Methods and indications for late pregnancy termination and feticide in European countries

Objective. Where the fetal abnormality is not lethal and termination of pregnancy is attempted after 22 weeks of gestation, absence of feticide could result in a live birth, an outcome that contradicts the intention of the abortion. The study aims to understand action for late termination of pregnancy and methods and indications for feticide among European countries.

Design. A cross-sectional survey with multiple-choice questions and open answers was made in the English language.

Method. An online questionnaire was sent to randomly selected gynaecologists in Europe. The study was conducted from January 2020 until January 2021. Data were collected and analyzed using Microsoft Excel.

Results. Answers were received from 18 countries: Austria, Croatia, the Czech Republic, Denmark, Estonia, France, Greece, Latvia, Lithuania, Malta, the Netherlands, Norway, Poland, Portugal, Slovenia, Switzerland, Turkey and the United Kingdom. Pregnancy termination was defined by law in all countries, except Malta. First-trimester screening from 11 to 13 + 6 weeks of gestation was performed in 15 countries (not performed in Malta and Norway, recommended but not paid from health insurance in Slovenia). Second-trimester screening from 20 to 22 + 6 weeks of gestation was performed in 16 countries, from 18 weeks of gestation in Norway and Poland. Pregnancy termination for medical indications can be performed in 17 countries, in 6 countries without a definite period. In 8 countries abortion due to medical indications was not allowed if fetal weight ≥ 500 grams and/or ≥ 24 weeks of gestation. In 12 countries late pregnancy termination was performed using misoprostol or surgically. Feticide was performed in 13 countries (except Norway, Lithuania, Poland, Malta and Croatia) mainly by a gynaecologist. Indications for feticide: pregnancy termination after 21 + 6 weeks of gestation, psychosocial reasons, women’s request. Reasons for feticide: to facilitate and induct termination, ethical, psychoemotional. Most used method for feticide was transabdominal intracardiac administration of potassium chloride. Reasons why feticide was not performed: legal, ethical, religious, non-acceptance by society. Consent ‘not to resuscitate’ can be signed in 5 countries: Austria, Estonia, France, the Netherlands and the United Kingdom.

Conclusions. Late termination of pregnancy and feticide is associated with ethical, legal and psychoemotional barriers. It is essential to establish a direct methodology for gynaecologists and ensure that every woman in Europe has equal rights and possibilities to receive generally accepted procedures and manipulations.