SEVERITY OF ABNORMALITY INFLUENCES DECISION TO TERMINATE PREGNANCIES AFFECTED WITH FETAL NEURAL-TUBE DEFECTS

We examined parental decision concerning pregnancy management in women having fetuses with neural tube defects (NTDs) to determine whether s everity of defect or method of detection has an impact on the decision making process. Analysis of decisions by 50 women, whose pregnancies were affected by an isolated neural tube defect (NTD) and characterize d by a singleton gestation at 24 gestational weeks or less with normal chromosomal complement (46,XX or 46,XY), were assessed. All 23 women carrying fetuses with anencephaly elected to terminate their pregnanci es. Of the 27 women carrying fetuses with spina bifida, 21 (77.8%) ele cted to terminate their pregnancies and 6 (22.2%) elected to continue their pregnancies. Of the 6 pregnancies that were continued, 4 were in itially detected by ultrasonography and 2 were ascertained by maternal serum alpha-fetoprotein screening; defects ranged from 2 to 14 verteb ral bodies, and none of the defects were craniad to the T9 level. This is in comparison to 5 of the 21 spina bifida cases that were elective pregnancy terminations, which were characterized by fetal lesions cra niad to the T9 level. Severity of NTD thus appears to influence the de cision to continue or terminate an affected pregnancy.