Termination of pregnancy for maternal indications

What it is

The SQUH policy exists to assist health care professionals to make decisions on termination of pregnancy for maternal medical indications, and to identify the maternal medical conditions that require termination of pregnancy before fetal viability.

Fetal viability is the gestational age at which a prematurely born fetus has a chance to survive outside the uterus. The limit of viability is considered to be 24 weeks of gestation.

At SQUH no termination of pregnancy is performed for fetal reasons unless it threatens the mother's life.

Causes and risk

Termination is performed without prior MTP committee approval for life threatening conditions or diseases that carry a high mortality rate of about or more than 50%:

• Severe maternal pulmonary arterial hypertension of any cause
• Eisenmenger's syndrome
• Severe systemic ventricular dysfunction: NYHA III-IV, or LVEF of 30% or less
• Previous peripartum cardiomyopathy with significant residual impairment of left ventricular function (EF < 40%)
• Severe left ventricular obstruction: hypertrophic obstructive cardiomyopathy, severe symptomatic aortic stenosis with aortic valve area less than 1 cm2, severe mitral stenosis with mitral valve area less than 1 cm2
• Marfan syndrome with aortic dilatation > 45 mm
• Aortic dilatation > 50 mm in aortic disease associated with bicuspid aortic valve
• Severe preeclampsia, eclampsia or hypertensive crisis
• Chorioamnionitis
• Severe obstetric hemorrhage or disseminated intravascular coagulopathy not responding to resuscitation