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Proportion of women that decide to terminate the pregnancy with fetal Down syndrome (DS) is reported to be 71%-100%. In continuing pregnancies with fetal DS, the fetal loss rate is about 23% from the time diagnosis to delivery. Now, the pregnancies with fetal DS are diagnosed earlier and have close fetal surveillance. But IUFD still occurs. There are no recent studies regarding the outcomes of the pregnancies with fetal DS.
Study Design
Between 1990 and 2012 at the University of Iowa Hospitals and Clinics, 261 pregnancies were diagnosed with trisomy 21 by a genetic amniocentesis. Adequate follow up was available on 249 pregnancies.
Results
146/249 (59 %) of the women were in the AMA group. The women in AMA group had amniocentesis earlier than those < 35 yrs of age. A total of 157 women chose to have pregnancy termination, of which 107 (73.3%) were in the AMA group. A total of 92 women continued the pregnancy including 51.5 % of younger women comparing to 26.7% of the women in the AMA group.
Detailed information regarding the ongoing pregnancy and outcomes were available in 67/92 continuing pregnancies. IUFD occurred in 13/67 (19.4%) of continuing pregnancies of which 6 were under 20 weeks at the time of IUFD, 6 were after 20 weeks and in 1 patient there was inadequate information. The rate of stillbirth after 24 weeks gestation was 3/57 (5.3%). 2 of the 3 IUFD occurred at 24 and 37 weeks gestation with multiple fetal anomalies. One IUFD occurred at 34 weeks.
Conclusion
Majority of the women diagnosed with fetal DS were AMA. Diagnosis was made at a later gestational age in younger women. The terminations were more frequent in the AMA group. IUFD occurred in 19.4% of the ongoing pregnancies and in 5.3% of those that progressed beyond 24 weeks.
Tabled
1Mean gestational age of diagnosis of DS and termination rate
Mean gestational age of diagnosis of DS and termination rate
