PubMed · 7745483
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D R Mitchell. 1995. RU 486.. https://doi.org/10.1111/j.1552-6909.1995.tb02451.x
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Appropriate management of fetal malformations needs confirmation by a tertiary center and search for associated abnormalities and further investigations oriented to causal and prognostic factors. Therapeutic decisions are taken by a multidisciplinary term: pregnancy termination, maternal transfer to a tertiary center, premature delivery or cesarean extraction. Some malformations require immediate surgical treatments, others can be followed up and later corrected. Intrauterine treatments are nowadays evaluated, such as chronic derivations, operative fetoscopy or open fetal surgery. In case of fetal death, a post mortem examination must be performed in order to improve genetic counseling.
The paper deals with first trimester diagnosis of exencephaly. In association with first trimester sonographic and cytogenetic screening of chromosomal anomalies in 1145 examined pregnancies 2 exencephalic fetuses with normal karyotype were diagnosed. Exencephaly was characterized with the absence of normal echoes of the exocranium, the lateral ventricles, the chorioid plexus, the cerebral falx, and with the presence of deformed shape of the head and irregular, lobulated cerebral material with increasing volume at follow-up examination. Anencephalic fetuses were diagnosed subsequent to therapeutic abortion, since the uterine and cervical wall contractions eroded the fragile brain tissue during fetal expulsion. However, fetal brain was identified in abortion material in both cases providing evidence that exencephaly is an embryologic precursor of anencephaly.
OBJECTIVE: To assess interregional differences in the utilization of abortion services in Ontario from 1985 to 1992. DESIGN: Retrospective analysis of provincial therapeutic abortion database. SETTING: All hospitals conducting abortions between 1985 and 1992 and all free-standing abortion clinics conducting abortions between 1990 and 1992. POPULATION: All women in Ontario aged 15 to 44 years who underwent a therapeutic abortion in Ontario during the study period. OUTCOME MEASURES: Utilization of abortion services by county and age-specific abortion rates by county of residence. RESULTS: From 1985 to 1989, when only hospital data were gathered, the mean therapeutic abortion rate increased by 11.2%. From 1990 to 1992, when data from hospitals and free-standing clinics were collected, the mean rate increased by 26.5%. Logistic regression analysis showed significant variation in the age-standardized abortion rates between counties in each study year (p < 0.0001). The counties with age-standardized rates below the 25th percentile had the highest proportions of women who sought abortion services outside their county of residence; in some of these counties no abortions were performed in local facilities. CONCLUSION: There are interregional variations in the utilization of abortion services in Ontario. These disparities raise questions about the accessibility of abortion services and need to be further investigated.