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Determinants of Parental Decision to Abort Or Continue After Non-Aneuploid Ultrasound- Detected Fetal Abnormalities

From the Division of Reproductive Genetics, Department of Obstetrics and Gynecology, Hutzel Hospital/Wayne State University, Detroit, Michigan

Abstract

Objective: This study evaluated factors influencing the decision to abort after abnormalities in the karyotypically normal fetus were found through ultrasonography.

Methods: We reviewed all pregnancies complicated by ultrasound - detected abnormalities managed on our service from April 1990 through August 1991 {N=262). Cases with associated karyotypic abnormalities were excluded (N=35), as were cases diagnosed after the legal gestational age limit for abortion (N=68). The remaining 159 cases were stratified into prognosis groups of "severe," "uncertain," and "mild."

Results: The prognostic severity of the ultrasound abnormality strongly correlated with the decision to abort (P<.0001). Rates of termination were 0, 12, and 66% in the "mild," "uncertain," and "severe" groups, respectively. The patients' age, gravidity, and parity, and the fetal gestational age at diagnosis did not differ significantly between the groups.

Conclusions: 1) In non-aneuploid pregnancies with an ultrasound diagnosis of fetal abnormality, the major predictor of the decision to abort was the severity of fetal prognosis. 2) The gestational age at diagnosis was not an important variable in the decision to abort for fetal structural abnormalities. 3) Parents who had fetuses with abnormalities associated with uncertain prognoses usually opted to continue the pregnancy. This appeared to be particularly true for defects that were potentially correctable in utero or by neonatal intervention (even if investigational).

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