PERINATAL LETHAL CONDITIONS - THE EFFECT OF DIAGNOSIS ON DECISION-MAKING

Objective: To identify factors influencing pregnancy management decisi ons following identification of a perinatal lethal condition. Methods: One hundred thirty pregnancies with perinatal lethal conditions diagn osed before 24 weeks' gestation were examined. Information collected i ncluded demographic data, estimated gestational age at presentation, r eferral indication, nature of the defect, and performance of autopsy. Results: Eighty-seven families elected to abort affected pregnancies a nd 43 elected to continue. Demographic factors did not influence decis ion making, nor did gestational age at diagnosis or referral indicatio n. When comparing the diagnosis of one lethal condition with diagnoses of all other lethal conditions, pregnancies with a central nervous sy stem defect or severe urinary tract defect were more often aborted; th ose with unexplained severe oligohydramnios and twin pregnancies in wh ich at least one twin was affected were more often continued. Autopsy was obtained much more often in pregnancies that were aborted than in those that were continued. Conclusion: The type of defect correlates w ell with the pregnancy management decision. It is important to conside r the type of malformation, certainty of the diagnosis, and level of m edical understanding when counseling patients after the diagnosis of a lethal fetal defect. Because many patients will continue pregnancies diagnosed with a perinatal lethal condition, the physician should conv ey understanding and acceptance of a decision not to abort such a preg nancy. The importance of follow-up testing, including autopsy when app ropriate, should be stated clearly.