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. 2024 Feb;31(2):441-451.
doi: 10.1007/s43032-023-01352-3. Epub 2023 Sep 25.

Feticide Before Termination of Pregnancy in Singleton Pregnancy - Trends in England and Wales 2012-2020, a Cross-sectional Study

Isabelle Schiff  1 , Panicos Shangaris  2   3   4   5 , Mary Grinsted  6 , Srividhya Sankaran  7   6
Affiliations

Feticide Before Termination of Pregnancy in Singleton Pregnancy - Trends in England and Wales 2012-2020, a Cross-sectional Study

Isabelle Schiff et al. Reprod Sci. 2024 Feb.

Abstract

Feticide is the practice of inducing fetal demise before the termination of pregnancy. In England and Wales, it is recommended for terminations of pregnancy beyond 21+6 weeks of gestation. This project analyses the trends in feticide in singleton pregnancy in England and Wales between 2012 and 2020. This project was a retrospective study that analysed data extracted from the Health and Social Act 4 (HSA4) forms submitted to the Department of Health and Social Care (DHSC). The data extracted by the DHSC included the prevalence of feticide, methods of feticide and termination, statutory grounds, gestation, service provider, maternal age, ethnicity and obstetric history. In addition, data analysis was carried out to identify trends. Between 2012 and 2020, there were 9310 feticides in England and Wales, undertaken in 0.5% of all abortions. The prevalence of feticide fluctuated; however, there was an overall decrease from 1084 cases in 2012 to 1000 cases in 2020. Intracardiac injection of potassium chloride was the most frequent method of achieving feticide (67.2%). Just over half (55.8%) of feticides took place under Ground E of the Abortion Act 1967, with the main indication being congenital malformations of the nervous system. Two-fifths (40.2%) of feticides took place at 23 weeks, 22.8% at 22 weeks and 13.5% between 20 and 21 weeks. The remainder occurred at later gestations: 17.5% at 24-29 weeks and 5.9% beyond 29 weeks. During our study period, it was more common for feticides to be carried out as part of a medical termination than a surgical termination and 60.3% occurred in NHS hospitals. Women undergoing feticide were mostly aged 30-34 years (38.3%) and of White ethnicity (78.6%). Feticide is an essential component of comprehensive abortion care for women undergoing late second and third-trimester abortions. This study provides insight into how feticide is carried out in England and Wales and demonstrates the effect of the COVID-19 pandemic on reducing feticide prevalence. Future research should analyse in more detail the use of the different methods of feticide.

Keywords: Abortion Act 1967; Department of Health and Social Care (DHSC); Feticide; Health and Social Act 4 (HSA4); Potassium chloride; Singleton pregnancy; Termination of pregnancy.

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Conflict of interest statement

Dr Panicos Shangaris is the Editor of Social Media and Emerging Technologies (ESMET) of the Reproductive Sciences Journal. He had no involvement in handling, assigning reviewers or reviewing the manuscript. The rest of the authors have no conflict of interest to declare. There are no relevant financial, personal, political, intellectual or religious interests.

Figures

Fig. 1
Fig. 1
Trend over time of the number of feticides that took place in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 2
Fig. 2
Prevalence of feticides by method/agent of feticide in residents and non-residents of England and Wales between 2014 and 2020. Data from the DHSC
Fig. 3
Fig. 3
Prevalence of feticides by method of termination in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 4
Fig. 4
Prevalence of feticides by Statutory Grounds of the Abortion Act 1967 in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 5
Fig. 5
Trend over time of the number of feticides by Statutory Grounds of the Abortion Act 1967 in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 6
Fig. 6
Prevalence of feticides under Ground E by primary diagnosis according to the systematic grouping of ICD-10 diagnostic codes in residents and non-residents of England and Wales between 2012 and 2018. Data from the DHSC
Fig. 7
Fig. 7
Prevalence of feticides by gestational age of the fetus in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 8
Fig. 8
Prevalence of feticides by abortion provider in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 9
Fig. 9
Prevalence of feticides by maternal age in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 10
Fig. 10
Prevalence of feticides by ethnicity in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 11
Fig. 11
Prevalence of feticides by parity (number of previous liveborn or stillborn) in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 12
Fig. 12
Prevalence of feticides by number of previous miscarriages or ectopic pregnancies in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
Fig. 13
Fig. 13
Prevalence of feticides by the number of previous abortions in residents and non-residents of England and Wales between 2012 and 2020. Data from the DHSC
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