Risk of ectopic pregnancy and previous induced abortion.

OBJECTIVES: This study investigated the role of prior history of induced abortion in subsequent ectopic pregnancies. METHODS: Data from two French case-control studies were used to examine the effect of induced abortion on ectopic pregnancy risk. Case patients (n = 570) were women admitted for ectopic pregnancy during the study period; controls (n = 1385) were women who delivered in the same center. RESULTS: The analysis among women with no previous ectopic pregnancy showed that, after control for the main ectopic pregnancy risk factors, prior induced abortion was associated with an increased risk of ectopic pregnancy (odds ratio [OR] = 1.5, 95% confidence interval [CI] = 1.0, 2.0); there was a significant trend between number of previous induced abortions and ectopic pregnancy risk (ORs = 1.4 for 1 previous induced abortion and 1.9 for 2 or more). CONCLUSIONS: This study suggests that induced abortion may be a risk factor for ectopic pregnancy for women with no previous ectopic pregnancy, particularly in the case of women who have had several induced abortions.     

Mifepristone-induced early abortion and outcome of subsequent wanted pregnancy

Follow-up information on subsequent pregnancies after mifepristone (RU486)-induced abortion is scarce. The authors examined whether one mifepristone-induced first-trimester abortion affects the outcome of a subsequent wanted pregnancy. In a study conducted in 1998-2001 at antenatal clinics in Beijing, Chengdu, and Shanghai, China, the authors enrolled 4,925 women with no history of induced abortion, 4,931 women with one previous mifepristone-induced abortion, and 4,800 women with one previous surgical abortion and followed them through pregnancy and childbirth. The adjusted odds ratio for preterm delivery in women with one mifepristone abortion compared with women with no abortion was 0.77 (95% confidence interval: 0.61, 0.98). Although the mean birth weight of infants born to women with mifepristone abortion was 33 g (95% confidence interval: 17, 49) higher than that of infants born to women with no abortion, the frequencies of low birth weight and mean lengths of pregnancy were similar. There were no significant differences in risk of preterm delivery, frequency of low birth weight, or mean infant birth weight in the comparisons of women with previous mifepristone abortion and women with surgical abortion. This study suggests that one early abortion induced by mifepristone in nulliparous women has no adverse effects on the outcome of a subsequent pregnancy.     

Assessing the prevalence and determinants of unwanted pregnancy and induced abortion in Nigeria

This study was conducted to determine the prevalence and sociodemographic determinants of unwanted pregnancy and induced abortion in the Jos and Ife local government areas of Nigeria. A total of 1,516 randomly selected women aged 15-45 responded to a pretested structured questionnaire designed to elicit information concerning previous unwanted pregnancies and induced abortions in a value-free manner. Nearly 20 percent of the women reported having had an unwanted pregnancy. Of these, 58 percent reported that they had successfully terminated the pregnancies; 32 percent continued the pregnancies; and nearly 9 percent stated that they had attempted termination but failed. Overall, the prevalence of self-reports of induced abortion was 11 percent. The results reveal that information can be obtained on abortion in areas with restrictive abortion policies if an indirect interviewing approach is used.     

Adverse outcomes of planned and unplanned pregnancies among users of natural family planning: a prospective study.

OBJECTIVES: The purpose of this study was to determine prospectively whether unplanned pregnancies are associated with adverse pregnancy outcomes among users of natural family planning. METHODS: Women who became pregnant while using natural family planning were identified in five centers worldwide: there were 373 unplanned and 367 planned pregnancies in this cohort. The subjects were followed up at 16 and 32 weeks' gestation and after delivery. The risks of spontaneous abortion, low birth-weight, and preterm birth were estimated after adjustment by logistic regression. RESULTS: The women with unplanned pregnancies were more likely to be at the extremes of age, to report more medical problems before and during the index pregnancy, and to seek antenatal care later in gestation than the women with planned pregnancies. However, women with planned pregnancies reported a higher rate of spontaneous abortion in previous pregnancies (28.8%) than did women with unplanned pregnancies (12.9%). There were no significant differences in the rates of spontaneous abortion, low birthweight, or preterm birth between the two groups. CONCLUSIONS: No increased risk of adverse pregnancy outcomes was observed among women who experienced an unplanned pregnancy while using natural family planning.     

