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Médecine thérapeutique / Pédiatrie

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Framework and limits of medical termination of pregnancy Volume 24, issue 1, January-February-March 2022

Authors
Hôpital Saint Joseph, Service de gynécologie obstétrique, 185 rue Raymond Losserand, 75014 Paris

Background: Medical termination of pregnancy (MTP) is done because of medical conditions concerning the fetus – i.e. cardiac pathology, central nervous system malformation, genetic disorders…- or the mother, without any delay of restriction. In 2019, 6 848 MTP were performed in France.

Prenatal diagnosis organization: MTP is part of a process initially of screening and then of prenatal diagnosis through an obstetric ultrasound. A medical framework is necessary in order to respect all the different stages allowing a global approach for parents. Given its complexity and in order to avoid any drift, MTP is regulated by a legislative framework which has evolved over time.

Deciding factors and prenatal diagnosis limits: MTP decision supposes a progressive way starting by the announcement of fetal malformation or severe maternal pathology. Intrinsic and extrinsic factors will have an impact on the patient’s reflecting process and will raise many questions concerning prenatal diagnosis limits. Limits concern both the patient and the medical team. They can be due to ethical or eugenic considerations. Other factors such as the understanding of the language, the socio-educational level, the different socio-economic evolutions or even the religion will have a direct impact on the ability of the patient to decide in full awareness of the outcome of the pregnancy. Finally, another limitation relates to the sometimes fine line between voluntary termination and medical termination of pregnancy.

Conclusions: MTP is a complex process which leads to wonder about life and death rights both by the request of the couple and by the acceptance of the multidisciplinary team. MTP is legally regulated in a non-exhaustive way, leaving room for the evolution of medicine, thus making it possible to adapt to each situation. MTP is and must remain a last resort for patient management. MTP must constantly be at the center of ethical debates with a continuous questioning to avoid falling in eugenic practices. Hence the importance to maintain a degree of liberty with a rigid framework.