Feticide Before Termination of Pregnancy in Singleton Pregnancy – Trends in England and Wales 2012-2020, a cross-sectional study

Abstract

Abstract Aim Feticide is the practice of inducing fetal demise before termination of pregnancy. In England and Wales, it is recommended for terminations of pregnancy beyond 21 + 6 weeks of gestation. This project analyses the trends in feticide in singleton pregnancy in England and Wales between 2012 and 2020. Methods This project was a retrospective study that analysed data extracted from the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC). The data extracted by the DHSC included the prevalence of feticide, methods of feticide and termination, statutory grounds, gestation, service provider, maternal age, ethnicity, and obstetric history. In addition, data analysis was carried out to identify trends. Results Between 2012 and 2020, there were 9310 feticides in England and Wales, used in 0.5% of all abortions. The prevalence of feticide fluctuated however, there was an overall decrease from 1084 cases in 2012 to 1000 cases in 2020. The most common method was intracardiac injection of potassium chloride (67.2%). Most feticides were performed before medical abortions (58.0%). 55.8% of feticides took place under Ground E of the Abortion Act 1967, and the main indication was congenital malformations of the nervous system. Most feticides occurred at 23 weeks gestation (40.2%) and in NHS hospitals (60.3%). Women undergoing feticide were mostly aged 30–34 years (38.3%) and of White ethnicity (78.6%). Conclusion Feticide is an essential component of comprehensive abortion care for women undergoing late second and third-trimester abortions. This study provides insight into how feticide is carried out in England and Wales and demonstrates the effect of the Covid-19 pandemic on feticide prevalence. Future research should analyse in more detail the use of the different methods of feticide.