Jennifer Kerns


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    D&E versus induction for second-trimester termination for fetal anomaly: a qualitative study

    Jennifer Kerns, USA

    Co-authors: R.Vanjani, L.Freedman, E.A.Drey, K.R.Meckstroth, J.E.Steinauer

    Objective: Approximately 3% of pregnancies are affected by a fetal anomaly. Prenatal screening for fetal anomalies is a routine part of prenatal care, and most women given that diagnosis will terminate the pregnancy. We know little about patient preferences for D&E versus induction for fetal anomaly termination. In this qualitative study, we sought to understand the factors influencing women’s choice between D&E and induction, and how their experiences differed.

    Methods: We conducted semi-structured phone interviews with 21 women from University of California San Francisco (UCSF) who had undergone a termination within the past three weeks for fetal anomaly or demise. All women had equal access to both methods. We used a generative thematic approach, facilitated by the NVivo qualitative software program.

    Results: Of the21 women, 13 (62%) underwent D&E and 8 (38%) underwent induction. Several key themes that emerged from the interviews were options counseling, referral experience, religious attitudes, abortion attitudes and emotional coping style. While some themes were shared across method of termination, others were differentially expressed by those undergoing D&E or induction.

    Conclusion: While some aspects of pregnancy termination for fetal anomaly are shared by women, factors and experiences associated with the method of termination are quite different. The decision to undergo D&E or induction is a highly personal one, and women should be offered equal access to both methods. Understanding key themes that drive that decision may aid in counseling women faced with this diagnosis.