Maternal 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 of gestation) and late (‡22 weeks of gestation) termination of pregnancy (TOP) among pregnant mothers with prenatal diagnosis of lethal fetal anomalies. Methods: This was a retrospective study reviewing all patients diag...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier Ireland Ltd.
2012
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/29183/1/Maternal_outcome_of_early_versus_-_p77.pdf http://irep.iium.edu.my/29183/ http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2012.03376.x/abstract |
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| Summary: | Objective: To compare the maternal morbidities between early
(<22 weeks of gestation) and late (‡22 weeks of 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 two
groups, i.e. early and late TOP groups. The maternal morbidities and outcome of these two groups of patients were compared
respectively.
Results: There were 25 patients diagnosed to have lethal fetal
anomalies, included fetuses with multiple structural abnormalities
(40.0%), anencephaly or severe encephalocele (32.0%), nonimmune
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, five (27.8%) patients had complicated delivery, included
three (16.7%) with assisted breech delivery and two (11.1%) with
abdominal delivery. 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%), postpartum 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
minimise the maternal morbidities and improve the outcome.
More data need to be recruited to prove this conclusion. |
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