SAN FRANCISCO – A minority of abortion providers who participated in a recent survey have knowledge of and experience with third-trimester terminations in cases involving lethal fetal anomalies.
Of 112 respondents, 32 (29%) reported having a “good” foundation of knowledge regarding third-trimester pregnancy termination, and 21 (19%) reported participating in the care of women undergoing third-trimester terminations. The provision of such care was significantly associated with training-related factors and encounters with affected patients, Dr. Jessica Maria Atrio reported at the annual meeting of the American College of Obstetricians and Gynecologists.
“Lethal fetal anomalies are common ethically and emotionally challenging obstetric scenarios,” said Dr. Atrio of Montefiore Medical Center, New York, noting that birth defects account for 20% of infant mortality and are the leading cause of death among newborns.
Estimates regarding prevalence and outcomes in cases involving fetal anomalies, however, are not well established, due in part to inconsistent reporting across regions and states. But some women dealing with lethal and other fetal anomalies do request termination of their pregnancy. The diagnosis of a lethal fetal anomaly typically involves referral to a tertiary care facility and coordination among multiple providers involved with the testing, counseling, diagnostic, and interventional planning, according to Dr. Atrio.
If there is no reasonable likelihood of the fetus or infant surviving, termination of the pregnancy should be offered for the safety and well being of the woman, Dr. Atrio said, adding that “in collaborative practice environments, family planning fellowship affiliates and abortion providers may be solicited for their insight regarding expeditious evacuation of the gravid uterus.”
“However, third-trimester termination of pregnancy is not part of the required curriculum in the family planning fellowship,” she said.
For this reason, the researchers designed a survey aimed at exploring the extent of knowledge and participation among U.S. abortion providers affiliated with family planning fellowship programs with respect to the care of women undergoing third-trimester pregnancy termination due to lethal fetal anomalies.
Most of the respondents to the electronically distributed survey were female abortion providers born in the late 1970s. About a third graduated from fellowship programs on the East Coast, a third from programs on the West Coast, and a third from programs distributed across the country. The vast majority (88%) were current academic faculty at teaching institutions in a clinical environment involving medical students or residents, but most did not have a family planning fellowship at their current academic home.
Age, gender, and type of abortion training were not significantly associated with provision of third-trimester termination for lethal fetal anomalies.
Of the 29% who reported having a good foundation of knowledge regarding the technical aspects and protocols used for third-trimester pregnancy termination, most said they learned during residency and through direct mentorship.
“This resonates with the classic edict of experiential learning, which is often involved in our canon of medical education: See one, do one, teach one,” Dr. Atrio said, adding that women who experience lethal fetal anomalies are vulnerable and deserve care that is informed by best practices and evidence-based protocols tailored to their clinical context.
One way to potentially improve access and knowledge regarding the care of these women is by expanding opportunities to involve trainees. The majority of survey respondents did express a desire to learn about the scope of care during their fellowship training, Dr. Atrio said.
“Enhancing collaborative care between various professionals such as gynecologists and obstetric providers may improve the quality of care offered to these vulnerable women,” she said.
Dr. Atrio reported having no financial disclosures.