seizure is always a reason for immediate delivery. Some answers revealed a significant difference in opinion between the MFM-specialists and the neonatologists. The first concern of the MFM-specialists is the health of the mother, while the first concern of the neonatologists is, to achieve optimal gestational age for the newborn. Conclusion Perpective of MFM-specialists and neonatologists differs with regard to counseling prospect parents in case of severe early-onset preeclampsia. The majority of professionals is willing to report late termination of pregnancy (after 24 weeks’ gestation) for severe maternal disease to medical experts for internal audits, but not for legal auditing.

Background. Early diagnosis and appropriate management of congenital anomalies can help prevent neonatal morbidity and mortality. Termination of pregnancy for severe congenital anomalies is permitted under South African law. Objective . To determine factors causing delayed diagnosis of lethal congenital abnormalities requiring late termination of pregnancy at Steve Biko Academic Hospital in Pretoria, South Africa. Methods. Medical records of pregnant women who presented with lethal fetal anomalies over a period of 7.5 years were analysed. Patients’ demographic profile, the interval from referral to feticide, gestational age at first scan and diagnosis, type of anomaly and feticide methods were considered. The cohort was divided in two groups based on timing of termination (i.e. earlier than 28 weeks and later than 28 weeks’ gestation) for statistical comparison. Results. The majority of women ( n =45; 78.9%) were younger than 35 years and had no chronic medical conditions or risk factors ( n =40; 70%). Although 30 women (52.6%) had been booked for antenatal examination early in their pregnancy, only three (5.2%) had a first-trimester scan. Mean time to referral was not significantly different between the women whose pregnancies terminated earlier than 28 weeks and those with a termination after 28 weeks ( p =0.671). Conclusion. A basic ultrasound scan in the second trimester is recommended for all pregnant women. Task shifting can be a viable option to provide this facility at primary and secondary health centres. A national registry should be established to document all late terminations for fetal anomalies.

Social status of woman in Serbia in the first decades of the XX century was moulded by patriarchal family and social relationships as well as traditional morals. Threats to woman’s health were labours at home and especially illegal abortions and late termination of pregnancy done without any doctor’s supervision, often by laypersons. Unsanitary conditions in Serbia were the leading death factor in mothers both close after giving birth and during the next few months. Records show higher mortality rate of children born in the country than in urban areas. During the first years after World War II a significant indicator of woman’s status in Serbia was acquired level of health care for women, pregnant women, mothers and children. Health education of women was related to protection and fight against consequences of ignorance and bad sanitary habits in backward and patriarchal environment. In the first years after war special attention was given to health education of women in the country. Liberalisation of legal abortion took place in the early 1960s, and constitutional right of every person to decide whether to have child or not was established in 1974. In the last decade of the XX century in Serbia status of women who gave birth and mothers got worse as a result of a long economic crisis.

Expectant mothers and their spouses spend months preparing to eagerly welcome their much-anticipated baby into their family. Stillbirth or a diagnosis of life-limiting fetal anomalies comes as a devastating turn of events for affected women and their families. From the time of diagnosis to intervention (i.e., induction of labor for stillbirth or late termination of pregnancy for fetal anomalies), affected women often feel vulnerable and abandoned, with many experiencing long-term psychological and emotional effects. Knowledge of obstetric management, ethical and medical challenges, and psychological aspects have evolved in recent years. Familiarity with this emerging knowledge better prepares the obstetric anesthesiologist to deliver effective and empathic care. Encounters with women experiencing stillbirth and life-limiting fetal anomalies prompted this review of current evidence regarding parturient' perspectives on their care as they set out on the road to recovery.

Objective The objective of this article was to ascertain the opinion of lay persons and medical practitioners in India regarding late termination of pregnancies (LTOP) for fetal abnormalities. Methods One hundred and fifty lay persons and 120 medical practitioners were given separate questionnaires and asked their opinions regarding LTOP for prenatally detected fetal abnormalities of varying severity. The views regarding legalisation of LTOP and the acceptability of feticide by the lay persons were also ascertained. Results More than two-thirds of the lay persons and majority (85.8%) of clinicians felt that LTOP should be allowed for fetal conditions with poor prognosis. At least 70% of lay persons felt that LTOP should be legalised for severe fetal abnormalities. For potentially treatable conditions, continuation of pregnancy in late gestation was the preferred option. For lethal malformations like anencephaly and disorders requiring lifelong treatment like meningomylocele and thalassemia major, majority of clinicians (86.7%, 69.2% and 55.8%, respectively) and lay persons (65%, 51% and 25%, respectively) had the opinion that termination of pregnancy can be offered at any gestational age. Conclusion Both the lay persons as well as the medical fraternity in India feel the need to look into revision of legalisation of LTOP particularly for fetal conditions with poor outcome. Copyright © 2011 John Wiley & Sons, Ltd.

