Material outcome of early versus late termination of pregnancy among pregnant mothers with prenatal diagnosis of lethal fetal anomalies: a retrospective review

Objective: To compare the maternal morbidities between early (< 22 weeks gestation) and late (≥ 22 weeks gestation) termination of pregnancy (TOP) among pregnant mothers with prenatal diagnosis of lethal fetal anomalies. Methods: This was a retrospective study reviewing all patients diagnosed prenatally to carry lethal fetal anomalies in Hospital Tengku Ampuan Afzan, Kuantan, Pahang, Malaysia during the year of 2011. Data was traced from patients’ medical record in hospital record office. These patients were divided into 2 groups, i.e. early and late TOP groups. The maternal morbidities and outcome of these 2 groups of patients were compared. Data was analyzed by using SPSS version 17.0. Results: There were 25 patients diagnosed (via ultrasound with or without genetic study) to have lethal fetal anomalies, included fetuses with multiple structural abnormalities (40.0%), anencephaly or severe encephalocele (32.0%), non-immune hydrops fetalis (16.0%) and syndromic fetuses (12.0%) i.e. Pentalogy of Cantrell and Edward’s syndrome. Seven (28.0%) and 18 (72.0%) patients had early and late TOP respectively. All patients with early TOP aborted vaginally. Among those with late TOP, 5 (27.8%) patients had complicated delivery, included 3 (16.7%) with assisted breech delivery and 2 (11.1%) with abdominal delivery. The abdominal deliveries were for transverse lie in labour and emergency hysterotomy for failed induction complicated by hysterectomy for ruptured uterus noted intraoperatively. Patients with late TOP were more prevalent to morbidities compared to early TOP arm, i.e. frequent hospital admissions (33.3% vs 14.3%), abnormal lie in labour (22.2% vs 0.0%), symptomatic polyhydramnios requiring amnioreduction (22.2% vs 0.0%), post-partum haemorrhage (16.7% vs 0.0%), blood transfusion (11.1% vs 0.0%) and uterine rupture (5.6% vs 0.0%). Mean duration of hospital stay was slightly longer in the late TOP group (6.9±4.1 days) than the early TOP group (5.7±2.8 days). One patient with late TOP developed impending eclampsia requiring IV MgSO4 infusion. However, there was higher prevalence of retained placenta in the group of early TOP (28.6%) compared to the group of late TOP (5.6%). One patient with early TOP developed endometritis following manual removal of retained placenta. Conclusion: Patients with late TOP seem to have more morbidities compared to patients with early TOP though the sample size is too small to yield statistically significant result. It may suggest that early prenatal diagnosis and TOP are essential to minimize the maternal morbidities and improve the outcome. More data need to be recruited to prove this conclusion