Early versus late termination for fetal anomalies: Women's perspectives and psychological impact in a mixed methods study

Introduction: A frequently cited benefit of the first-trimester anomaly scan (FTAS) is that it reduces psychological impact by enabling earlier termination of pregnancy (TOP). However, the impact of early versus late TOP due to fetal anomalies remains unclear. This study evaluates the psychological impact and perspectives associated with early versus late TOP. Material and Methods: A prospective mixed methods study was conducted. The early group (TOP <18 weeks) included women with an abnormal FTAS; the late group (TOP 20–24 weeks) included women with an abnormal second-trimester scan (SAS), abnormal FTAS, or normal FTAS followed by abnormal SAS. Women completed questionnaires 2 (T1) and 6 months (T2) postpartum addressing psychological impact using validated scales (State–Trait Anxiety Inventory, Edinburgh Depression Scale, Impact of Event Scale, Perinatal Grief Scale) and study-specific questions. Semi-structured interviews were conducted with women and their partners 3–6 months after termination. Results: 149 women with early TOP (15 + 2 weeks, range 14 + 4–16 + 1) and 129 with late TOP (22 + 0, 21 + 0–23 + 1) completed T1. In both groups, the majority had clinically relevant anxiety at T1 and T2 and moderate/severe distress at T1. The late TOP group had higher median depression and mean grief scores at T1 (5.0, range 3.0–8.0 vs. 4.0, range 2.0–7.0, p = 0.004) (85.9 ± 21.0 vs. 76.5 ± 22.4, p < 0.001) and at T2 (4.0, 1.0–7.0 vs. 3.0, 1.0–6.0, p = 0.043) (81.3 ± 22.9 vs. 70.8 ± 22.6, p < 0.001), respectively, and higher mean distress scores at T1 (33.8 ± 13.3 vs. 30.2 ± 14.7, p = 0.034). Of 51 interviews with women and partners (22 early, 29 late TOP), four themes were identified: fetal attachment, time pressure, grief, and reflections on gestational age. Most late TOP participants expressed strong fetal attachment; for early TOP participants, the experiences were more variable. Half of the late TOP participants reported time pressure due to the legal limit. Perceived grief and impact were substantial in both groups. Conclusions: Our findings suggest that early TOP is associated with lower psychological impact compared to late TOP, mainly in the first months postpartum. This may reflect less intense fetal attachment and more time for reproductive decision-making for some parents, supporting the presumed benefit of earlier intervention. Nevertheless, TOP causes a significant emotional impact at any gestational age.