Review of Fetocides at Chris Hani Baragwanath Academic Hospital Over a Three-Year Period

Abstract

Background: Fetocide is necessary where termination of pregnancy is indicated after 24 weeks. Not many studies have been done particularly in a South African context. It is still regarded as a controversial issue in some countries. An earlier diagnosis allows more time for the counselling of parents and decision-making. • Objectives: To establish the demographics of patients offered fetocides procedures and the indications. To determine the gestational age at which the fetocides were performed at the Chris Hani Baragwanath Academic Hospital and the techniques (routes) used. • Methods: Retrospective cross-sectional study of 58 patients who underwent fetocide procedure for severe congenital anomalies at the Chris Hani Baragwanath Academic Hospital Feto maternal Unit. Means with standard deviations (SD) and medians with centiles were used for the continuous variables such as patients’ demographics. Frequencies and percentages were used for categorical and dichotomous variables. The chi-square test or Fisher ‘exact test were used in the descriptive analysis. The data were transferred into the STATA program for analysis. • Results: Fifty-eight patients underwent fetocide procedure. Fifteen percent Potassium chloride was the only agent used. The median age was 30 years (IQR=22-35), the median Body Mass Index (BMI) was 24 kg/m2, the median Gestational Age (GA) was 29 weeks (IQR=26-32). The umbilical vein route was used in 55% of mothers and the median Potassium Chloride volume used was 20 ml. Central Nervous System anomalies were the leading indication and anencephaly the leading anomaly. A total of 25(66%) fetuses had a normal karyotype result and 13(34%) of the 38 patients who had karyotype had an abnormal karyotype result. • Conclusion: Fetocides are a safe and effective method to induce fetal demise. Central Nervous System anomalies were the most common with anencephaly the leading one. There was an increasing risk of congenital anomalies with advanced maternal age, particularly above 35 years old. The umbilical vein route was the preferred route used. Further research is needed to explore especially the ethical implications for both the mother and the health care worker.