Induced abortion and the risk of subsequent ectopic pregnancy.

This study assessed the effect of legal induced abortion on ectopic pregnancy risk by using a comparison group of reproductive-age women who were at risk of becoming pregnant during the same time period the women with ectopic pregnancy conceived. Cases were members of Group Health Cooperative of Puget Sound who were hospitalized for ectopic pregnancy from October 1981 through September 1986 (N = 211). Controls were randomly selected members matched to cases on age and county of residence (N = 457). All subjects in this analysis had had one or more prior pregnancies. Eighty-eight cases (41.7 per cent) and 177 controls (38.7 per cent) had a history of one or more induced abortions. The relative risk of ectopic pregnancy associated with one abortion was 0.9 (95 per cent confidence interval 0.6, 1.3), adjusted for age, county, reference date, religion, gravidity, age at first pregnancy, lifetime number of sexual partners, and miscarriage history. Among women with two or more prior pregnancies, the risk associated with two or more abortions was 1.2 (0.6, 2.4). Controlling for pelvic inflammatory disease and use of intrauterine devices did not alter these risks. We conclude that legal abortion as performed in the US since 1970 has little or no influence on a woman's risk of ectopic pregnancy in subsequent pregnancies.     

Factors related to induced abortion among young women in Edo State, Nigeria

Sub-Saharan Africa has the highest death rate from induced abortion in the world, and young women in southern Nigeria are particularly likely to terminate their pregnancies. This study assesses the prevalence of and factors associated with induced abortion among 602 young women aged 15-24 who were surveyed in Edo State, Nigeria, in 2002. We find that 41 percent of all pregnancies reported by the young women surveyed were terminated, and we estimate the age-specific abortion rate for 15-19-year-olds in Edo State at 49 abortions per 1,000 women, which is slightly higher than previous local estimates and nearly double the countrywide estimate for women aged 15-49. We construct explanatory multivariate models to predict the likelihood that a young woman has experienced sexual intercourse, has become pregnant, and has undergone an induced abortion, controlling for important demographic and risk-behavior factors. Young women unmarried at the time of the interview are found to be significantly more likely than married women to have had an abortion. Young women who have experienced transactional or forced sex are also significantly more likely to report ever having had an abortion, as are young women who have experienced more than one pregnancy. We conclude with suggestions for modifying the content and target populations of behavioral change messages and programs in the area.     

Induced abortion and low birthweight in the following pregnancy

BACKGROUND: To examine whether induced abortion increases the risk of low birthweight in subsequent singleton live births. METHODS: Cohort study using the Danish Medical Birth Registry (MBR), the Hospital Discharge Registry (HDR), and the Induced Abortion Registry (IAR). All women who had their first pregnancy during 1980-1982 were identified in the MBR, the HDR, and the IAR. We included all 15,727 women whose pregnancy was terminated by a first trimester induced abortion in the induced abortion cohort and 46,026 women whose pregnancy was not terminated by an induced abortion were selected for the control cohort. All subsequent pregnancies until 1994 were identified by register record linkage. RESULTS: Low birthweight (<2500 g) in singleton term live births occurred more frequently in women with one, two, three or more previous induced abortions, compared with women without any previous induced abortion of similar gravidity, 2.2% versus 1.5%, 2.4% versus 1.7%, and 1.8% versus 1.6%, respectively. Adjusting for maternal age and residence at time of pregnancy, interpregnancy interval, gender of newborn, number of previous spontaneous abortions and number of previous low birthweight infants (control cohort only), the odds ratios (OR) of low birthweight in singleton term live births in women with one, two or more previous first trimester induced abortions were 1.9 (95% CI: 1.6, 2.3), and 1.9 (95% CI: 1.3, 2.7), respectively, compared with the control cohort of similar gravidity. High risks were mainly seen in women with an interpregnancy interval of more than 6 months. CONCLUSIONS: The findings suggest a positive association between one or more first trimester induced abortions and the risk of low birthweight in subsequent singleton term live births when the interpregnancy interval is longer than 6 months. This result was unexpected and confounding cannot be ruled out.     

