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First-trimester abortions are less expensive and easier to access than second-trimester procedures. Nonetheless, many women who terminate pregnancies for fetal abnormalities detected during the first trimester delay the procedure until late in the second trimester. In a study involving 30 women (median age, 35, 73% white, 29 insured) undergoing abortions at 12 to 24 weeks' gestation for genetic or structural fetal abnormalities, investigators explored the reasons for the delay.
Median time from detection of fetal anomaly to termination of pregnancy was 16.5 days. Factors contributing to later gestational ages at termination included:
Initial perception of a healthy pregnancy (with no urgency for testing) abruptly shifted by abnormal results
Emotional adjustment and seeking of information, support, and guidance
Inefficient medical team interaction (e.g., delays in specialist referrals, perceived inadequate communication)
Barriers to access (e.g., no physicians “in-network” or accepting Medicaid, restrictions on “elective” procedures, limited geographic access)
Gawron LM et al. An exploration of women's reasons for termination timing in the setting of fetal abnormalities. Contraception 2013 Jul; 88:109. (http://dx.doi.org/10.1016/j.contraception.2012.12.004)
Comment
The women in this small sample reported that they needed time to seek confirmation, information, and assistance, particularly as they negotiated barriers to accessing pregnancy termination. Clinicians may be able to help by communicating clearly, offering emotional support and resources, and facilitating referrals to specialists, especially genetic counselors (indeed, the 18 women who obtained genetic counseling after diagnosis found it helpful). Unfortunately, the current political climate has made second-trimester abortions even more difficult to obtain. Women coping with diagnoses of serious fetal abnormalities should not have to face this additional burden.