Fetal anomaly diagnosis and termination of pregnancy in Ireland: a service evaluation following implementation of abortion services in 2019

Hadas Miremberg; Oladayo Oduola; John J Morrison; Keelin O'Donoghue

doi:10.1016/j.ajogmf.2023.101111

Fetal anomaly diagnosis and termination of pregnancy in Ireland: a service evaluation following implementation of abortion services in 2019

Am J Obstet Gynecol MFM. 2023 Oct;5(10):101111. doi: 10.1016/j.ajogmf.2023.101111. Epub 2023 Jul 31.

Authors

Hadas Miremberg¹, Oladayo Oduola², John J Morrison², Keelin O'Donoghue³

Affiliations

¹ Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland (Drs Miremberg and O'Donoghue). Electronic address: dasile2@gmail.com.
² Department of Obstetrics and Gynaecology, Galway University Hospital, University of Galway, Galway, Ireland (Drs Oduola and Morrison).
³ Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork, Ireland (Drs Miremberg and O'Donoghue); INFANT Research Centre, University College Cork, Cork, Ireland (Dr O'Donoghue).

PMID: 37532025
DOI: 10.1016/j.ajogmf.2023.101111

Abstract

Background: Approximately 3% of pregnancies are diagnosed with a fetal anomaly, of which a proportion is fatal or life-limiting. The introduction of legislation for termination of pregnancy in Ireland in 2019 for conditions "likely to lead to the death of the fetus" made termination of pregnancy for "fatal fetal anomaly" an option for pregnant women in Ireland.

Objective: This study examined all cases of termination of pregnancy performed for major fetal anomaly over the first 3 years of service implementation, including cases that did not meet the legal criteria, resulting in women traveling outside Ireland for abortion care.

Study design: A retrospective service evaluation of tertiary fetal medicine clinics in 2 tertiary maternity hospitals between 2019 and 2021 was undertaken. We compared pregnancies of patients diagnosed with fatal fetal anomaly who underwent termination of pregnancy in Ireland with those of patients who did not meet the legal criteria and hence traveled outside Ireland for termination of pregnancy.

Results: Overall, 139 pregnancies met the inclusion criteria; 83 (59.7%) patients had termination of pregnancy in the tertiary maternity hospital (local), and 56 (40.3%) traveled abroad, mainly to the United Kingdom. Demographic characteristics were similar between the 2 groups, as was gestation at diagnosis and delivery. All cases where termination of pregnancy was local were discussed at fetal medicine multidisciplinary meetings, as opposed to 34% of cases of patients who ultimately traveled outside Ireland for termination of pregnancy. The most common indication (25/83; 30.1%) for local termination of pregnancy was trisomy 18, followed by anencephaly. Traveling to obtain abortion care was mainly due to diagnosis of trisomy 21 (30/56; 53.6%), followed by other multiple structural anomalies/syndromes deemed locally as not meeting the legal criteria.

Conclusion: Legislation for termination of pregnancy for fetal anomaly, restricted to fatal diagnoses, is difficult to implement, requires significant multidisciplinary input, and can lead to limited services for pregnancies diagnosed with major fetal anomalies. Our findings emphasize the impact of legislative barriers to abortion care for fetal anomaly and the need for policies and services that support women's access to termination of pregnancy for fetal anomaly.

Keywords: abortion travel; fatal fetal anomaly; fetal anomaly; legislation; termination of pregnancy.