Induced abortion and risk of subsequent miscarriage

BACKGROUND: To evaluate the impact of surgically induced first-trimester abortion on the risk of miscarriage in a subsequent pregnancy. METHODS: The study is a pregnancy cohort study. It was conducted among 15 general hospitals or maternity and infant health institutes in Shanghai, China from November 1993 to March 1998. The abortion cohort consisted of pregnant women whose previous pregnancies were terminated by vacuum aspiration (98%). The reference cohort consisted of primigravidae. Subjects were recruited at 35-63 days of gestational age. A total of 2953 pregnant women were enrolled; 1502 in the abortion cohort, 1451 in the reference cohort. RESULTS: There were only 62 women lost to follow-up. The remaining 2891 women had 2732 live births, and 137 miscarriages. About 5.5% of pregnancies in the abortion cohort were miscarried and 4.0% in the reference cohort. Once potential confounders were controlled for by logistic regression, odds ratio (OR) of miscarriage between the abortion cohort and the reference cohort was 1.55 (95% CI: 1.08-2.23). The adjusted OR were 2.44 (95% CI: 1.16-5.15) among women who were recruited within 49 days of gestational age, and 1.72 (95% CI: 1.09-2.72) for the first-trimester miscarriage. CONCLUSIONS: Induced abortion by vacuum aspiration is associated with an increased risk of first-trimester miscarriage in the subsequent pregnancy.     

Characteristics of pregnant women who report previous induced abortions

Associations between previous induced abortion and demographic and health factors in pregnancy were measured in 9 874 women who gave birth and who had been interviewed during pregnancy. Previous abortion was most rare among women having their first baby and increased with increasing birth order up to the fourth, thereafter decreasing. It was positively correlated with maternal age and negatively with age at marriage. There was no effect of years of schooling, when other variables were taken into account, but there were significant differences between ethnic groups, abortion being commonest among Jewish women from North African countries and more prevalent in those from western and Asian countries than in the second-generation Israel-born or in Arab women.     

Socioeconomic Inequalities in Unintended Pregnancy and Abortion Decision

Pregnancy planning allows women to better control their life trajectory and contributes to the future child’s health and development. Many studies that have analyzed socioeconomic inequalities in unintended pregnancy only took into account those pregnancies ending in births. Few of them that analyzed unintended pregnancy, including both induced abortion and births, and its socioeconomic determinants, concluded that unintended pregnancy is more frequent in young, poor, or unmarried women. These inequalities have been poorly studied in Europe, especially in the southern European context. The aim of the present study is to describe socioeconomic inequalities in unintended pregnancy and in abortion decision in Barcelona, Spain. The major findings are that unintended pregnancies accounted for 41% of total pregnancy and of these, 60% ended in abortion. From all pregnancies, the proportion of induced abortion reached 25.6%. Compared to women with university studies, those with primary education uncompleted had more unintended pregnancies (OR = 7.22). When facing an unintended pregnancy, women of lower socioeconomic position are more likely to choose induced abortion, although this is not the case among young or single women. This study reveals deep socioeconomic inequalities in unintended pregnancies and abortion decision in Barcelona, Spain, where the birth rate is very low and the abortion rate is rising. Women in low socioeconomic positions have many more unintended pregnancies than better educated women. Except for young or single women, the lower the socioeconomic position, the higher the proportion of women who choose an induced abortion when facing an unintended pregnancy. Font-Ribera, Pérez, Salvador, and Borrell are with the Health Information Service, Agency of Public Health of Barcelona, Barcelona, Spain; Pérez and Borrell are with the University Pompeu Fabra, Barcelona, Spain; Pérez and Borrell are with the CIBER in Epìdemiology and Public Health (CIBERESP), Barcelona, Spain; Pérez is with the Agency of Public Health of Barcelona, Barcelona, Spain.     

