Psychological aspects of therapeutic abortion after early prenatal diagnosis.

The early discovery of a fetal pathology creates a 'crisis' situation fraught with psychic problems for the couple who must live through it. The Authors observed a group of patients in the second trimester of pregnancy. They had all requested therapeutic abortion since serious malformation of the fetus had been confirmed. By means of a questionnaire constructed fot the purpose, certain characteristics of fetal malformation and of pregnancy were evidenced, as well as the way these were experienced by the patients. The immediate and delayed reactions to the diagnosis of malformation were also studied, as was the experience lived when faced with the choice of abortion.The psychological aspects of therapeutic abortion after early prenatal diagnosis of a fetal pathology among 50 2nd trimester (16th-22nd week) patients at the University of Rome obstetric clinic are described. A crises is experienced after discovery of a fetal pathology (e.g., chromosomic, dismetabolic, infectious, and multifactorial). An open ended questionnaire format was used to obtain information on the malformations and to solicit responses to the malformation and the choice to abort. Respondents' average age was 32, and all educational levels and job types were represented. 80% of malformations had a low recurrence risk of 2-3%, and 20% had a high risk of 25-50%. 42% were planned pregnancies and 36% were desired; 22% occurred by chance. 44% had previous healthy children. 22% were in a 1st pregnancy and 10% were in a 2nd pregnancy following an abortion. 14% had both healthy and handicapped children. Visual representation of the expected child was clear to 44%, unclear to 44%, and unimaginable to 12%. Only 26% had programmed a future for the child. 82% had a clear view of themselves as mothers, while 18% were vague. 76% had confident maternal attitudes toward child rearing. 76% considered the pregnancy to be organically easy. 16% felt it was decidedly difficult, and 8% had some difficulty. 60% felt emotionally comfortable with the pregnancy. 38% felt ambivalent, of which 80% had high-risk pregnancies. After notification of the malformation or suspicion, 90% felt emotionally aroused. 22% felt anxiety, particularly if the extent and gravity were not indicated; 18% felt amazement and 8% rejection. 14% rebelled. Examples of the exact responses are given. The reasons for choosing abortion are also given, ranging from being against abortion, but finding the malformation to be incompatible with life, to not wanting to inflict the consequences on other family members. 80% considered abortion as an option to limit the frustration and disappointment to a short period in their lives and to prevent repercussions. After the decision is made, the focus turns to the immediate aspects of the abortion.