Induced abortion and placenta complications in the subsequent pregnancy

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.     

Induced abortion and subsequent pregnancy duration

OBJECTIVE: To examine whether induced abortion influences subsequent pregnancy duration. METHODS: Women who had their first pregnancies during 1980, 1981, and 1982 were identified in three Danish national registries. A total of 15,727 women whose pregnancies were terminated by first-trimester induced abortions were compared with 46,026 whose pregnancies were not terminated by induced abortions. All subsequent pregnancies until 1994 were identified by register linkage. RESULTS: Preterm and post-term singleton live births were more frequent in women with one, two, or more previous induced abortions. After adjusting for potential confounders and stratifying by gravidity, the odds ratios of preterm singleton live births in women with one, two, or more previous induced abortions were 1.89 (95% confidence interval [CI] 1.70, 2.11), 2.66 (95% CI 2.09, 3.37), and 2.03 (95% CI 1.29, 3.19), respectively. Odds ratios of post-term singleton live births in women with one, two, or more previous induced abortions were 1.34 (95% CI 1.24, 1.44), 1.50 (95% CI 1.26, 1.78), and 1.58 (95% CI 1.09, 2.28), respectively. CONCLUSION: The study showed an increase in preterm and post-term pregnancies after induced abortions. The risk of post-term delivery was high regardless of the interpregnancy interval, whereas increased risk of preterm delivery was seen mainly when interpregnancy intervals were longer than 12 months.     

The course of pregnancy following spontaneous abortion

With the aim of being able to advise women concerning a recommended interval between spontaneous abortion and a new pregnancy, the course of pregnancies following spontaneous abortion was studied. Nineteen women conceived within the first 12 weeks. There were no abortions, and 18 pregnancies proceeded normally. Thirty women conceived between 12 and 26 weeks, 29 pregnancies proceeded normally, and none aborted. Forty-two women conceived later than 26 weeks after the abortion. Seven pregnancies terminated in abortion, and 30 proceeded normally. We found no reason to advise women to postpone a new conception after spontaneous abortion.     

Spontaneous abortion: a prospective cohort study of younger women from the general population in Denmark. Validation, occurrence and risk determinants

OBJECTIVE: To assess the occurrence of spontaneous abortion, comparing two different data sources. To estimate the rate of spontaneous abortion over a 2-year period, and examine potential predictors of the risk for incident spontaneous abortion. METHODS: We used interview data from a population-based prospective cohort study comprising 11,088 women and data from a linkage of the cohort with the Hospital Discharge Register to compare spontaneous abortions as reported in the interview with those identified in the register. Based on interview data, we estimated the rate of spontaneous abortion during the two-year follow-up. Finally, risk determinants for incident spontaneous abortion were analyzed by means of logistic regression. RESULTS: A total of 654 spontaneous abortions before enrolment in the study were reported by the women compared to 531 abortions found in the register. More than 80% of the spontaneous abortions identified from both sources were recorded in the same year. During follow-up a total of 20.9% of pregnancies intended to be carried to term ended as a spontaneous abortion. In the risk factor analysis, we found that previous spontaneous abortion, being single, never having used oral contraceptives, and use of intrauterine device were associated with increased risk of subsequent spontaneous abortion. In addition, it was indicated that a short interpregnancy interval following a spontaneous abortion may confer an increased risk of abortion in the subsequent pregnancy. CONCLUSION: We found a high rate of spontaneous abortion in the present study and an acceptable agreement between information obtained by interview and register information. More than 25% of the spontaneous abortions were only reported by the women, and this could not be explained by erroneously reported induced abortions, and may be early, nonhospitalized abortions. We confirm that number of previous spontaneous abortions is a strong determinant, and our data may also indicate a role of previous contraceptive habits. A role of the length of interpregnancy interval in the risk of spontaneous abortion cannot be ruled out.     