Reproductive mortality in Lusaka, Zambia, 1982-1983

In this study, age- and parity-specific birth data were used to estimate maternal mortality rates for 1982-83 at University Teaching Hospital in Lusaka, Zambia. Overall, 60 maternal deaths occurred during pregnancy or within 42 days after pregnancy termination, and four pregnancy-related deaths occurred more than 42 days after pregnancy termination. Nine of the 60 maternal deaths were caused by induced abortion, one by spontaneous abortion, twelve by hypertensive disease of pregnancy, ten by hemorrhage, nine by puerperal sepsis, and four by ectopic pregnancy. Of the 12 women who died from nonobstetric causes, one committed suicide because of an unwanted pregnancy. Women aged 35 years and older or who had had four previous pregnancies had a higher risk of dying than other women, especially by hemorrhage. The chief risk factors included not using an effective method of contraception, using an unsafe means to terminate unintended pregnancies, lack of prenatal care, refusing a blood transfusion (for religious reasons), and inadequately treating hypertensive disease of pregnancy. Overall, 31 of 60 women who died lacked adequate or appropriate medical care and 19 failed to obtain available health care. Medical management problems appeared to occur more frequently during the night-time medical shift.     

Induced abortion and spontaneous fetal loss in subsequent pregnancies.

The effect of induced abortion on spontaneous pregnancy loss in subsequent pregnancies was studied based on 3,416 pairs of matched data in a follow-up investigation. Pregnancy outcome was examined also in relation to abortion procedure, gestation length at time of abortion, and number of previous abortions. In general there was no significant association between prior induced abortion and risks of pregnancy loss with the relative risks of 1.10, 0.88, and 0.81 for the first to third trimester respectively. A slight increase of first-trimester spontaneous loss was noted with the D&C/Suction procedure and early induced abortion (less than 9 weeks). The D&C procedure was associated with non-significant increase of second-trimester loss with the relative risk of 1.59.     

Reproductive history and the risk of neonatal sepsis

Summary. It was recently suggested that a previous abortion increases the risk of intrapartum infection in a following pregnancy. The authors hypothesised that abortion also could be associated with a higher risk of neonatal sepsis. A case-control study of neonatal sepsis was conducted using the Washington State Birth Registry. Cases of sepsis were selected among singleton livebirths during the period 1984-90, and compared with a control group for the occurrence of spontaneous or induced abortion in previous pregnancies. The risk estimates were calculated using a stratified analysis. After exclusion of primigravidae, the age-adjusted odds ratio (OR) was 1.68, with a 95% confidence interval (CI) 1.33,2.11 for previous spontaneous abortion, and 2.20 (95% CI 1.73, 2.79) for induced abortion, compared with previous livebirth. After exclusion of nullipa-rous women, the OR decreased to 1.19 (95% CI 0.90,1.58) for spontaneous abortion and 1.45 (95% CI 1.03, 2.04) for induced abortion. After controlling for the effect of parity, induced abortion is associated with an increased risk of neonatal sepsis in a subsequent pregnancy, but the association between spontaneous abortion and sepsis is small and nonsignificant. The authors suggest that the procedures involved in a therapeutic abortion might produce a latent, sub-clinical infection that persists until the next pregnancy, and is then transmitted to the newborn.     

