Medline ® Abstracts for References 9-11
of 'Patient education: Abortion (pregnancy termination) (Beyond the Basics)'
The effect of pregnancy termination on future reproduction.
Atrash HK, Hogue CJ
Baillieres Clin Obstet Gynaecol. 1990;4(2):391.
A variety of conditions have been anecdotally ascribed to induced abortion, including subsequent reproductive complications. Since most women obtaining induced abortions are at the beginning of their reproductive life, the effect of induced abortion on subsequent reproduction becomes a very significant one. Our review of the literature confirms findings reported previously. First, except in the case where an infection complicates induced abortion, there is no evidence of an association between induced abortion and secondary infertility or ectopic pregnancy. Second, the risk of midtrimester abortion, premature delivery and low birthweight in women whose first pregnancy is terminated by vacuum aspiration is not higher than that in women in their first pregnancy or women in their second pregnancy whose first pregnancy was carried to term. However, the risk of having a premature delivery or a low birthweight baby tends to be higher (but not significantly) among women whose first pregnancy is terminated by induced abortion when compared with women in their second pregnancy than when compared with women in their first pregnancy. This suggests that an induced abortion does not protect a women against the known risk of low birthweight for first-born offspring. Finally, women whose pregnancy is terminated by dilatation and evacuation may have an increased risk of subsequent premature delivery and a low birthweight baby. Very little has been published and no conclusions can be made regarding the effects of instillation procedures and repeat abortions on futurereproduction. In conclusion, except for the association between pregnancies following dilatation and evacuation procedures and premature delivery and low birthweight, no significantly increased risk of adverse reproductive health has been observed following induced abortion.
Induced abortion and placenta complications in the subsequent pregnancy.
Zhou W, Nielsen GL, Larsen H, Olsen J
Acta Obstet Gynecol Scand. 2001;80(12):1115.
BACKGROUND: To study the risk of placenta complications following an induced abortion as a function of the interpregnancy interval.
METHODS: This study is based on three Danish national registries; the Medical Birth Registry, the Hospital Discharge Registry, and the Induced Abortion Registry. All primigravida women from 1980 to 1982 were identified in these three registries. A total of 15,727 women who terminated the pregnancy with a first trimester induced abortion were selected to the abortion cohort, and 46,026 women who did not terminate the pregnancy with an induced abortion constituted the control cohort. By register linkage all subsequent pregnancies were identified from 1980 to 1994. Only women who had a non-terminated pregnancy following the index pregnancy were selected to the study. Placenta complications were identified using either the Hospital Discharge Registry ICD-8 codes or the Medical Birth Registry records.
RESULTS: A slightly higher risk of placenta complications following an abortion was found. Retained placenta occurred more frequently in women with one, two or more previous abortions, compared with women without any previous abortion of similar gravidity. Adjusting for maternal age and residence at time of pregnancy, the interpregnancy interval, and the number of previous miscarriages (control cohort only), the odds ratios of retained placenta in deliveries of singleton live births in women with one previous abortion was 1.17 (95%CI=1.02-1.35), and for women with two or more previous abortions it was 1.68 (95%CI=1.23-2.30), respectively, compared with the control cohort of similar gravidity. Only for women who had one abortion did the results follow the predicted pattern of a higher risk of retained placenta after a short pregnancy interval. No association with placenta previa was seen.
CONCLUSIONS: The findings suggest a positive association between abortions and retained placenta in subsequent singleton live births, but the association was weak and confounding cannot be ruled out.
Shanghai Institute of Planned Parenthood Research, Shanghai.
Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome.
Kalish RB, Chasen ST, Rosenzweig LB, Rashbaum WK, Chervenak FA
Am J Obstet Gynecol. 2002;187(4):882.
OBJECTIVE: This study was undertaken to evaluate the impact of second-trimester dilation and evacuation (D&E) on subsequent pregnancy outcome.
STUDY DESIGN: Medical record review of 600 patients undergoing midtrimester (14-24 weeks) D&E from 1996 to 2000 and evaluation of subsequent pregnancy outcome. Mann Whitney U, Spearman rho, and chi(2) tests were used in statistical analysis with a P value<.05 considered significant.
RESULTS: Ninety-six subsequent pregnancies were identified, including 12 first-trimester spontaneous abortions, 1 second-trimester fetal death, 1 ectopic pregnancy, and 5 elective terminations. Seventy-seven pregnancies resulted in the delivery of a live-born infant at a median gestational age of 39.0 weeks. Five pregnancies (6.5%) were complicated by spontaneous preterm birth. Patients delivered preterm had an earlier gestational age at D&E (18.0 vs 20.0 weeks, P =.02) and a trend toward less preoperative cervical dilation (2.0 vs 3.0 cm, P =.09) than patients delivered at term.
CONCLUSION: Second-trimester D&E is not a risk factor for midtrimester pregnancy loss or spontaneous preterm birth. Preterm delivery in future gestations appears less likely when greater preoperative cervical dilation is achieved with laminaria, possibly because of a decrease in cervical trauma.
Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, New York Weill Cornell Medical Center, 525 E. 68th Street, Room J-130, New York, NY 10021, USA. ROBINKAL@aol.com