Impact of pregnancy termination law reforms in Ireland on pregnancy termination rates in the setting of fetal congenital heart disease: A trend analysis

IF 2.6 3区医学 Q2 OBSTETRICS & GYNECOLOGY

International Journal of Gynecology & Obstetrics Pub Date : 2024-12-06 DOI:10.1002/ijgo.16021

Fiona Cody, Nollaig Kelleher, Zara Molphy, Patrick Dicker, Fergal Malone, Sirisha Bellamkonda, Fiona Mc Elligott, Fionnuala M. Breathnach

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Abstract

Objective

Prior to 2019, termination of pregnancy (TOP) was unlawful in Ireland. We sought to examine the impact of legislative change on TOP for major congenital heart disease (CHD) and its effect on parental decision-making regarding the options of complex surgery, TOP, or palliative perinatal care.

Methods

This was a trend analysis of second-trimester TOP for major CHD before and after the law reforms relating to pregnancy termination in Ireland. Retrospective data were collected on pregnancies complicated by major CHD at the largest tertiary referral obstetric center in Ireland from January 2017 to December 2023. Suspected CHD cases were referred to a dedicated fetal medicine/cardiology service. Major CHD was defined as an expected requirement for cardiac intervention in the first year of life. Genetic testing was performed where required, counseling was offered, and individualized care plans were developed.

Results

In a consecutive unselected cohort, 269 of 60 871 screened pregnancies fulfilled criteria for a diagnosis of major CHD. Major CHD was an isolated abnormality in 55% (147/269) of cases, while an extracardiac diagnosis was identified in 45% (162/269). TOP was chosen in 21% (16/76) of cases prior to legislative change and in 20% (39/193) of cases after legislative change (P = 0.158). The TOP rate was 8% (13/147) in isolated CHD cases, compared with 34% (42/122) in the setting of additional abnormalities (structural or genetic).

Conclusion

We observed no difference in the rate of TOP for major CHD before and after TOP law reforms in Ireland on the grounds of fetal abnormality.

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爱尔兰终止妊娠法改革对胎儿先天性心脏病患者终止妊娠率的影响：趋势分析

目的：2019年之前，终止妊娠（TOP）在爱尔兰是非法的。我们试图研究立法变化对重大先天性心脏病（CHD） TOP的影响及其对父母选择复杂手术、TOP或姑息性围产期护理决策的影响。方法：对爱尔兰有关终止妊娠的法律改革前后妊娠中期主要冠心病的TOP进行趋势分析。回顾性数据收集了2017年1月至2023年12月在爱尔兰最大的三级转诊产科中心合并严重冠心病的妊娠。疑似冠心病病例被转介到专门的胎儿医学/心脏病学服务。重度冠心病被定义为生命第一年预期需要心脏干预。在需要的地方进行基因检测，提供咨询，并制定个性化的护理计划。结果：在一个连续的非选择队列中，60871例筛查妊娠中有269例符合严重冠心病的诊断标准。在55%（147/269）的病例中，重度冠心病是孤立的异常，而45%（162/269）的病例被确诊为心外诊断。立法变更前选择TOP的占21%(16/76)，立法变更后选择TOP的占20% (39/193)（P = 0.158）。在单独的冠心病病例中，TOP率为8%(13/147)，而在其他异常（结构或遗传）的情况下，TOP率为34%（42/122）。结论：在爱尔兰，我们观察到以胎儿畸形为理由的TOP法律改革前后，主要冠心病的TOP率没有差异。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Gynecology & Obstetrics 医学-妇产科学

CiteScore

5.80

自引率

2.60%

发文量

493

审稿时长

3-6 weeks

期刊介绍： The International Journal of Gynecology & Obstetrics publishes articles on all aspects of basic and clinical research in the fields of obstetrics and gynecology and related subjects, with emphasis on matters of worldwide interest.