[Trends in indications for therapeutic abortion. Statistical study of 20 years]. / Evolution des indications de l'interruption therapeutique de grossesse. Statistiques sur 20 annees.

ABSTRACT

PIP 2 conditions are necessary for a therapeutic abortion a medical indication of the threat to the mother's health posed by the pregnancy or the risk of incurable malady in the fetus, and the obtaining of clear consent from the woman, who has been duly advised of the risks. Medical indications for therapeutic abortion have preceded legal dispositions. An 1850 vote after animated debate at the French Academy of Medicine approved therapeutic abortion if no other treatment could save the mother's life, but the practice was not precisely codified until promulgation of a decree in 1955. The physician was to obtain the opinions of 2 consultants. Despite a few therapeutic abortions for fetal indications, a public debate on the issue did not arise until the thalidomide crisis of 1962. The 1975 and 1979 laws permitted therapeutic abortion if the pregnancy posed a grave threat to the mother's health or there was a strong probability that the fetus would be afflicted by a grave disorder recognized as uncurable at the moment of diagnosis, 179 records of therapeutic abortions performed from 1964-82 showed that the average age of the woman varied from 29 to 33 years from 1964 to 1973 and thereafter declined to 27-28 years by 1982. The declining age is directly related to the widespread use of sonography. The average gestation at time of therapeutic abortion has been about 19 weeks since 1964. None of the 20 therapeutic abortions performed from 1964-70 were for fetal indications, while in 1982 only 6 of 24 indications involved maternal risk and the other 18 included 2 cases of German measles, 2 of anencephalie, 3 of trisomy 21 and 1 of trisomy 18, 3 of spina bifida, 4 of coelosomies, and 3 of hydrocephalies. Therapeutic abortions for maternal indications are becoming proportionately less frequent because more of the conditions posing threats to maternal health during pregnancy are amenable to treatment, while improved contraceptive methods offer greater protection against pregnancy and improved methods of prenatal diagnosis of fetal morphologic, enzymatic, or chromosomal anomalies incompatible with a normal life. The availability of therapeutic abortion poses medicolegal problems, especially concerning the right of the fetus to be born.^ieng