Ethical and medico-legal aspects of the therapeutic abortion - our experience

Objective. Our study aims to analyze the indications for therapeutic abortion and to discuss the legal implications of this procedure in Romania. Methods. We performed a retrospective cohort study of singleton and as well as twin pregnancies terminated for therapeutic reasons between 2014 and 2016 in "Bucur" Maternity, Bucharest. The patients that were admitted in our clinic were cared by obstetrics-gynecology specialists, and interdisciplinary consults were requested if needed. We conducted blood tests, fetal morphology scans, amniocentesis as well as a complete survey of the patients' medical history, and the diagnosis was made according to the findings by a team of OG experts. The patients were given full access to information and guidance according to AGOG guidelines. The decision to terminate the pregnancy was made after undergoing prenatal and psychological counselling and after the patient was informed about the risks and complications of the procedure. Results. A total of therapeutic abortions were conducted in our clinic from 2014-2016. in 65% of cases the causes were fetal, in 20% were maternal and in 15% maternal and fetal causes were reported. The mean maternal age vas 31.65 years, for maternal indications the means was 36.25 years and for fetal indications-plurimalformative syndrome diagnosed fetuses 27.57 years of age. 80% of the women were multiparous, with 55% non-smokers. The psychyatric maternal pathology dominated the maternal indications (4/7), and regarding the fetus related indications 7/13 were diagnosed with plurimalformative syndrome, 3 associated with T21 diagnosis. Regarding the procedure 35% were uterine curettages, 50% induced oxytocin births, there was one caesarean operation and one total histerectomy. Conclusions. The most frequent reasons for therapeutic abortion were fetal anomalies. Considering the legal, ethical and medical implications the decision of pregnancy termination should follow only an accurate diagnosis, specialised team counseling and thoroughly informed couple. Legislation must differentiate therapeutic abortion from the challenge of premature delivery, therapeutic abortion not being "in the fetal interest" while premature elective delivery maybe maternal but also fetal.