Relations of gestational length and timing and type of incomplete pregnancy to ovarian cancer risk

While the protective nature of parity with respect to ovarian cancer has been well documented, whether a history of incomplete pregnancy affects ovarian cancer risk is uncertain. Data collected from 739 epithelial ovarian cancer cases and 1,313 community controls in the Delaware Valley from 1994 to 1998 were used to evaluate the relation between gestational length and timing of first induced or spontaneous abortion and ovarian cancer risk. Incomplete pregnancy was not associated with ovarian cancer among nulliparous women or among ever-pregnant women either before or after adjustment for relevant confounders (for nulliparous women, odds ratio (OR) = 1.12, 95% confidence interval (CI): 0.66, 1.89; for ever-pregnant women, OR = 0.95, 95% CI: 0.76, 1.18). Among unigravid women, one full-term pregnancy was more protective than an incomplete pregnancy (adjusted OR = 0.29, 95% CI: 0.15, 0.57). These results were independent of the type of pregnancy loss. Among ever-pregnant women, a spontaneous abortion before a first birth provided significant protection (adjusted OR = 0.47, 95% CI: 0.30, 0.75), while no significant effect was found for an induced abortion prior to a first birth (adjusted OR = 0.80, 95% CI: 0.44, 1.47). These data do not support an independent association between incomplete pregnancies, either spontaneous or induced, and ovarian cancer risk.     

Work with visual display units in pregnancy.

Data from the Montreal survey on occupational factors in pregnancy were used to test the hypothesis that visual display units (VDUs) constitute a hazard to reproduction. Use of a VDU was recorded in 4712 current and 2164 previous pregnancies of women in full time employment at time of conception. After allowance for seven confounding variables, the risk of spontaneous abortion in current pregnancies relative to all working women was 1.19 (90% CI 1.09-1.30) and in previous pregnancies, 0.97. In an analysis by occupational title, in which 60 occupational groups were aggregated into eight categories according to use of VDUs, the relative risk for spontaneous abortion was 1.06 (90% CI 0.8-1.4) in current pregnancies and 1.01 (90% CI 0.7-1.3) in previous pregnancies. This suggests that the small excess of spontaneous abortions among individual women reporting the use of VDUs in current pregnancies may have been due to recall bias. Relative risks for stillbirth, preterm birth, and low birth weight all had 90% confidence limits which included unity. In an analysis of congenital defects the number of pregnancies was increased to include women who worked 15 or more hours a week. In all but one of nine groups of congenital defect examined confidence limits for the relative risk included unity in both current and previous pregnancies. The relative risks for the renal urinary group of defects were raised in both current (1.84, 90% CI 1.07-3.15) and previous pregnancies (1.66, 90% CI 0.82-3.25). There being no prior reason to suspect a causal link with this type of defect, interpretation remains open to question.     

Work with visual display units in pregnancy

Data from the Montreal survey on occupational factors in pregnancy were used to test the hypothesis that visual display units (VDUs) constitute a hazard to reproduction. Use of a VDU was recorded in 4712 current and 2164 previous pregnancies of women in full time employment at time of conception. After allowance for seven confounding variables, the risk of spontaneous abortion in current pregnancies relative to all working women was 1.19 (90% CI 1.09-1.30) and in previous pregnancies, 0.97. In an analysis by occupational title, in which 60 occupational groups were aggregated into eight categories according to use of VDUs, the relative risk for spontaneous abortion was 1.06 (90% CI 0.8-1.4) in current pregnancies and 1.01 (90% CI 0.7-1.3) in previous pregnancies. This suggests that the small excess of spontaneous abortions among individual women reporting the use of VDUs in current pregnancies may have been due to recall bias. Relative risks for stillbirth, preterm birth, and low birth weight all had 90% confidence limits which included unity. In an analysis of congenital defects the number of pregnancies was increased to include women who worked 15 or more hours a week. In all but one of nine groups of congenital defect examined confidence limits for the relative risk included unity in both current and previous pregnancies. The relative risks for the renal urinary group of defects were raised in both current (1.84, 90% CI 1.07-3.15) and previous pregnancies (1.66, 90% CI 0.82-3.25). There being no prior reason to suspect a causal link with this type of defect, interpretation remains open to question.     

