Clinical Care Pathways for Second and Third Trimester Termination of Pregnancy for Medical Reasons in Canada.

Objective: Termination of pregnancy in the 2/3 trimester for fetal or maternal complications (i.e., for medical reasons) is an essential health service. We aimed to describe the systems-level pathways for this care in Canada.

Methods: We conducted one-on-one semi-structured interviews with maternal fetal medicine (MFM), medical genetics, and nursing/social work clinicians at the 10 academic MFM sites in Canada. We conducted qualitative content analysis to identify categories describing the clinical care pathway. We triangulated data from participants within sites, and then compared data across sites to describe similarities and differences in care. We used NVivo14 Software for coding.

Results: We recruited 28 participants representing all sites - 10 MFM specialists, 9 medical geneticists/genetic counsellors, and 9 nurses/social workers. We identified 4 main categories describing the clinical care pathway: (1) initial visit and clinic structure, (2) offering termination, (3) provision of procedural and medication termination, and (4) post-termination care. Across sites, although clinic structure and post-termination care were similar, there were differences in offering the option of termination (e.g. variable indications qualifying for approval), and variation in details regarding the provision of procedural and medical termination (e.g. upper gestational age limits for procedural versus medical approaches).

Conclusions: Clinical care pathways for 2/3 trimester termination for medical reasons are variable across Canadian academic MFM centres, especially regarding circumstances under which termination is offered and details regarding the provision of procedural and medical termination. These differences provide opportunities to inform efforts to optimize equitable and comprehensive services in Canada.