Is there a slippery slope? - Data on 22 years of medically indicated terminations of pregnancy from a tertiary obstetric center in Germany.

Abstract

Purpose: To evaluate the impact of changes in legislation regarding termination of pregnancy (TOP) and new diagnostic procedures such as non-invasive prenatal testing (NIPT) on timing and diagnoses of medically indicated TOPs at a tertiary obstetric center during a 22-year period.

Materials and methods: This retrospective study was conducted at the Department of Obstetrics and Gynecology of a tertiary obstetric center between 2002 and 2023. Data on TOP was extracted from the electronic patient files. Cases were divided into subgroups according to legislative changes as well as groups before and after the introduction of NIPT. Descriptive statistics were computed and Mann-Whitney-U and Kruskal-Wallis tests were conducted to compare the non-normally distributed variables among subgroups.

Results: 1726 cases of TOP were included in this study. Altogether, there was no noticeable change in diagnoses for TOP over the 22-year study period. We observed a noticeable increase in gestational age at the time of TOP which remained, however, below fetal viability. Towards the end of the study period, there was a noticeable increase in TOP requiring feticide.

Conclusion: Neither changes in TOP legislation nor the introduction of NIPT resulted in a steep increase in TOP for certain diagnoses. The increase in gestational age as well as the increasing number of feticides can most likely be attributed to multiple factors beyond changes in legislation and diagnostic procedures.