Decision-making for termination of pregnancies with fetal anomalies: Analysis of 53,000 pregnancies
Decision-making for termination of pregnancies with fetal anomalies: Analysis of 53,000 pregnancies
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DOI：
10.1016/s0029-7844(01)01673-8
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发表时间：
2002-02-01
影响因子：
7.2
通讯作者：
Rothman, SM
中科院分区：
文献类型：
--
作者：
Schechtman, KB;Gray, DL;Rothman, SM
目的：为了评估产前胎儿畸形知识和社会人口学特征的程度决定了53,000例妊娠结局。方法：在1984年至1997年期间，在一所大学医院连续评估妊娠。异常的严重程度采用顺序量表进行分级，其中0为无异常，1为对生活质量无影响，2为影响不大但可能需要药物治疗，3为即使采用最佳药物治疗仍对生活质量有严重影响，4为与生活不相容。1级和3级异常的流产率分别从0.9%增加到72.5%，中枢神经系统和非中枢神经系统异常的流产率分别从0.9%增加到37.1%（P <0.001）。多因素Logistic回归分析显示，未接受过高中教育的母亲比完成高中教育的母亲更有可能终止正常妊娠（比值比[OR] 1.62，95%置信区间[CI] 1.07，2.45）。在452例妊娠中，有一个3级异常，逻辑回归也表明，流产率下降了6%，每年作为母亲年龄的下降（OR 0.94，95%CI 0.91，0.97）。结论：异常的严重程度与流产率直接相关，但在类似的严重程度，中枢神经系统异常更容易导致流产。母亲的教育水平与终止正常妊娠的可能性呈负相关，因为当存在严重异常时，母亲的年龄与终止妊娠直接相关。严重的先天性畸形可能对来自最年轻母亲家庭的儿童造成不成比例的影响，因为这些母亲很可能继续怀孕。(C)2002年由美国妇产科医师学院发布。
OBJECTIVE: To evaluate the degree to which prenatal knowledge of fetal anomalies and sociodemographic characteristics determined outcome of 53,000 pregnancies.METHODS: Pregnancies were consecutively evaluated at a university hospital between 1984 and 1997. The severity of anomalies was graded by using an ordinal scale, in which 0 was no anomalies, 1 was no impact on quality of life, 2 was little impact but possibly requiring medical therapy, 3 was serious impact on quality of life even with optimal medical therapy, and 4 was incompatible with life.RESULTS: The abortion rates for grades 1 and 3 anomalies increased from 0.9% to 72.5%, and 0.9% to 37.1% for central nervous system and non-central nervous system anomalies, respectively (P < .001). Multiple logistic regression showed that mothers without a high school education were more likely than those who completed high school to abort a normal pregnancy (odds ratio [OR] 1.62, 95% confidence interval [CI] 1.07, 2.45). In the 452 pregnancies in which there was one grade 3 anomaly, logistic regression also showed that the abortion rate decreased by 6% per year as maternal age decreased (OR 0.94, 95% CI 0.91, 0.97).CONCLUSIONS: The severity of anomalies directly correlates with abortion rates, but at similar degrees of severity, central nervous system anomalies are more likely to lead to abortion. Maternal level of education inversely correlates with likelihood of termination of a normal pregnancy, where-as maternal age directly correlates with pregnancy termination when serious anomalies are present. Serious congenital anomalies may disproportionately affect children from families with the youngest mothers because these mothers are likely to continue these pregnancies. (C) 2002 by the American College of Obstetricians and Gynecologists.