Abstract
Objective Advances in ultrasound and molecular genetics have changed the field of late termination of pregnancy (LTOP), sparking ethical debates worldwide. In 2007, Israel updated its LTOP policies, requiring a 30% or higher probability of severe handicap for approval of LTOP after 24 weeks’ gestation.
Purpose In this retrospective study we compared LTOP indications and approval rates before (Group 1: 1998–2007) and after (Group 2: 2008–2021) this policy change.
Methods Shamir medical records from January 1, 1998 to December 31, 2021 were examined, and yielded 4057 abortions of which 338 were identified as LTOP preformed after 24 weeks’ gestation. These cases were then categorized into two groups. Data including maternal age, obstetric history, indications for abortion, diagnosis, week of termination, and genetic/sonographic findings were analyzed. The approval rates and indications pre- and post- policy change were compared.
Results Group 1 (LTOP 1998–2007) comprised 135 cases (39.9%), and Group 2 (LTOP 2008–2021) was composed of 203 cases (60.1%). Fetal structural anomalies remained the dominant indication for both groups (66.7% and 56.2%, respectively), with a slight increase in confirmed genetic anomalies from 28.1% (Group 1) to 33% (Group 2).
Conclusion Despite the policy changes in 2007, our findings indicate an increase from 39.9–60.1% in the rate of LTOP. Technological advances in genetic evaluation and sonography may have contributed to the increased detection and approval of cases. These results highlight the importance of ongoing ethical reviews and adherence to strict protocols for early detection and termination before 24 weeks’ gestation.