International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2026
Timing, indications, and outcomes of termination of pregnancy after 20 weeks: A retrospective single-center cohort study.
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Fadiloglu Erdem, Cagan Murat, Eyupoglu Mert, Mamtiyeva Zeynab, Salim Rahiba, Deren Ozgur
Аннотация
OBJECTIVE: This study evaluate the indications, timing, and maternal outcomes of termination of pregnancy (TOP) after 20 weeks of gestation.
METHODS: This single-center retrospective cohort study included all TOP cases performed after 20 weeks between January 2020 and December 2025 in a tertiary referral center. Clinical characteristics, indications, gestational age at diagnosis and termination, time interval between diagnosis and TOP, and delivery methods were analyzed. Cases were stratified into peri-viable (20-24 weeks) and post-viable (>24 weeks) groups. Univariable analyses were used to assess associations with delivery method and gestational age.
RESULTS: A total of 116 TOP cases were included. The median gestational age at diagnosis and termination were 22 and 24 weeks, respectively, with a median interval of 11 days. The most common indications were central nervous system, cardiovascular, and genetic abnormalities. Post-viable cases accounted for 30.2% of the cohort and were associated with higher parity and a higher rate of hysterotomy (28.6% vs. 11.1%, P = 0.028). Vaginal delivery was the predominant method (83.6%). Hysterotomy was associated with advanced gestational age, higher birth weight, and prior cesarean section but did not increase transfusion or intensive care unit admission rates despite greater hemoglobin decline.
CONCLUSION: Late TOP is a clinically complex but generally safe procedure with heterogeneous indications. While some cases might reflect delayed care, others are intrinsically late. Hysterotomy was not associated with increased major maternal morbidity in our cohort when clinically indicated.
METHODS: This single-center retrospective cohort study included all TOP cases performed after 20 weeks between January 2020 and December 2025 in a tertiary referral center. Clinical characteristics, indications, gestational age at diagnosis and termination, time interval between diagnosis and TOP, and delivery methods were analyzed. Cases were stratified into peri-viable (20-24 weeks) and post-viable (>24 weeks) groups. Univariable analyses were used to assess associations with delivery method and gestational age.
RESULTS: A total of 116 TOP cases were included. The median gestational age at diagnosis and termination were 22 and 24 weeks, respectively, with a median interval of 11 days. The most common indications were central nervous system, cardiovascular, and genetic abnormalities. Post-viable cases accounted for 30.2% of the cohort and were associated with higher parity and a higher rate of hysterotomy (28.6% vs. 11.1%, P = 0.028). Vaginal delivery was the predominant method (83.6%). Hysterotomy was associated with advanced gestational age, higher birth weight, and prior cesarean section but did not increase transfusion or intensive care unit admission rates despite greater hemoglobin decline.
CONCLUSION: Late TOP is a clinically complex but generally safe procedure with heterogeneous indications. While some cases might reflect delayed care, others are intrinsically late. Hysterotomy was not associated with increased major maternal morbidity in our cohort when clinically indicated.