Elevated maternal glycohemoglobin in early pregnancy and spontaneous abortion among insulin-dependent diabetic women

Insulin-dependent diabetic women without adequate glucose control have a higher rate of spontaneous abortions than does the general population of pregnant women. The present study examined whether insulin-dependent diabetic women who experienced spontaneous abortions had higher levels of glycohemoglobin in the first trimester than did insulin-dependent diabetic women who had normal pregnancy outcomes. Measurement of glycohemoglobin during the first trimester provides an integrated, retrospective index of glucose control during the phase of organogenesis. This study evaluated 116 pregnancies in 75 insulin-dependent diabetic women. Ninety pregnancies progressed beyond 20 weeks, with normal outcome. Twenty-six pregnancies terminated in spontaneous abortions before 20 weeks. The mean gestational ages for sampling of glycohemoglobin for the women who experienced spontaneous abortion and those for the women with pregnancies of more than 20 weeks were not significantly different. The mean level of glycohemoglobin for the women who experienced spontaneous abortions was significantly greater than that for the women with pregnancies of more than 20 weeks (p less than 0.05). Individual levels of glycohemoglobin of less than 12% at 8 to 9 weeks' gestation were associated with favorable outcomes, whereas levels of glycohemoglobin of more than 12% were predictive of a greater incidence of spontaneous abortions (p less than 0.05). These data suggest that the poorly controlled pregnant diabetic patient, as reflected by high levels of glycohemoglobin early in pregnancy, has an increased risk of spontaneous abortion.     

Induced abortion and duration of third stage labour in a subsequent pregnancy.

We set out to evaluate the impact of first trimester induced abortion on the duration of third stage labour and related complications in a subsequent pregnancy. The study was conducted in Shanghai city at 15 general hospitals (or maternity and infant health institutes) from November 1993 to March 1998. We identified all nulliparae who came for antenatal care within the first 63 days of pregnancy (2953); the women were divided into two cohorts according to their previous history of first trimester induced abortion. After enrollment, the women were interviewed five times from recruitment until 42 days after delivery. We included in the study all 1363 women who had a singleton vaginal live birth. Of these women, 703 were primigravida (non-exposed), 534 had had one previous first trimester induced abortion, and 126 women had had two or more first trimester induced abortions. The duration of third stage labour in minutes was longer in women with one or more previous induced abortions (mean=7.32 minutes) compared with primigravid women (mean=6.79 minutes). Prolonged third stage labour (>30 minutes) following one or more induced abortions was seen for 3.4% versus 1.0% in primigravid women. After adjusting for a number of potential confounders, women with one or more previous first trimester induced abortions had an odds ratio of prolonged third stage labour of 2.59 (95%C.I.=1.06-6.37) compared with primigravida, especially after an interpregnancy interval of more than 6 months (OR=3.24, 95%C.I.=1.29-8.13). The odds ratio of prolonged third stage labour was 3.14 (95%C.I.=1.22-8.09) if gestational age at the time of the induced abortion exceeded 49 days. Women with a first trimester induced abortion had no significantly increased risk of postpartum haemorrhage or retained placenta. It was concluded that a history of one or more first trimester induced abortions was related to an increased risk of prolonged third stage labour in the following pregnancy, particularly if the induced abortion was performed after 49 days of gestation.     

Spontaneous abortion and interpregnancy interval

Analysis of 8972 pregnancies and 5089 interpregnancy intervals, computer-registered over 12 years at the Haguenau Hospital Maternity Department, showed that the length of interpregnancy interval may be considered as a risk factor in spontaneous abortion; this was still true after other important known risk factors, i.e. maternal age, parity, previous spontaneous abortion and contraceptive practice, had been taken into account. However, separate analysis of pregnancies according to whether they occur more or less than 1 year after contraception (if used) had been stopped showed that the relationship between a long interval and spontaneous abortion was only significant for subfertile women who took longer than 1 year to conceive. This supports the hypothesis that the same mechanism is involved in the aetiologies of spontaneous abortion and of difficulty in conceiving.     

Reproductive performance in the next pregnancy for nulliparous women with history of first trimester spontaneous abortion

Objective

To determine whether interpregnancy interval after the first spontaneous abortion has an effect on reproductive performance of women in their next pregnancy.

