Objective: To determine how severe were the conditions leading to termination of pregnancy for foetal anomaly (TOPFA) in France.
Methods: Detailed indications for TOPFA were extracted from medical charts.
Results: Of 2465 completed records, indications were: chromosomal anomalies n = 963 (39.1%), malformations of a single organ without chromosomal or genetic aetiologies n = 898 (36.4%), multiple malformations without chromosomal or genetic aetiologies n = 238 (9.7%), obstetrical complications n = 161 (6.5%), non-chromosomal genetic diseases n = 158 (6.4%), foetal infections n = 21 (0.9%), unexplained severe oligohydramnios n = 20 (0.8%), foetal exposure to teratogenic agents n = 6. Overall, 33.3% of anomalies were lethal (e.g. anencephaly), 25.2% were expected to result in isolated mental retardation (e.g. Down) and 35.1% in substantial handicap (e.g. myelomeningocele). In 6.4% of cases, the anomaly was either of late onset (e.g. Huntington's disease) or with uncertain prognosis (e.g. agenesis of corpus callosum) or severity was debatable (e.g. single limb agenesis, sickle cell disease).
Conclusions: Although there is no indisputable definition of which anomalies are 'severe', 93.6% of the decisions to terminate the pregnancy were made by women and professionals in reaction to anomalies which clearly were lethal or would lead to substantial physical and/or mental disabilities.