When the prenatal diagnosis (ultrasound, amniocentesis) reveals that the baby has a serious condition or that the continuation of the pregnancy endangers the life of the pregnant woman, the medical profession offers the couple a medical termination of pregnancy (or therapeutic termination of pregnancy). The IMG is strictly supervised and governed by article L2213-1 of the Public Health Code (1). Thus, according to the legislation, “The voluntary termination of a pregnancy can, at any time, be practiced if two doctors members of a multidisciplinary team certify, after this team has rendered its advisory opinion, either that the continuation of the pregnancy seriously endangers the health of the woman, that is to say that there is a strong probability that the unborn child will suffer from a condition of a particular gravity recognized as incurable at the time of the diagnosis. “

The law does not therefore set a list of diseases or malformations for which the IMG is authorized, but the conditions of consultation of the multidisciplinary team which will be brought to examine the request for IMG and to give its agreement.

If the IMG is requested for the health of the mother-to-be, the team must bring together a minimum of 4 people including:

• a gynecologist-obstetrician member of a multidisciplinary prenatal diagnosis center
• a doctor chosen by the pregnant woman
• a social worker or psychologist
• a specialist in the condition the woman has

If the IMG is requested for the health of the child, the request is examined by the team of a multidisciplinary prenatal diagnosis center (CPDPN). The pregnant woman can request that a doctor of her choice participate in the consultation.

In all cases, the choice to terminate the pregnancy or not rests with the pregnant woman, who must have been previously informed of all the data.

Today, it is rare that the IMG is performed due to the state of health of the pregnant woman. According to the report of the Multidisciplinary Centers for Prenatal Diagnosis 2012 (2), 272 IMG were performed for maternal reasons against 7134 for fetal reasons. Fetal motives include genetic diseases, chromosomal abnormalities, malformation syndromes and infections that could prevent the survival of the baby or cause death at birth or in its early years. Sometimes the survival of the child is not at stake but he will be the bearer of a serious physical or intellectual handicap. This is particularly the case in the case of trisomy 21. According to the CNDPN report, malformations or malformation syndromes and chromosomal indications are at the origin of more than 80% of IMGs. In total, nearly 2/3 of IMG certificates for fetal reasons are carried out before 22 WA, that is to say at a term when the fetus is not viable, indicates this same report.

Depending on the term of pregnancy and the health of the mother-to-be, the IMG is done either by medical or surgical method.

The medical method takes place in two stages:

• taking an anti-progestogen will block the action of progesterone, a hormone essential for maintaining pregnancy
• 48 hours later, the administration of prostaglandins will make it possible to induce childbirth by inducing uterine contractions and dilation of the cervix. Pain-relieving treatment by infusion or epidural analgesia is systematically performed. The fetus is then expelled naturally.

The instrumental method consists of a classical cesarean section. It is reserved for emergency situations or contraindicating the use of the medicinal method. The natural delivery is indeed always privileged in order to preserve the possible subsequent pregnancies, by avoiding a caesarean scar which weakens the uterus.

In both cases, a feticide product is injected before the IMG in order to cause the fetal heart to stop and to avoid fetal distress.

Placenta and fetal exams are offered after the IMG to find or confirm the causes of fetal abnormalities, but the decision whether or not to do them is always up to the parents.

A psychological follow-up is systematically offered to the mother and the couple to get through this difficult ordeal of perinatal bereavement.

If it is well accompanied, vaginal birth is an important step in the experience of this bereavement. More and more aware of the psychological care of these couples going through perinatal bereavement, some maternity teams even offer a ritual around the birth. Parents can also, if they wish, establish a birth plan or organize a funeral for the fetus. Associations often prove to be invaluable support during these difficult times.