Method

A prospective cohort study was conducted on 4,619 women with history of spontaneous abortion in their first pregnancy. Of them 2,422 (52.4 %) conceived within 6 months of the miscarriage (group A) and 2,197 47.6 % after 12 months (group B). The primary outcome was abortion, live birth, termination, or ectopic pregnancy in the next pregnancy. Secondary outcomes were preterm delivery, low birth weight infants, caesarean section rate and occurrence of preeclampsia, placental abruption and induced labour in the second pregnancy.

Results

Women who conceived again within 6 months were less likely to have another abortion, termination, or ectopic pregnancy compared with women with interpregnancy interval more than 12 months. Women with an interpregnancy interval more than 12 months were less likely to have live birth in the second pregnancy and more likely to have a caesarean section, preterm delivery, or infant of low birth weight compared with women who conceived again within 6 months.

Conclusions

Women who conceive within 6 months after their first spontaneous abortion have better reproductive outcomes and the lowest complication rates in their subsequent pregnancy.     

A prospective study of maternal smoking and spontaneous abortion

BACKGROUND: Cigarette smoking has been considered a risk factor for spontaneous abortion, but conclusions from many studies may be impaired by methodological problems. Studies are required that use data on smoking habits collected before knowledge about outcome of pregnancy and in which adjustment is made for potential confounders. METHODS: All Danish-speaking pregnant women booking for delivery at the Department of Obstetrics and Gynecology, Aarhus University Hospital, from September 1989 to August 1996 were invited to participate in the study (n=24,608 pregnancies, including 321 spontaneous abortions and 100 induced abortions). Information about smoking habits before pregnancy and during the first trimester was obtained from self-administered questionnaires before the knowledge about pregnancy outcome. Information about spontaneous and induced abortions was obtained from the Danish National Patient Registry. We used Cox regression analyses with delayed entry (left truncation) for analyses, and hazard ratios to express the association between smoking and spontaneous abortion. Multivariate analyses were performed using a model including alcohol and coffee intake during pregnancy, maternal age, marital status, occupation, education, prepregnancy body mass index, and parity. RESULTS: Overall, 104 (1.3%) of those contributing time at risk in the first trimester experienced a spontaneous abortion in the first trimester, and 217 (0.9%) of those contributing time at risk in the second trimester experienced a second-trimester abortion. We found no association between smoking and first- and second-trimester abortions. Adjustment for alcohol, coffee, maternal age, marital status, occupation, education, prepregnancy body mass index and parity did not change the result substantially. CONCLUSION: Our study did not support findings from previous studies of an association between smoking and spontaneous abortion.     

Impact of abortion on subsequent fecundity

The impact of abortion on subsequent fecundity has been extensively studied, especially since abortion was legalized in Eastern Europe during the 1950s and 1960s and in Western Europe and the USA during the 1960s and 1970s. A review of this literature reveals a number of consistent findings. First, women who choose to have their first pregnancy terminated are at no increased risk of failing to conceive at a later date. Exceptions include abortions complicated by infection leading to pelvic inflammatory disease (PID). However, this combination of factors occurs very infrequently. Second, women whose first pregnancy is terminated by vacuum aspiration are at no increased risk of subsequent ectopic pregnancy. Exceptions may be women whose abortion is complicated by pre-existing C. trachomatis and others who experience post-abortion infection leading to PID. Third, women whose first pregnancy is terminated by vacuum aspiration are at no increased risk of subsequent mid-trimester spontaneous abortion, preterm delivery or low birthweight, when compared with women who are pregnant for the first time. Fourth, women whose first pregnancy is terminated by D&C may have an increased risk of subsequent ectopic pregnancy, mid-trimester spontaneous abortion and low birthweight. Fifth, more research is needed before it is clear whether multiple induced abortions carry an increased risk of adverse pregnancy outcomes. Finally, too little is known about fecundity following mid-trimester abortion procedures to state definitively that they carry no increased risk of adverse outcomes. However, studies to date suggest that instillation procedures carry little, if any, excess risk. Risks related to dilation and evacuation, if any, may be related to the method and extent of cervical dilation.     

