Reasons for Termination of Pregnancy (Abortion)
Pregnancy termination may be pursued for maternal medical indications, fetal anomalies, psychosocial reasons, or maternal autonomy, with the decision resting solely with the pregnant woman who has decision-making capacity. 1, 2
Medical/Maternal Indications
Maternal Health Risks:
- Significant risk to the woman's physical health at any stage of pregnancy, including cardiovascular disease, pulmonary arterial hypertension, or other life-threatening conditions 1, 2
- Women with congenital heart disease and pulmonary arterial hypertension should undergo earliest possible termination after counseling, with first-trimester termination being safer 2
- Need for chemotherapy or radiotherapy during first trimester, which carries high risk of fetal malformations 2
- Mental health risks, though psychiatric assessment of these risks remains challenging and represents a grey area in clinical practice 3
Fetal Indications
Severe Fetal Anomalies:
- Diagnosis of major congenital abnormalities detected by ultrasound, with detailed examination having 85% sensitivity and 99% specificity at 11-14 weeks 4
- Chromosomal anomalies such as trisomy 21, with termination rates varying by population (54.5% in one studied population) 5
- Total malformation of the fetus, such as anencephaly, which is considered ethically justifiable for termination 6
- Structural abnormalities identified on second-trimester anatomical ultrasound at 18-22 weeks 4
Critical Pitfall: Never recommend termination based solely on history of a previous affected child without confirming the current fetus is affected through appropriate genetic testing 4
Psychosocial Reasons
Personal and Social Factors:
- Psychosocial circumstances that impact the woman's ability to continue pregnancy, though these remain ethically complex and require careful psychiatric assessment when mental health disorders are present 3
- Financial inability to care for a child with special needs, with 45% of women in one study reporting insufficient resources despite medium standard of living 7
- Lack of adequate state financial support for children with disabilities, perceived as insufficient by 81% of women considering termination 7
Decision-Making Framework
Autonomy and Consent:
- A pregnant woman with decision-making capacity has sole legal and ethical authority to consent to termination, regardless of partner or family objections 2
- No spousal consent is required for medical procedures performed on a competent adult woman 2
- Women define satisfaction based on receiving adequate information about termination options and having autonomy to decide on method consistent with their personal values 1
Counseling Requirements:
- Nondirective counseling should cover short- and long-term maternal health risks, risks/benefits of pregnancy continuation versus termination, and all treatment options 1, 4
- Counseling should be performed as expeditiously as possible to optimize choices, as delays directly impact success rates and complication risks 1, 2
- Risk assessment and counseling should be continuous throughout pregnancy as health status can change rapidly 1
Documentation Categories for Pregnancy Registries
Standardized Reasons for Elective Termination:
- Termination due to fetal malformation 1
- Termination due to other reasons (non-malformation related) 1
- Gestational age at termination should be documented 1
Important Consideration: Women typically do not consider society's opinion when making termination decisions (95% in one study), relying instead on support from partners (97% informed) and close family (82% informed), with only 32% informing friends 7