Code of practice for late pregnancy terminations and fetocides

Background: There is an ongoing discussion about the performance and practice of pregnancy terminations in Germany. The majority of pregnancy terminations are performed before 12 weeks after conception according to the regulations on pregnancy counselling; however, termination of pregnancy on maternal grounds is often performed as a late pregnancy termination aftermore than 12 weeks of gestation. This leads to an ethical dilemma for parents and the various professional disciplines involved. Particularly problematic are terminations performed after 22 weeks of gestation in which a fetocide is frequently carried out before the medical induction of labor. The legislative authorities have defined the juristic features, whereby differences in state-specific law have to be considered. Clinical and administrative personnel are faced with the complex challenge of the practical implementation. Objective: This publication describes the transparent organization of the necessary procedures for late pregnancy termination on maternal grounds, considering all legal prerequisites and at the same time guaranteeing a sympathetic understanding for those affected. The result of the cooperation between gynecologists, nursing personnel and midwives, colleagues from forensic medicine and pathology, the civil registry office, the criminal investigation department and the public prosecutor's office in Freiburg im Breisgau, is intended to serve as an incentive for other obstetric clinics in Germany to develop analogous practical procedural guidelines considering all legally applicable provisions when dealing with late pregnancy terminations.