Frequency of spontaneous abortion and premature birth after acute mumps infection in pregnancy

OBJECTIVE: Since mumps infection is endemic, the occurrence of acute mumps infection during pregnancy is rare. As a result, data on the possible negative consequences of acute mumps infection on pregnancy outcome are limited. PATIENTS AND METHODS: The clinical diagnosis of acute mumps infection was serologically confirmed in 79 pregnant women between January 1985 and December 2002. Data on pregnancy outcome were obtained from the gynaecologist or obstetrician. Cord blood from 26 of the 57 live-born infants was investigated for mumps-specific IgM and IgG antibodies by enzyme-linked immunoassay. RESULTS: Sixty-two patients were prospectively followed up with respect to pregnancy outcome. Two of the 62 pregnancies were electively terminated. The overall rate of fetal loss was 6.6% (4/60). Only 2 cases of spontaneous abortion occurred during the first trimester. However, all 4 spontaneous abortions occurred in women who had contracted mumps infection during the first trimester. The time interval between mumps infection and fetal loss varied widely. The median gestational age at delivery was 40 weeks.Only 2 of the 57 live-born infants (3.5%) were delivered before completion of the 37th week of pregnancy. Mumps-specific IgM anti-bodies were not detected in any of the 26 cord blood samples tested. CONCLUSION: The lack of mumps-specific antibodies in the cord blood samples tested suggests that prenatal mumps infection did not occur. The frequency of premature birth and spontaneous abortion following mumps infection in pregnancy does not appear to be increased over normal levels.     

Influence of pregnancy outcome on subsequent pregnancy

In this study to determine the harmful effect of abnormal pregnancy outcome on the immediately following pregnancy, 573 recently delivered women (with 2347 pregnancies) were interviewed. Data were recorded on their pregnancy outcomes (normal, abortion, stillbirth and congenital malformation), as well as on their interpregnancy intervals. A significant difference was found between the chances of having a spontaneous abortion following a normal outcome (5.5%) against that following a spontaneous abortion (31.1%). Also, the chances of a normal outcome following a normal outcome were 92.4%, compared with 63.9% following a spontaneous abortion. The delivery of a malformed baby is associated with a larger proportion of abortion and congenital malformation in the subsequent pregnancy, while stillbirth was followed by a larger proportion of abortion and stillbirth. A longer interpregnancy interval did not appear to have any protective effect on the subsequent pregnancy.     

Low birth weight subsequent to induced abortion. A historical prospective study of 948 women in Skopje, Yugoslavia.

In the fall of 1972, interviews were conducted with 948 Yugoslavian women whose first pregnancies had been terminated by induced abortion (222) or delivery (726) during 1968-1969. Subjects were indentified from records of the Obstetrics and Gynecology Clinic of Skopje University, Macedonia. Subsequent pregnancies were studied to determine the relative effects of first-pregnancy abortion or delivery on incidences of adverse outcomes. No significant difference were found between first-pregnancy aborters and deliverers for subsequent conception rates, spontaneous abortions, or low-birth-weight rates. The data suggest that while induced abortion of the first pregnancy did not protect against the greater risk of low birth weight for a primiparous birth, neither did it increase that risk. The high proportion of women who denied their abortion raises questions about results of retrospective abortion studies which depend on patient recall.     

