Late termination of pregnancy for severe fetal malformation in a resource constrained setting: feticide versus perinatal palliative care

Logambal Govender, Jagidisa Moodley, Jonathan Hyett

Abstract


In South Africa (SA) a large proportion of fetal abnormalities are detected after the period of viability in women attending the public health institutions. Viability is defined as period ?24 week gestation. While most fetal malformations due to aneuploidy abort early in pregnancy, those fetal abnormalities that continue into the late gestations are usually due to structural abnormalities, commonly involving the brain and spine. Should they survive, these children are likely to suffer severe physical and mental handicap. Rarely, a termination may be performed in maternal interest. Irrespective of the reason for the late termination of pregnancy (LTOP), the decision-making on whether to continue or terminate a viable fetus poses a difficult challenge to the health care providers and the women / family. Even after the painful decision to terminate the pregnancy is made, there are no current guidelines for the practice of feticide in SA. In this study, we wish to explore the role of feticide in termination of pregnancy (TOP) after the confirmed diagnosis of a severe fetal anomaly detected beyond clinical viability in a resource constrained setting. This includes the decision-making processes for accepting or declining LTOP with feticide; and the feasibility, safety and efficacy of intracardiac potassium chloride (KCl) as a method of feticide for LTOP. The delivery outcome in the group that accepted late termination (with or without feticide) will be compared with the perinatal outcome in the group that declined LTOP - with or without aggressive fetal management (perinatal palliative care). The women’s views and concerns after delivery of an anomalous fetus between the groups will be compared shortly after delivery and 6 weeks later. The results from this study will help us in developing clinical guidelines for the practice of feticide in SA.