Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 4 , Pages 318-326, December 2005

Late Abortion: A Comprehensive Review

  • Sheng Chiang

      Affiliations

    • Corresponding Author InformationCorrespondence to: Dr. Sheng Chiang, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92, Section 2, Chung-Shan North Road, Taipei 10449, Taiwan

Department of Obstetrics and Gynecology, Mackay Memorial Hospital, and Mackay Medicine, Nursing and Management College, Taipei, Taiwan

Received 21 October 2005; received in revised form 21 October 2005; accepted 21 October 2005.

Article Outline

Summary

Late termination of pregnancy (LTOP) is defined as an abortion carried out beyond 24 gestational weeks, when the fetus has arguably attained viability. In Taiwan, the current abortion law, bearing a eugenic title, allows LTOP on certain medical grounds. However, the fetal and maternal conditions that constitute medical grounds are not clarified and remain legally untested. Professional debate on the abortion issue is also lacking in academia in Taiwan, despite societal concerns. With the advent of technology to detect fetal abnormalities, obstetricians are now confronted more frequently with acute dilemmas regarding LTOP. Quite often, they sail in an uncharted sea with no clinical guidelines from their professional societies or affiliated hospitals. Recently, LTOP at 35 gestational weeks for a fetus with Down syndrome, complicated with polyhydramnios and tetralogy of Fallot, triggered media scrutiny and aroused much public attention. Although the clinical decision making for pregnancies with fetal abnormalities entails increasingly balanced information and consideration in terms of the medical, ethical, legal, psychologic, and societal aspects, society at large is unaware of the complexity and intertwined nature of various abortion issues, especially LTOP. Obstetricians are now in a vulnerable position in Taiwanese society, where litigations relevant to the practice of early abortions are not rare. Therefore, a global and in-depth look into abortion issues from legal and ethical dimensions is indispensable for modern obstetric practice. This review considers the core issues in LTOP, including what conditions constitute a “serious” fetal abnormality to justify LTOP, the incidence of LTOP, legislation regarding LTOP in Western countries, and recent research on ambivalent fetal pain. It will also present procedures, some under the auspices of the ethical committee of a Presbyterian hospital in Taiwan, for clinical decision making, particularly when abortions are considered in the third trimester.

Key Words:  abortion law , fetal abnormalities , late termination of pregnancy , medical ethics

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References 

  1. Mackay's doctor and feticide. Apple Daily, 31 May 2005. Available at: www.appledaily.com.tw
  2. Police examine cleft palate abortion. BBC News, 28 October 2002. Available at: www.news.bbc.co.uk
  3. Rogers L . Doctors revolt over last-minute abortion of twin . The Sunday Times . 10 November 2002;
  4. Eugenic health law, Taiwan. Available at: www.sinica.edu.tw/∼whchou/01/aa127.html
  5. China's 'eugenics' law still disturbing despite relabelling  . Nature . 1998;394:707
  6. De Crespigny LJ , Savulescu J . Abortion: time to clarify Australia's confusing laws . Med J Aust . 2004;181:201–203
  7. Gross ML . After feticide: coping with late-term abortion in Israel, Western Europe, and the United States . Camb Q Health Ethics . 1999;8:449–462
  8. Dommergues M , Benachi A , Benifla J , Des Noëttes R , Dumez Y . The reasons for termination of pregnancy in the third trimester . Br J Obstet Gynaecol . 1999;106:297–303
  9. Chervenak FA , McCullough LB , Campbell S . Third trimester abortion: is compassion enough? . Br J Obstet Gynaecol . 1999;106:293–296
  10. Shalev J , Meizner I , Rabinerson D , et al.   Improving pregnancy outcome in twin gestations with one malformed fetus by postponing selective feticide in the third trimester . Fertil Steril . 1999;72:257–260
  11. Lipitz S , Shalev E , Meizner I , et al.   Late selective termination of fetal abnormalities in twin pregnancies: a multicentre report . Br J Obstet Gynaecol . 1996;103:1212–1216
  12. Late Abortion: A Review of the Evidence. Available at: www.prochoiceforum.org.uk
  13. Available at: www.nationalstatistics.gov.uk/STATBASE/Product.asp?vlnk=68
  14. Senata MV , Fischerb C , Bernarda JP , Villea Y . The use of lidocaine for fetocide in late termination of pregnancy . Br J Obstet Gynaecol . 2003;110:296–300
  15. de Crespigny L , Chervenak F , Coquel PA , Ville Y , McCullough L . Practicing prenatal diagnosis within the law . Ultrasound Obstet Gynecol . 2004;24:489–494
  16. Woodrow NL . Termination review committees: are they necessary? . Med J Aust . 2003;179:92–94
  17. Brazier M . In: Medicine, Patients and the Law . London: Penguin Books; 2003;p. 42
  18. Roe v Wade, 410 US 113(1973).
  19. Strong C . Fetal anomalies: ethical and legal considerations in screening, detection, and management . Clin Perinatol . 2003;30:113–126
  20. Savulescu J . Is current practice around late termination of pregnancy eugenic and discriminatory? Maternal interests and abortion . J Med Ethics . 2001;27:165–171
  21. Chervenak FA , McCullough LB , Campbell S . Is third trimester abortion justified? . Br J Obstet Gynaecol . 1995;102:434–435
  22. Chervenak FA , McCullough LB . An ethically justified, clinically comprehensive management strategy for third-trimester pregnancies complicated by fetal anomalies . Obstet Gynecol . 1990;75:311–316
  23. Chervenak FA , McCullough LB , Skupski D , Chasen ST . Ethical issues in the management of pregnancies complicated by fetal anomalies . Obstet Gynecol Survey . 2003;58:473–483
  24. Lee SJ , Ralston HJ , Drey EA , Partridge JC , Rosen MA . Fetal pain: a systematic multidisciplinary review of the evidence . JAMA . 2005;294:947–954
  25. Provoost V, Cools F, Mortier F, Bilsen J, Ramet J, Vandenplas Y, et al. Medical end-of-life decisions in neonates and infants in Flanders . Lancet . 2005;365:1315–1320
  26. Feudtner C . Control of suffering on the slippery slope of care . Lancet . 2005;365:1284–1286
  27. Elimian A , Verma U , Tejani N . Effect of causing fetal cardiac asystole on second-trimester abortion . Obstet Gynecol . 1999;94:139–141
  28. Report of the RCOG Working Party on Termination of Pregnancy for Fetal Abnormality in England, Wales and Scotland . London: RCOG; 1996;
  29. Report of the RCOG Ethics Committee on a Consideration of the Law and Ethics in Relation to Late Termination of Pregnancy for Fetal Abnormality . London: RCOG; 1998;

PII: S1028-4559(09)60164-9

doi:10.1016/S1028-4559(09)60164-9

Taiwanese Journal of Obstetrics and Gynecology
Volume 44, Issue 4 , Pages 318-326, December 2005

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