Therapeutic Termination of a Pregnancy

Midwife checking woman's pregnancy in hospital
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Being told by your doctor that you need to consider ending a pregnancy for health reasons—sometimes called therapeutic termination—is very difficult news. Therapeutic termination is also known as medically indicated termination or medically indicated abortion. It is only recommended in cases where:

  • The fetus has a medical condition which is certain to result in death either before or shortly after birth.
  • The mother risks death by continuing the pregnancy.

The decision to go ahead with a termination is usually very painful for parents. There are many things to consider, from your personal moral beliefs to religious laws, state laws, and insurance coverage. As always, the choice is personal, and your doctor should not pressure you into any decision that makes you feel uncomfortable. In most cases, you can take your time to decide.

Before any decisions can be made, most parents want to thoroughly understand the reason a termination is indicated. The reasons are best broken down into two types: problems with the developing fetus or problems associated with the pregnancy.

Problems With the Fetus

The process by which a fetus develops is complex and intricate. Even tiny changes in the process can dramatically affect the health and well-being of a baby. If your baby is diagnosed with any of these conditions during routine prenatal testing, discuss the diagnosis thoroughly with your physician. If possible, request to meet with a perinatologist who has experience with the diagnosis.

Note that there are spectrums of severity for some conditions. For example, amniotic band syndrome may result in a minor malformation of the fingers or toes in one case, while in another amniotic bands might restrict the umbilical cord, which is potentially fatal. Not every condition is life-threatening, but some are fatal.

It is important to know that none of these conditions require you to have a therapeutic termination. Some women choose to carry a pregnancy as long as possible, potentially to full term, and allow nature to take its course.

If you decide to continue a pregnancy when your baby has a condition known to be fatal, you may want to seek out a program that specializes in palliative care for infants. You may also want to consult with a neonatologist who can explain the diagnosis and prognosis fully.

Anencephaly

Early in the development of an embryo, a flaw in the formation of the neural tube (which eventually becomes the brain and spinal cord) can result in a failure of the brain, skull, and scalp to develop, a condition called anencephaly. In a fetus with anencephaly, the forebrain and cerebrum do not develop, and the remaining parts of the brain may not be covered by bone or skin.

Although babies with anencephaly may live to full-term and be born alive, only basic functions like breathing are possible. They will never be fully conscious. Most of these babies only survive a few hours or days after birth.

Chromosomal Abnormalities

Chromosomal abnormalities are the genetic changes responsible for the majority of miscarriages and many stillbirths. They are generally random and do not repeat in subsequent pregnancies, unless the father or mother is affected by a genetic disorder called balanced translocation. Chromosomal abnormalities are a frequent indication for therapeutic termination.

Hydrocephalus

Hydrocephalus, or "water on the brain," occurs when cerebral spinal fluid cannot flow properly between the ventricles in the brain, resulting in a build-up of pressure. Independently, it is not usually life-threatening, but if your baby is found to have excess fluid in the brain, you will need further evaluation to look for related conditions and associated causes.

Meckel-Gruber Syndrome

Meckel-Gruber syndrome is a rare genetic disorder that only occurs when both parents carry the recessive gene for it. It results in a combination of congenital malformations that include a too-large fontanel (soft spot), polycystic kidneys, polydactyly (too many fingers or toes), and impaired liver and lung development. It is always fatal.

Pentalogy of Cantrell

This is a rare genetic disorder with five possible malformations. Most affected fetuses do not have all five, but the condition can be life-threatening even without all of them.

These defects include omphalocele (a defect in the abdominal wall which allows intestines to protrude outside the body), anterior diaphragmatic hernia (an internal muscle defect which can allow lower organs to intrude into the chest cavity), sternal cleft (a groove or cleft in the sternum), ectopia cordis (where the heart may protrude outside the body), and intracardial defect (a hole or defect in one of the walls of the heart).

An ultrasound diagnosis of any of the possible malformations should be referred to a perinatologist for a complete assessment and to form a treatment plan.

