OBJECTIVES: To report indications and risk factors for effective termination of pregnancy (TOP) when multidisciplinary prenatal diagnosis centers refuse request for TOP. METHODS: This is a retrospective study from a French national registry between 2005 and 2009. Indication groups for TOP refusal were created. Risk factors for pregnancy outcomes and effective TOP were determined by multinomial logistic regression model. RESULTS: The overall number of TOP refusals was 573. Indications were single malformations (37%), chromosomal abnormalities (16.6%), hygroma (5.2%), potential fetopathies (11%), maternal indications (17.4%), and other indications (12.7%). Pregnancy outcomes were live infants (35.1%), effective TOP (36.3%), intra-uterine fetal death (5.4%), and lost to follow-up (23.2%). Logistic regression model showed an increased likelihood of effective TOP in groups with single malformations [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.6-7.4], chromosomal abnormalities (OR 3, 95% CI 1.2-7.2), and hygromas (OR 19.6, 95% CI 2.3-16.8) compared with other groups. An increased likelihood of effective TOP was also reported when the request was made at first (OR 29.5, 95% CI 10-16.7) and second (OR 6.3, 95% CI 2.3-16.7) trimesters compared with the third trimester. CONCLUSIONS: Effective TOP is particularly frequent when requested during the first trimester and in cases of structural anomalies of the fetus.
OBJECTIVES: To report indications and risk factors for effective termination of pregnancy (TOP) when multidisciplinary prenatal diagnosis centers refuse request for TOP. METHODS: This is a retrospective study from a French national registry between 2005 and 2009. Indication groups for TOP refusal were created. Risk factors for pregnancy outcomes and effective TOP were determined by multinomial logistic regression model. RESULTS: The overall number of TOP refusals was 573. Indications were single malformations (37%), chromosomal abnormalities (16.6%), hygroma (5.2%), potential fetopathies (11%), maternal indications (17.4%), and other indications (12.7%). Pregnancy outcomes were live infants (35.1%), effective TOP (36.3%), intra-uterine fetal death (5.4%), and lost to follow-up (23.2%). Logistic regression model showed an increased likelihood of effective TOP in groups with single malformations [odds ratio (OR) 3.4, 95% confidence interval (CI) 1.6-7.4], chromosomal abnormalities (OR 3, 95% CI 1.2-7.2), and hygromas (OR 19.6, 95% CI 2.3-16.8) compared with other groups. An increased likelihood of effective TOP was also reported when the request was made at first (OR 29.5, 95% CI 10-16.7) and second (OR 6.3, 95% CI 2.3-16.7) trimesters compared with the third trimester. CONCLUSIONS: Effective TOP is particularly frequent when requested during the first trimester and in cases of structural anomalies of the fetus.