陕西省咸阳地区贫困农村育龄妇女自然流产状况调查

目的了解陕西省贫困农村育龄妇女自然流产状况及其相关因素。方法于2002—2005年间对陕西省长武县、彬县的农村怀孕妇女进行入户访问获得孕产妇的既往生育史,并对孕妇进行随访,直至获得本次妊娠结局。结果共随访5844例孕产妇,总妊娠次数为9638次,其中1153次为自然流产。孕产妇自然流产妊娠比为12.0%,自然流产率为13.6%,发生自然流产的比例为16.4%。随着妇女年龄的增加、妊娠次数的增加等,育龄妇女发生自然流产的危险性也在增加。结论加强计划生育,减少妊娠次数,延长生育间隔,防止高龄怀孕将有助于降低陕西省贫困农村育龄妇女自然流产的发生水平。     

Abortions in a hospital setting: hidden realities in Dar es Salaam, Tanzania.

This study investigates the extent of unwanted pregnancy, the use of illegally induced abortion, and the attitudes toward and practice of contraception among women admitted to a hospital with the diagnosis of abortion in Dar es Salaam, Tanzania. (In Tanzania, induced abortion is permitted only to save the mother's life.) A random sample of 300 women with early pregnancy loss admitted to Muhimbili Medical Centre, the teaching hospital in Dar es Salaam, were interviewed between September and November 1987, using a structured questionnaire. Among the 300 respondents, 155 said that their pregnancy had been unwanted: 94 of them presented with an illegally induced abortion and 61 with a spontaneous abortion. The number of spontaneous abortions of unwanted pregnancies increased with age and stability in a relationship. Having a small child to look after and having completed the family were the most common reasons for the pregnancy to be unwanted in this group. Induced abortion was more a problem of the young, unmarried woman. The 61 women with spontaneous abortion but unwanted pregnancy suggest that a much larger group of pregnant women continue to term with what are, at least initially, unwanted pregnancies--precisely the group of women family planning programs want to reach. The low prevalence of contraceptive use in this group indicates the failure of family planning clinics to motivate their target group. Recommendations are made for improved functioning of family planning clinics.     

The resolution of teenage first pregnancies

First conceptions occuring in tennage women in the U.S., the outcomes of the pregnancies, the marital status of the teenage women at conception and at the outcome, whether the pregnancy was intended or not, and whether contraception was used to prevent the pregnancy are discussed. It was determined that 30% of a cross section of teenage women have had premarital intercourse and 58% of those married had premarital intercourse. Of those experiencing premarital intercourse, 30% were pregnant before marriage, i.e., fewer than 10% of all females 15-19. Twice as many blacks have premarital intercourse than whites, and twice as many of these become pregnant. 35% of those who have a premarital first pregnancy marry before the baby is born. 64% of premarital first pregnancies are unintended. Of those who did not want to become pregnant, 13-16% used contraception to prevent the premarital pregnancy. 86% of births to blacks from first pregnancies are illegitimate compared with 23% for whites. More than 1/5 of the women who do not marry end the pregnancy by induced abortion. White teenagers who do not marry prior to the outcome of the pregnancy are 7 times more likely to have an induced abortion than blacks. 18% of the whites who have illegitimate births from first pregnancies give up their children for adoption compared with 2% blacks. Fewer than 30% of postmarital first pregnancies of teenage women are unintended. Blacks appear to display less anxiety than whites over illegitimate births. It may be that escape via abortion and marriage is less accessible to blacks than to whites both economically and psychologically.     

Can we identify women at risk of more than one termination of pregnancy?

One in five women will have more than one abortion in her lifetime. This study was designed to identify risk factors in women requesting termination of pregnancy (TOP) after previous TOPs so that women at risk of recurrence, attending for the first time, could be identified. A retrospective case note review of 358 women undergoing TOP during October and November 2000 was performed. Twenty-six percent of women had had a previous TOP. Women undergoing a second or subsequent therapeutic abortion were more likely to be older and have experienced more pregnancies to full term, but these two factors were confounded. When women were both parous and deprived, the risk of them having had more than one TOP was over 50%.