Termination of Pregnancy due to Fetal Anomaly (TOPFA)
What is a TOPFA?
TOPFA is where an anomaly (life-threatening or life- altering condition) is identified and a parent makes the incredibly difficult choice to end the pregnancy. This anomaly is at times found and parents have a period of time to decide their course of action, however at times, it poses an immediate threat to the health of the mother, and urgent decisions have to be made.
Terminating a pregnancy where an anomaly has been identified is an area of maternity care that is usually managed in the fetal medicine department. A specialist team of obstetricians who are able to interpret complex ultrasound scans and specially trained midwives look after women and families at this time.
What is the physical and/or medical process of a TOPFA?
A very detailed discussion should take place with the family before a plan can be made for a termination of pregnancy. This is not an easy decision for any family to make and the team will allow the family to take as much time as they need and it may be performed at any time in the pregnancy. If the pregnancy is more than 22 weeks, a process is offered to stop the baby’s heart beating – another medical name for this procedure is ‘feticide’, which ultimately ends the life of the baby in the womb. This will be performed by the fetal medicine obstetrician and a specialist midwife, and following this, the woman is given medicine so that labour will start in a similar way to other methods of inducing labour.
However, some women prefer to give birth to their baby and to have their baby die in their arms. If this is the case, a detailed plan of care is prepared to ensure that no mistakes are made in the baby’s initial response to life. This plan should be discussed fully with the woman and her family so that they are in agreement.
What should a person be aware of during TOPFA?
Words are important and therefore only skilled clinicians should be involved in this procedure so that the family have the most experienced people around them. The drugs that are used to induce labour do not work immediately and some women prefer to go home and wait for labour to start. These drugs stop the pregnancy hormone progesterone being produced and after a period of time the cervix (opening of the womb) starts labour. Unfortunately, for some women labour can take a few days to start and be over.
For anyone who is given a diagnosis of TOPFA, please remember:
Take all the time you need before making a decision about what your next steps should be and don’t let anyone rush you. Feel free to ask for a second or even third opinion if you want to; there is no shame in asking for more medical views.
Seek independent counsel and look at several sources of information. Some websites are written to steer you in certain directions; be savvy to this by looking at as many sites as possible.
Extended families often want to advise and make things better for a couple going through this; it is vital that the couple are able to reach their own decisions.
All information on this website, and advice and support offered by the charity team is on a non-medical basis. The charity advises that anyone going through baby loss, medical treatment or health issues, should seek advice from their own GP, Consultant, Midwife or Healthcare Professional.Download the Saying Goodbye Support Leaflet (PDF)