Late terminations of pregnancy are rare and account for only a small percentage of the total number of terminations of pregnancy, which generally occur in the first trimester. In Canada, for example, in 2012, 70.4 % of terminations occurred during the first 12 weeks of pregnancy, and only 2.2 % after 21 weeks [1]. This category is not homogeneous. The reasons for the terminations are varied, and so are the methods used for terminating the pregnancy.

These approaches to termination are delicate and sensitive issues, both to parents and to healthcare teams and need to be well explained and transparent. But the approaches also influence outcome statistics differently. In the case of the feticide, Christine will be counted as a stillbirth, and in the other, as a neonatal death. For parents, beyond the emotional and psychological impact, practical considerations will also matter. For example, work compensations for parents, such as sick leave, are often shorter for an in utero death than for a neonatal death.

The second category is comprised of stillbirths. Even with our increasing technological prowess, some fetuses die in utero. With an increased ability to monitor pregnancies, fetal mortality is less common than before in industrialized countries. In the United States, for example, fetal mortality was estimated at 7.83 per 1000 live births in 1985, compared to 6.05 in 2006 [4]. Further categorization of stillbirths is important. They can be categorized as follows: (a) unanticipated fetal demise, (b) anticipated fetal demise following medical withholding of intervention (delivery or operative delivery), and (c) fetal demise following maternal-fetal interventions.

Some fetal deaths remain unanticipated and are often inevitable, but others are avoided by inducing the birth of an at-risk fetus. For example, in some cases of placental insufficiency, the fetus no longer grows and fetal demise is thought to be a significant risk. In these situations, medical induction of birth can prevent fetal death. In other cases, however, even if the medical team and the parents are aware that the fetus is at significant risk of in utero demise, induction of birth is not performed, because the team and parents choose to let “nature follow its course.” The reasons for this choice vary: some fetuses show signs of distress at a gestational age that is too early to be compatible with extra utero life, some demonstrate a level of fetal maturity that is compatible with life but with a significant risk of future mortality or sequelae, and others present a known fetal condition that will affect their future quality of life. Also, compromised fetuses often do not tolerate labor well and may develop fetal distress with contractions. Although it may be indicated to ensure survival, a cesarean section at the limits of viability increases maternal risks and future reproductive risks more than one later in pregnancy. In summary, the estimation of risks and benefits of a cesarean section sometimes points towards withholding surgical intervention when the compromised fetus has a poor predicted outcome.