The current practice of late termination of pregnancy in Germany has been criticized by the German Medical Association as well as several sociopolitical groups. The controversy has especially concerned the time limit for the termination of pregnancies and the counseling process prior to that intervention. The criticism, in part, originates from the reform of the German Abortion Law in 1995, and demands for change led to legislative initiatives in 2008.

Objective To provide an in-depth account of the role feticide has relative to experiences of late termination of pregnancy (TOP). Method Exploratory qualitative interview study. Participants were recruited from three National Health Service (NHS) units that provide secondary and tertiary level fetal medicine services. Data were collected from 36 in-depth interviews, with 12 parents (representing eight cases) who had experienced late TOP for fetal anomaly and 23 health professionals with experience of feticide provision. The qualitative analysis utilised a generative thematic approach, facilitated by Atlas.ti qualitative software package. Results Two key themes from the study provide data on how perceptions of feticide were described by those involved in late TOP: (1) feticide is recognised and described as a legitimate clinical procedure and (2) the practice of feticide is conceptualised as difficult but necessary. Conclusion For health professionals who provide and facilitate feticide, and for parents making decisions about late TOP and feticide, the procedure is understood as a necessary rather than chosen activity. Parents' perceptions of feticide may differ, and good clinical care must be designed to cope with this variation. For health professionals, feticide seems more readily distinguished from other types of TOP activities and may evoke simultaneous positive and negative perceptions. Copyright © 2009 John Wiley & Sons, Ltd.

Objective To compare the experience and attitude of obstetricians in Europe towards late termination of pregnancy and the factors affecting their responses. Design Cluster sampling cross-sectional survey. All neonatal intensive care unit (NICU)-associated maternity units were recruited (census sampling) in Luxembourg, the Netherlands and Sweden. In France, Germany, Italy, Spain and the UK, units were selected at random. In every recruited unit, all obstetricians with at least 6 months' experience were invited to participate. Setting NICU-associated maternity units in eight European countries. Population Obstetricians with at least 6 months' clinical experience. Methods An anonymous, self-administered questionnaire was used. Multinomial logistic analysis was used to identify factors predicting the obstetricians' views about modifying the law governing late termination in their country. Main outcome measure Obstetricians' experience of late termination of pregnancy and views about national policies. Results One hundred and five units and 1530 obstetricians participated (response rates 70 and 77% respectively). The most common indications for late termination were congenital anomalies and women's physical health. Feticide was not common except in France, Luxembourg and the UK. Active euthanasia of a liveborn was practiced in France and the Netherlands. Obstetricians in Germany were more likely to feel that late termination should be more severely restricted, the opposite was true in Spain and the Netherlands. In Italy, there was dissatisfaction with current status, but opinion was divided, reflecting views on both sides of the debate. Conclusions This research outlines current practice in a difficult and sensitive area and suggests the need for more discussion and support for all those who were involved.

We report our experience of late feticide in Taiwan as well as a novel technique, fetal cardiac tamponade, which can be used in the late termination of pregnancy. Twenty-six patients who elected to undergo feticide were enrolled in this study (among 40 pregnancies with fetal abnormalities diagnosed late in gestation during 2005–2008 in a tertiary referral center in Taiwan). The fetal abnormalities in these patients included structural malformations and/or genetic defects. This study conformed strictly to the regulation of law and was approved by the Institutional Review Board/Ethics Committee of the Changhua Christian Hospital. Two methods were used to perform feticide: intracardiac injection of potassium chloride (6 mmol) and intracardiac injection of lidocaine (10 mL in 2% preparation). If fetal asystole was not achieved 3 minutes after initial injection, fetal cardiac tamponade was then performed by instilling normal saline into the fetal pericardium. Permanent cessation of fetal heart activity was regarded as successful feticide. The gestational age of the feticide group ranged from 24 to 38 weeks (mean, 30.85 ± 3.77 weeks). The body weight of the aborted fetuses ranged from 675 g to 2,860 g (mean, 1,618.1 ± 590.7 g). The use of lidocaine was successful in six of the seven cases (85.7% success rate). The use of potassium chloride was successful in 11 of the 19 cases (57.9% success rate). Fetal cardiac tamponade as a salvage technique was performed in nine cases, including eight cases in which pumping of the fetal heart resumed following potassium chloride administration and in one case when lidocaine alone failed to achieve permanent cessation of fetal heart activity. The success rate of fetal cardiac tamponade as a salvage technique was therefore 100%. No maternal complications were noted in our series. Fetal cardiac tamponade is a useful and safe supplementary technique in late feticide when cardiac depressing agents fail to cease fetal cardiac activity.

