Abstract
Background In Germany, the highly sensitive issue of late terminations of pregnancy and feticide
is regulated in Sec. 218a para. 2 of the German Penal Code (medical indication). This
study aimed to investigate the prenatal obstetric approach after feticide and the
rate of maternal complications.
Material and Methods All feticides of singleton pregnancies carried out at Leipzig University Hospital
(n = 164) in the period between 01/2016 and 12/2019 were retrospectively analyzed.
Selective feticides of multiple pregnancies were excluded from the study. Target indicators
for the prenatal obstetric approach were sonographic accuracy of estimation, method
used to induce feticide, time between feticide and delivery, and whether curettage
was required. The rate of maternal complications was defined as blood loss of ≥ 500 ml.
Results The number of feticides as a percentage of the total number of births during the
investigation period was 1.6%. None of the terminations were performed primarily because
of a serious risk to the motherʼs physical health; all of the indications to terminate
the pregnancy were based on the psychosocial burden and the risk to the motherʼs mental
health as outlined in Sec. 218a StGB (German Penal Code). The most common fetal diagnoses
in the context of a maternal psychosocial emergency were central nervous system abnormalities
(29.3%), numerical chromosomal aberrations (29.3%) and structural chromosomal aberrations/syndromes
(21.3%). Sonographic measurements were used to estimate fetal weight and the weight
of around half of the fetuses was underestimated (− 121.8 ± 155.8 g). The margin of
estimation error increased with increasing gestational age (p < 0.001). Misoprostol
was the most common drug administered to induce labor. No significant association
was
found between the method chosen for induction, parity, fetal birth position,
fetal anomaly, fetal gender, birth mode or the number of previous cesarean sections
and Δdelivery. However, a significantly higher loss of blood was observed with longer Δdelivery (p = 0.02). The likelihood of requiring curettage increased with increasing loss
of blood. The number of maternal complications as a percentage of the total patient
population was 10.4%. Only 11% of patients agreed to a postmortem examination.
Conclusion Late terminations of pregnancy carried out in accordance with Sec. 218a para. 2 StGB
are a reality and must be understood and accepted as a possible consequence of modern
prenatal medicine. The complication rate after feticide and the subsequent obstetric
procedure was 10% for the above-defined maternal complication. Late terminations and
their obstetric management should be carried out in specialized perinatal centers
which offer interprofessional expertise.
Key words
feticide - late termination - maternal outcome - induction of labor - blood loss
