Prenatal diagnosis · 2006
Critical evaluation of elective termination of pregnancy in a tertiary fetal medicine center during 43 months: correlation of prenatal diagnosis findings and postmortem examination.
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Ramalho Carla, Matias Alexandra, Brandão Otília, Montenegro Nuno
Аннотация
OBJECTIVES: The aim of this study is the critical evaluation of cases of elective termination of pregnancy (TOP) in the Prenatal Diagnosis Center of S. João Hospital.
MATERIAL AND METHODS: We performed a retrospective study of cases of elective TOP over a 43-month period in a tertiary referral hospital. The fetal indications for termination were analyzed. A comparative study of the prenatal diagnosis, established by ultrasound, and the results of postmortem findings, was performed. These were classified as having complete agreement, complete disagreement and major agreement with additional information.
RESULTS: In total, during this period, 76 elective terminations of pregnancy were performed due to fetal causes. The number of fetal identified grounds was 25 cases of chromosomal abnormalities, 36 cases of morphological anomalies and 15 cases of other fetal situations. The comparison between ultrasound and fetopathologic findings showed complete agreement of diagnosis in 61.1% of cases, and no case of absolute discordance was identified. Major concordance with additional information was found in 38.9% of cases, with an increased risk of recurrence in six cases, and a decreased estimated risk of recurrence in three cases.
DISCUSSION: This study reinforces the importance of the systematic evaluation of all cases of elective TOP by autopsy performed by a specialist fetal pathologist. This is the most reliable way of assessing the adequacy of prenatal diagnosis and implementing quality control. More than corroborating or correcting the prenatal diagnosis, systematic autopsy may establish a definite diagnosis, adjust prognosis and may be helpful in counseling the parents for a future pregnancy.
MATERIAL AND METHODS: We performed a retrospective study of cases of elective TOP over a 43-month period in a tertiary referral hospital. The fetal indications for termination were analyzed. A comparative study of the prenatal diagnosis, established by ultrasound, and the results of postmortem findings, was performed. These were classified as having complete agreement, complete disagreement and major agreement with additional information.
RESULTS: In total, during this period, 76 elective terminations of pregnancy were performed due to fetal causes. The number of fetal identified grounds was 25 cases of chromosomal abnormalities, 36 cases of morphological anomalies and 15 cases of other fetal situations. The comparison between ultrasound and fetopathologic findings showed complete agreement of diagnosis in 61.1% of cases, and no case of absolute discordance was identified. Major concordance with additional information was found in 38.9% of cases, with an increased risk of recurrence in six cases, and a decreased estimated risk of recurrence in three cases.
DISCUSSION: This study reinforces the importance of the systematic evaluation of all cases of elective TOP by autopsy performed by a specialist fetal pathologist. This is the most reliable way of assessing the adequacy of prenatal diagnosis and implementing quality control. More than corroborating or correcting the prenatal diagnosis, systematic autopsy may establish a definite diagnosis, adjust prognosis and may be helpful in counseling the parents for a future pregnancy.