Objectives The aim of this study is to determine the complications of third trimester amniocentesis for fetal karyotyping among women unwilling to accept the fetal loss risks of second trimester amniocentesis. Materials and methods A retrospective study was carried out from January 1998 to December 2006 of 182 singleton pregnancies that underwent a late amniocentesis (after 32 weeks) for fetal karyotyping. The indications were integrated risk (maternal age, first trimester nuchal translucency, second trimester maternal serum markers) over 1/250 (n=68), isolated maternal age over 38 years (n=51), isolated abnormal second trimester biochemical markers (n=34), history of personal or familial a chromosomal abnormality (n=21) or maternal choice (n=8). Presence of fetal abnormalities at ultrasound or context of viral or parasitologic seroconversion as well as multiple pregnancies were considered as non-inclusion criteria. Results Median maternal age and gestational age at sampling were 39 years (range 23-48) and 32.4 weeks (29.5-37.6). Median interval between amniocentesis and definitive results of amniocentesis on the one hand, and delivery on the on the hand were 15 days (7-42) and 47 days (8-69), respectively. There were no chromosomal abnormality and non-termination of pregnancy. Nine patients out of 182(5%) had a spontaneous labour followed by premature delivery before 37 weeks and six women (3.3%) among those nine displayed preterm premature rupture of membranes (PPROM). Four patients out of 182 (2%) gave birth before definitive karyotyping result but all of them had a direct fluorescence in situ hybridisation analysis with a normal karyotyping result known well before delivery. Conclusions The risk of preterm premature rupture of membrane is 3.3%, with a 5% risk of premature delivery before 37 weeks. This late procedure provides a safe reassurance to women who are unwilling to accept the risks of earlier amniocentesis. However, it should only be used in particular situation and in countries were legislation allows late termination of pregnancy.

We report our experience with intracardiac administration of potassium chloride as safe and effective method for late termination of pregnancy (TOP) and to document the indications for feticide in a major tertiary unit. During the study period (January 2000 and December 2005), 239 late terminations of pregnancy were performed at a median gestational age of 22(+6) weeks (range 20(+6) to 36(+3) weeks). The most frequent indication was represented by aneuploidy (24.3%), followed by brain abnormalities (17.6%). Maternal indications were responsible for 2.9% of the total number of terminations. No maternal complications occurred and complete asystole was achieved in all cases with a median volume of potassium chloride of 4.7 ml (range 2-10 ml). Potassium chloride injected directly in the left ventricle induces immediate asystole, and it is a safe and effective method of TOP. Interestingly, despite the widespread introduction of aneuploidy screening, chromosomal abnormalities, particularly trisomy 21, still represent the major indication for late TOP.

The aim of the present review was to explore the role of the psychiatrist in late terminations of pregnancy. A literature review was conducted using MEDLINE and psycINFO databases, focussing on articles that explored (i) existing decision-making processes in late terminations; (ii) psychological sequelae of both early and late termination of pregnancy; (iii) the role of psychiatry in both early and late termination of pregnancy; and (iv) the involvement of psychiatry in complex medical decisions. The decision to perform a late termination of pregnancy is complex. Contributing to its complexity is an array of political, legal, societal, and ethical factors. The literature regarding psychological sequelae is frequently confusing and weakened by methodological problems. Methods of assisting in this decision-making process include the involvement of committees and psychiatrists. There are precedents for the involvement of psychiatrists in such a setting. Historically, psychiatrists played a role in screening women who requested an early termination. Psychiatrists are often involved in ethically challenging and complex clinical decisions in the general hospital setting. The involvement of psychiatry in this complex decision-making process has potential advantages and disadvantages. It is timely for psychiatrists to consider their position on their discipline's involvement.

We investigated the attitudes and experiences of women pregnant with an anomalous fetus after being offered late termination of pregnancy (LTOP) before and after delivery or TOP.This was a pre- and post-intervention structured interview questionnaire-based study. Pregnant women with severe fetal abnormalities (lethal and nonlethal) diagnosed after 24 weeks gestation were recruited. All were managed according to standard protocol. Interviews were conducted by the researcher over a 3 months period (August-October 2010). Experiences, demographic profile, and sociocultural characteristics were compared between the groups that accepted and declined LTOP.Fifteen pregnant women with severe fetal anomalies were enrolled. Around 5 (33.3%) requested termination, and 10 (66.6%) continued the pregnancy. Those who continued their pregnancies were significantly younger (mean age 25 years, range 20-32 years) than those who requested termination (mean age 31 years, range 22-35 years) (P0.05). Mean parity was one (range 0-3) in the patients who continued the pregnancy, and 2 (1-3) in those who terminated it. Partners and immediate family members influenced decision making. All women reported a positive experience of the treatment protocol.The decision to continue or terminate a pregnancy for severe fetal abnormalities diagnosed after viability is complex and variable. Younger primigravidas were more likely to continue with the pregnancy in the hope that the baby would be born normal. Good support from partners and family, after delivery, was associated with less regret about the decision that had been made.