23 April 2007

Outcomes of abortions for fetal abnormality

A study claims that one in 30 fetuses aborted for medical reasons is born alive. The charity Antenatal Results and Choices responds.

The 10-year study at 20 UK hospitals, by M P Wyldes and A M Tonks, was published in the British Journal of Obstetrics and Gynaecology.

Anti-abortion campaigners said the figures in the study were likely to be the tip of the iceberg. But abortion experts said such incidents were extremely rare.

About 190,000 abortions take place annually in England and Wales. Most abortions are carried out on ‘healthy’ fetuses for social reasons, reports the BBC. Abortion is allowed in Britain up to the 24th week of pregnancy. Beyond this, a termination is only sanctioned if the fetus has a severe disability or if the mother’s life is at risk.

The study, however, looked at the outcomes of 3,189 abortions performed between 1995 and 2004 because the fetus had a disability of some kind. It showed that 102 - or around one in 30 - were born alive. Most of these babies with disabilities were born between 20 and 24 weeks of pregnancy and all lived for no more than a few hours.

Julia Millington of the anti-abortion campaign Alive and Kicking said the rates found at West Midlands hospitals studied were likely to be mirrored elsewhere in the UK. ‘If 102 out of 3,189 babies aborted for reasons of impairment are born alive, then how many healthy babies must be surviving?’ she said. ‘It is difficult to comprehend the number of babies, throughout the country, left fighting for their lives.’

The Royal College of Obstetricians and Gynaecologists (RCOG) said it had “very strong” guidelines on terminations of pregnancy after 22 weeks. According to the guidelines, after 22 weeks and beyond, if there are signs of major fetal abnormality and the patient has requested an abortion, the patient should be offered feticide, where a lethal injection is administered. The patient has the right to refuse this course of action. If the baby is born alive, palliative care should be provided till the baby dies.

Theoretically, such an event could result in a doctor being accused of murder if a ‘deliberate act’ - that is, legal abortion - were to be followed by a live birth and the subsequent death of the child because of immaturity. An RCOG spokesman said an expert group was examining the management of cases when babies are born before 21 weeks 6 days and will produce a report with guidelines in due course.

Ann Furedi, chief executive of BPAS, said:

‘Termination for fetal abnormality is rare. This only occurs where there is a diagnosis of a severe or life-threatening disability in the fetus. To end a wanted pregnancy because of severe fetal impairment is understandably, a very difficult choice for women and couples.

‘Medical induction for termination of pregnancy due to fetal abnormality is not something we specialise in at BPAS. It would be wrong to imply from this retrospective study, that if women undergo a medical induction abortion at under 24 weeks’ gestation for reasons aside from fetal abnormality, that this is at all likely to result in a live birth. Doctors working in abortion care have for some years now followed the Royal College of Obstetricians and Gynaecologist’s guidance, that the fetal heart is stopped before a medical induction abortion around 22 weeks’ gestation.’

A comment for the charity Antenatal Results and Choices reads as follows:

‘The paper by Wylde and Tonks identifies some of the difficult issues faced by women, their partners and by health professionals caring for them when a fetal abnormality is diagnosed late in pregnancy. It is particularly welcome news that this paper confirms that increasing numbers of terminations after prenatal diagnosis are taking place earlier in pregnancy because that is safer for women and can sometimes be carried out more easily – although we would like to make clear that whatever the gestational age at termination, it is still distressing for parents to make the decision to terminate what has been a wanted pregnancy.

‘However, in spite of earlier screening and more rapid testing we know that many diagnoses cannot be confirmed earlier in pregnancy – often it is because parents and doctors seek as much certainty as is possible about the implications of a suspected anomaly that can delay a termination. We would argue that such certainty is important for all concerned and confirms that these are not decisions taken lightly. Management of late termination is a complex area of obstetric practice and all of the evidence suggests that this is done within a framework of reference to the law, professional guidance and sensitivity to the individual needs of parents.

‘The paper shows that feticide precedes an increasing number of late terminations to ensure that a baby is not born alive but ‘signs of life’ do not mean that even with major interventions that baby could survive. In many cases there is absolutely no likelihood that even if the pregnancy progressed to term these babies would survive beyond the early neonatal period. Feticide is technically demanding and stressful for parents and professionals alike. Enforcing the procedure in cases where death is the inevitable outcome either as a means to reduce apparent perinatal mortality figures or to satisfy those who do not support the legal availability of abortion will not benefit anyone. It may also call into question the option of planned palliative care for babies with prenatally diagnosed abnormalities where parents choose not to terminate.’

Antenatal Results and Choices exists to offer parents support when facing decisions around prenatal testing. The charity’s helpline is 020 7631 0285.

One in 30 aborted foetuses lives, BBC News, 20 April 2007

Termination of pregnancy for fetal anomaly: a population-based study 1995 to 2004. Wyldes MP; Tonks AM. BJOG: An International Journal of Obstetrics and Gynaecology. Volume 114 Issue 5 Page 639 - May 2007. Email