LATE TERMINATION OF PREGNANCY IN NORTH HOLLAND

Objectives To estimate the extent to which late termination of pregnan cy (gestational period >24 weeks) is practised, to find out what fetal diseases and abnormalities lead to termination and to obtain insight into the clinical judgement and decision-making process by gynaecologi sts with regard to termination. Design A retrospective study. Place Pr ovince of North Holland, The Netherlands. Methods An anonymous printed questionnaire, was sent to all associations or departments of gynaeco logy in the 21 hospitals in North Holland. The period of study covered the years 1990 to 1994. Results Completed questionnaires were receive d from 19 associations or departments in the 21 hospitals (90% respons e). In the five-year period under study in 14 of these hospitals had t erminated 103 pregnancies beyond the 24th week of gestation. Antenatal sonography had been performed on all these pregnancies. Anencephaly w as diagnosed before termination in 21% and severe chromosomal defects in a further 21%, Other severe abnormalities were neural groove defect s, such as hydrocephaly and/or spina bifida (16%), no renal function ( 12%) and skeletal abnormalities (11%). In 87% the antenatal diagnosis was verified postnatally; in 78% this was done by autopsy. The diagnos is was confirmed in ail these cases ('almost confirmed' in two cases). In every case the pregnant woman herself had asked for her pregnancy to be terminated, In 75% the prognosis was discussed with other medica l specialists and the professionals concerned with management; there w as a consultation about the termination in 91% of the cases. A report was always compiled for the medical records. Conclusion Late terminati on of pregnancy is practised on a substantial scale in North Holland, The reasons for termination were severe structural abnormalities which , In most cases, were not compatible with survival. The gynaecologists in North Holland dealt prudently and responsibly with late terminatio n of pregnancy, although they did not always adhere to the guidelines set out in the 1994 report of the Netherlands Association for Obstetri cs and Gynaecology.