Potter’s Syndrome

This term may refer to the characteristic appearance of a baby without adequate amniotic fluid (the fluid or "water" that surrounds the baby inside the uterus) during pregnancy. It is more specifically applied to a fetus with bilateral renal agenesis (BRA, failure of the kidneys to develop). In cases of BRA, the condition is lethal and may be an indication for a therapeutic termination.

Thanatophoric Dysplasia

This genetic disorder causes severe skeletal malformations. The skull, long bones, and torso are affected. Although there have been rare cases of affected people surviving into early childhood, the condition is still largely considered lethal. This disorder is an indication for a therapeutic termination.

Problems in the Pregnancy

Sometimes, during pregnancy, unexpected events threaten the life of the fetus or the mother. While these conditions do not always result in a pregnancy loss, there is a possibility you will not want to, or be able to, continue your pregnancy.

Amniotic Band Syndrome

When strands of the amniotic sac detach from the sac, they can become wrapped around any part of a developing fetus. Complications of amniotic band syndrome can include amputations of fingers or toes, fused digits, clubbed feet, and cleft lip. In more severe cases, amniotic bands can wrap around the head or umbilical cord and become life-threatening.

Maternal Health Conditions

For people with certain severe medical problems, the biological stress of pregnancy can be dangerous or deadly. These situations could include a severely compromised heart or a new diagnosis of dangerous cancer requiring immediate treatment.

These cases are unusual and recommending a termination is not done lightly. Your doctor should thoroughly assess the risks and benefits of continuing your pregnancy, including your wishes, and work with you to choose a satisfactory treatment plan.

It's important to note that it is possible for some women to receive chemotherapy during pregnancy, at least during the second and third trimester. If you are diagnosed with cancer during pregnancy it is important to work with both an obstetrician who specializes in high-risk pregnancies and an oncologist who is comfortable treating women who are pregnant.

Premature Rupture of Membranes

Premature rupture of membranes (PROM) is a condition in which the bag of waters (amniotic sac) breaks before the pregnancy reaches full term. There are many reasons why this happens.

If PROM occurs prior to 24 weeks gestation, physicians may recommend a therapeutic termination because the lack of fluid will severely impair the normal development of the baby’s organs. There is also a high risk of infection for the pregnant person. If you become infected, ending your pregnancy may be the only cure.

Selective Reduction

In multiple pregnancies, your doctor may recommend a selective reduction, or terminating one or more of the fetuses. This is intended to decrease risk to the other babies or the mother. For example, if in vitro fertilization is done and seven embryos implant, a woman may choose to reduce this to two or three in order to prevent the likely loss of all the embryos.

Severe Pre-Eclampsia

Rarely, a woman can develop severe pre-eclampsia before a fetus is viable (can live outside the womb). Because the only known cure for pre-eclampsia is delivery, it may be necessary to end a pregnancy to save a mother's life. Continuing a pregnancy with severe pre-eclampsia can lead to seizures, kidney failure, stroke, liver complications, and death.

Making the Decision to Terminate 

After you understand the reasons why your doctor may recommend termination, you may wish to review some of the pros and cons of ending a pregnancy for medical reasons or a poor prognosis. If you have questions or concerns, discuss them with your physician. A consultation with a perinatologist may help.

It's important to state again that there is not a right or wrong decision to make most of the time. The right decision is the one that you feel most comfortable with after you fully understand your situation and have reviewed all of the possible options.

This can be a deeply emotional time, especially if any of your loved ones have opinions that differ from yours, or are advocating for a different choice. You may have to firmly remind friends and loved ones that you appreciate their thoughts and input, but that you must make the decision both you and your partner feel is best.

When you make your decision, you will also need to decide whom you will tell. If you do decide to share with others, choose people who will be entirely non-judgmental of your choice. At this time you need all the support your loved ones can share, not a discussion of what they would do in a situation they have not faced.

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