Miyuki Nishiyama1, Akihiko Sekizawa2, Kohei Ogawa1, Hideaki Sawai3, Hiroaki Nakamura4, Osamu Samura5, Nobuhiro Suzumori6, Setsuko Nakayama7, Takahiro Yamada8, Masaki Ogawa9, Yukiko Katagiri10, Jun Murotsuki11, Yoko Okamoto12, Akira Namba13, Haruka Hamanoue14, Masanobu Ogawa15, Kiyonori Miura16, Shunichiro Izumi17, Yoshimasa Kamei13, Haruhiko Sago1. 1. Center of Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan. 2. Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan. 3. Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Japan. 4. Department of Obstetrics, Osaka City General Hospital, Osaka, Japan. 5. Department of Obstetrics and Gynecology, The Jikei University School of Medicine, Tokyo, Japan. 6. Department of Obstetrics and Gynecology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. 7. Department of Obstetrics and Gynecology, Aiiku Clinic, Tokyo, Japan. 8. Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. 9. Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo, Japan. 10. Department of Obstetrics and Gynecology, Toho University Omori Medical Center, Tokyo, Japan. 11. Department of Maternal and Fetal Medicine, Miyagi Children's Hospital, Sendai, Japan. 12. Department of Obstetrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Osaka, Japan. 13. Department of Obstetrics and Gynecology, Saitama Medical University, Moroyama, Japan. 14. Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, Yokohama, Japan. 15. Department of Obstetrics and Gynecology, Clinical Research Institute, National Kyusyu Medical Center, Fukuoka, Japan. 16. Department of Obstetrics and Gynecology, Nagasaki University School of Medicine, Nagasaki, Japan. 17. Department of Obstetrics and Gynecology, Tokai University School of Medicine, Isehara, Japan.
Abstract
OBJECTIVE: To investigate the rates of termination of pregnancy (TOP) for fetal chromosomal abnormalities and factors related to such parental decision in Japan. METHODS: A multicenter retrospective cohort study of chromosomal abnormalities diagnosed before 22 weeks of gestation between April 2008 and March 2015. The pregnancy outcomes and parental decisions were investigated. RESULTS: Among 931 fetuses with chromosome abnormalities, the total TOP rate was 75.1% (699/931). TOP rates were 89.3% (585/655) in autosomal aneuploidies and 40.8% (51/125) in sex chromosome aneuploidies. Trisomy 21 showed the highest TOP rate (93.8% [390/416]) followed by trisomy 18 (84.5% [163/193]) and trisomy 13 (71.9% [23/32]). Indications for karyotyping were related to a parental decision for TOP (p < 0.01): in cases of autosomal aneuploidy, with fetal abnormal ultrasound findings as the reference value, diagnoses made following positive results at non-invasive prenatal testing (adjusted odds ratio [OR]: 13.7, 95% confidence interval [CI] 4.07-45.9) and those because of advanced maternal age (adj. OR 2.91, 95% CI 1.15-7.35) were significantly more frequent. CONCLUSIONS: In Japan, pregnancies with fetal trisomy 21 are more likely to result in TOP when diagnosed in utero than any other chromosome anomaly. The indications for prenatal karyotyping strongly affect the decision to TOP.
OBJECTIVE: To investigate the rates of termination of pregnancy (TOP) for fetal chromosomal abnormalities and factors related to such parental decision in Japan. METHODS: A multicenter retrospective cohort study of chromosomal abnormalities diagnosed before 22 weeks of gestation between April 2008 and March 2015. The pregnancy outcomes and parental decisions were investigated. RESULTS: Among 931 fetuses with chromosome abnormalities, the total TOP rate was 75.1% (699/931). TOP rates were 89.3% (585/655) in autosomal aneuploidies and 40.8% (51/125) in sex chromosome aneuploidies. Trisomy 21 showed the highest TOP rate (93.8% [390/416]) followed by trisomy 18 (84.5% [163/193]) and trisomy 13 (71.9% [23/32]). Indications for karyotyping were related to a parental decision for TOP (p < 0.01): in cases of autosomal aneuploidy, with fetal abnormal ultrasound findings as the reference value, diagnoses made following positive results at non-invasive prenatal testing (adjusted odds ratio [OR]: 13.7, 95% confidence interval [CI] 4.07-45.9) and those because of advanced maternal age (adj. OR 2.91, 95% CI 1.15-7.35) were significantly more frequent. CONCLUSIONS: In Japan, pregnancies with fetal trisomy 21 are more likely to result in TOP when diagnosed in utero than any other chromosome anomaly. The indications for prenatal karyotyping strongly affect the decision to TOP.
Authors: Natalia Prodan; Markus Hoopmann; Harald Abele; Philipp Wagner; Diethelm Wallwiener; Sara Brucker; Karl Oliver Kagan Journal: Geburtshilfe Frauenheilkd Date: 2018-09-14 Impact factor: 2.915