(504) Termination of Pregnancy Among Patients at Risk for Periviable Delivery

Patients at risk of periviable delivery may opt for termination of pregnancy (TOP). We aimed to understand the clinical and demographic factors associated with patients’ decisions to pursue TOP in order to inform patient-centered counseling and care.

Study Design:

We retrospectively reviewed 207 patients admitted between 21w0d-24w6d at high risk for periviable delivery, excluding those with a documented plan for TOP prior to admission. We compared demographic and clinical characteristics between patients who underwent TOP (n=22) and those who did not (n=185), including gestational age at admission, estimated fetal weight, maternal age, race/ethnicity, BMI, mental health history, presence of fetal anomaly, and social factors.

Results:

Overall, 35.3% (54/207) were counseled about TOP and 10.6% (22/207) underwent TOP. Patients who were counseled about the option for TOP were significantly more likely to undergo TOP (38.9% vs. 0.7%, p< 0.001). Counseling about TOP was documented in 95.5% (21/22) of patients undergoing TOP and 17.8% (33/185) of those continuing pregnancy. Patients opting for TOP presented at significantly earlier gestational ages (median 22.1 vs. 23.6 weeks, p< 0.001) and had lower estimated fetal weights (median 399g vs. 595g, p< 0.001). Those undergoing TOP had significantly lower BMI (median 26.1 vs. 30.9, p< 0.001). No significant differences were found in maternal age, race/ethnicity, presence of fetal anomalies, mental health disorders, or substance use. Receipt of periviability counseling was similar between groups (86.4% vs. 78.9%, p=0.578). 

Conclusion:
Earlier gestational age, lower fetal weight, and lower maternal BMI were associated with termination of pregnancy in patients at high risk of periviable delivery. These findings highlight key clinical factors influencing patients’ choices and underscore the need for timely, nuanced counseling.