Ectopic pregnancy concurrent with induced abortion: incidence and mortality

From 1972 through 1985, 24 women who underwent an induced abortion died as a result of a concurrent ectopic pregnancy. We analyzed data from the Joint Program for the Study of Abortion, National Hospital Discharge Survey, and the Centers for Disease Control Ectopic Pregnancy and Abortion Surveillance Systems to determine the incidence and mortality of ectopic pregnancy concurrent with induced abortion. During the period 1971 through 1985, the incidence of ectopic pregnancy concurrent with induced abortions was 1.35/1000 induced abortions, compared with 13.6/1000 pregnancies not terminated by induced or spontaneous abortion. The rate was higher among women who obtained abortions at earlier gestational age and among older women. The death-to-case rate for ectopic pregnancies concurrent with induced abortion was 1.3 times higher than that for women not undergoing abortion. Most of the deaths of women with ectopic pregnancy who underwent induced abortion were attributable to the failure to diagnose the ectopic pregnancy before the woman left the facility where the abortion was performed. Such deaths could be prevented by the provider of the abortion assuring that the tissue is examined for products of conception at the time of the abortion.     

Macroscopic and microscopic morphology of first trimester miscarriage and subsequent pregnancy outcome - An exploratory study

IntroductionReduced chorionic villous vascularization is associated with first trimester miscarriage and second trimester fetal loss. Differences in villous vascularization have been observed in combination with complications in the third trimester of pregnancy. The aim of this study was to investigate whether abnormal morphology and reduced chorionic villous vascularization in first trimester miscarriages are associated with an increased risk on adverse outcome and/or pregnancy complications in subsequent pregnancy. Secondly, to assess the influence of these parameters on the length of the interpregnancy interval and infertility.MethodsIn a retrospective cohort study 134 consecutive women who underwent dilatation and curettage for a miscarriage were included. The degree of chorionic villous vascularization in miscarriage tissue was determined by a pathologist. Ultrasound details of these miscarriages and clinical data on the subsequent pregnancy of these women were obtained.ResultsNeither reduced vascularization nor early embryonic arrest in first trimester miscarriages are associated with an increased risk of a subsequent miscarriage or adverse obstetric and perinatal outcome of subsequent pregnancy. Abnormal morphology of the first trimester miscarriage did not influence the time to subsequent pregnancy. A shorter mean interpregnancy interval between miscarriages was observed after miscarriages with reduced chorionic villous vascularization (5.5 vs. 10.7 months; p = 0.051), showing a trend towards an association.DiscussionChorionic villous vascularization and morphology have no influence on subsequent pregnancy outcome. Therefore it remains unknown what aspects of miscarriage are causing the increased risk on subsequent miscarriage and complications in the third trimester of the subsequent pregnancy.     

Risk of a second consecutive first-trimester spontaneous abortion in women who conceive with menotropins

It is generally recognized that a spontaneous abortion rate of approximately 25% exists in human menopausal gonadotropin/human chorionic gonadotropin (hMG/hCG)-induced pregnancies. Despite this, little is known regarding the prognosis of future menotropin-induced pregnancies in women who abort in their first hMG pregnancy. We retrospectively reviewed the obstetrical outcome of women who achieved two or more menotropin pregnancies between the years 1980 and 1987. Nineteen of 40 patients (48%) whose first hMG pregnancy ended in an early spontaneous abortion went on to abort in a second hMG pregnancy, as compared with only 1 of 15 women (6.7%) whose first hMG pregnancy was successful. Age, parity, weight, height, and plasma estradiol levels at hCG administration did not differ between the two groups. From this data we conclude that women whose first hMG pregnancy results in a spontaneous abortion are at high risk for another spontaneous abortion in a subsequent menotropin conception.     

Ectopic pregnancy and recurrent spontaneous abortion: two associated reproductive failures

The association between spontaneous abortion and ectopic pregnancy was evaluated in a case-control study conducted on 161 women (cases) with recurrent spontaneous abortions (two or more consecutive spontaneous abortions) and 170 control subjects who delivered normal infants. The risk of ectopic pregnancy in women with a history of recurrent spontaneous abortion was about fourfold that of controls (relative risk adjusted for age and number of pregnancies = 4.3; 95% confidence interval 1.4-14.7). This association was confirmed by comparing the observed number of extrauterine pregnancies in women with recurrent spontaneous abortions with the expected number computed from regional data on the frequency of ectopic pregnancies; the estimated relative risk was 3.7, with a 95% confidence interval of 2.2-7.0. The present report found an association between spontaneous abortions and ectopic pregnancies, suggesting some common risk/etiologic factors for these two reproductive failures.     

Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study

Objective

Previous studies have shown that pregnancy loss may affect the mental health of women in subsequent pregnancies. The China Anhui Birth Defects and Child Development cohort study therefore aimed to investigate the influence of pregnancy loss on anxiety and depression in subsequent pregnancies.

Study design

In total, 20,308 pregnant women provided written informed consent and completed the study questionnaire. The Self-rating Anxiety Scale and Center for Epidemiologic Studies–Depression Scale were used to evaluate anxiety and depression in pregnant women. Pearson's χ² test and binary logistic regression were used for statistical analyses.

Results

Of 20,308 pregnant women, 1495 (7.36%) had a history of miscarriage and 7686 (37.85%) had a history of induced abortion. The binary logistic regression model found that pregnant women with a history of miscarriage had a significantly higher risk of anxiety and depression in the first trimester than primigravidae after stratified analysis according to the timing of the first prenatal visit (p < 0.05). Compared with pregnant women with no history of miscarriage, women who had a history of miscarriage and an interpregnancy interval of less than 6 months had increased risk of anxiety symptoms (p < 0.05) and depression symptoms (p < 0.05) during the first trimester. Women with an interpregnancy interval of 7–12 months had a 2.511-fold higher risk of depression (p < 0.05) than women with no history of miscarriage. These findings were not changed after adjustment for maternal age, maternal education, family income, place of residence and pre-pregnancy body mass index.

Conclusions

Women with a history of miscarriage experienced significant anxiety and depression during their next pregnancy. A short interpregnancy interval and the first trimester are risk factors for adverse mental health.     

Are complications after an induced abortion associated with reproductive failures in a subsequent pregnancy?

BACKGROUND: We have previously shown that induced abortions result in a slightly increased risk of spontaneous abortion and preterm delivery in subsequent pregnancies. Danish records show that approximately 4% of women who undergo surgically induced abortions have complications related to the procedure. We examined whether it was women who had the short-term complications that carried an excess risk of spontaneous abortion and preterm delivery in the subsequent pregnancy. METHODS: Two cohorts of women who had had an induced abortion and a subsequent pregnancy were followed. The cohort with no reported complications comprised 12,972 women, and the cohort with complications 605 women. RESULTS: The cohort with complications did not have more spontaneous abortions or preterm births. They did, however, have a higher risk of stillbirth, mainly seen in women whose induced abortion had been complicated by an infection. CONCLUSION: Most of the women who had had an induced abortion with reported complications did, however, carry a subsequent pregnancy to term with no more complications than other women of similar parity and age.     

Maternal smoking predicts the risk of spontaneous abortion

BACKGROUND: Few studies have examined smoking prior to pregnancy and the occurrence of spontaneous abortion, as most studies have addressed the risk of spontaneous abortion in relation to smoking during pregnancy. However, results are not entirely consistent. The aim of the present study was to assess the risk of spontaneous abortion considering smoking prior to pregnancy. METHODS: We performed a nested case-control study using prospective data from a population-based cohort comprising 11,088 women aged 20-29 years. From this cohort, women who experienced either a spontaneous abortion (n=343) or who gave birth (n=1,578) during follow-up were selected. Associations between self-reported smoking at enrollment and subsequent spontaneous abortion were analyzed by means of multiple logistic regression. RESULTS: The risk of spontaneous abortion in relation to pre-pregnancy smoking showed a clear dose-response effect. The adjusted odds ratio (95% confidence interval) for spontaneous abortion among current smokers prior to conception was 1.20 (1.04-1.39) per every extra five cigarettes smoked per day. The increased risk was only present for current smokers. The duration of smoking prior to pregnancy was not a significant predictor for subsequent spontaneous abortion. CONCLUSIONS: The amount of daily smoking prior to pregnancy seems to be associated with an increased risk of spontaneous abortion, whereas the duration of smoking does not seem to be related to an increased risk of spontaneous abortion.