Effects of mid-trimester induced abortion on the subsequent pregnancy

The outcome of the pregnancy following (a) a mid-trimester termination of pregnancy (TOP) for fetal neural tube defect (NTD) (77 women = group 1); (b) mid-trimester TOP for fetal Down's syndrome (13 women = group 2); (c) delivery of a baby with NTD (119 women = group 3) was studied. The prenatal fetal loss was relatively high in all groups. In group 1 it was similar to that found in other studies after first trimester TOP, in group 2 it was associated with advanced maternal age and the unexpected finding in group 3 was not attributable to advanced maternal age. It is suggested that a previous NTD per se might increase the risk of fetal loss in the next pregnancy. A previous mid-trimester TOP for NTD was not associated with an increase in premature labour, small for dates babies or congenital abnormality in the next pregnancy, but there was a slight increase in the number of babies weighing less than 2500 g.     

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.     

The effect of induced abortion on subsequent pregnancy outcome.

OBJECTIVE--To investigate the effect of induced abortion on the outcome of the next pregnancy. DESIGN--Long-term prospective controlled cohort study. SETTING--Joint Royal College of General Practitioners/Royal College of Obstetricians and Gynaecologists study based in general practice in England, Scotland and Wales. SUBJECTS--1311 women whose recruitment pregnancy had ended in induced abortion (the abortion group) and 2131 women whose recruitment pregnancy had a natural conclusion (the non-abortion group). MAIN OUTCOME MEASURES--Non-viable outcome (spontaneous or missed miscarriage, ectopic pregnancy or stillbirth), birthweight, length of gestation. RESULTS--Induced abortion was not materially associated with any of the three measures of adverse outcome. Compared with the non-abortion group the relative risk of a non-viable outcome in the abortion group was 1.01 (95% CI 0.81 to 1.27). In the abortion group birthweight was an average 23 g lighter (95% CI -76 g to + 30 g) and length of gestation an average 0.9 days shorter (95% CI -2.2 days to + 0.4 days) than in the non-abortion group. Women who had their abortions in NHS premises had an increased risk of a non-viable outcome (RR 2.55, 95% CI 1.31 to 4.94) and had babies with significantly lower mean birthweight (-119 g, 95% CI -233 g to +5 g) compared with those who obtained their operations in the private sector. Women whose abortion had been carried out by a consultant had the lowest risk of non-viable outcome. Although these differences remained after adjustment for a number of important variables, it is possible that factors not measured in the present study, such as economic status and occupation, played a contributory role. CONCLUSION--Overall, induced abortion was not associated with any important effect on the three measures of adverse outcome in the subsequent pregnancy.     

Previous history of surgically induced abortion and complications of the third stage of labour in subsequent normal vaginal deliveries

Objective. To estimate the risk of complications of the third stage of labour needing manual revision of uterine cavity or curettage in deliveries following one or multiple induced abortions in nulliparous women who had singleton live births in Estonia in 1994–2002.

Methods. Registry study using the data from the Estonian medical birth registry: 32,652 women had not had any abortions, 7333 women had had one and 2383 women had had two or more surgically induced abortions before their first delivery. Multiple logistic regression analysis was performed to estimate crude odds ratios (OR), adjusted ORs and their 95% confidence intervals, with women having had no abortions as the reference group. Adjustment was made for maternal age, sex and weight of infant, labour induction/augmentation.

Results. In the single abortion group, the crude OR was 1.25 (95% confidence intervals (CI) 1.12–1.40), the adjusted OR was 1.23 (95% CI 1.10–1.38); in the multiple abortion group the crude OR was 1.28 (95% CI 1.06–1.53), the adjusted OR was 1.24 (95% CI 1.03–1.49).

Conclusions. Our findings suggest a positive association between one or more first trimester abortion(s) and the risk of complications in the third stage of labour in subsequent singleton delivery.     

Effects of different doses of intraumbilical oxytocin on the third stage of labor

ObjectiveTo determine the optimal dose of oxytocin to be injected intraumbilically after fetal delivery for active management of the third stage of labor.MethodsA prospective randomized study was carried out with 125 primigravidas to compare the duration of the third stage of labor following the intraumbilical administration of 50 mL of a normal saline solution alone (in a control group), or with 10 IU, 20 IU, or 30 IU of oxytocin. The volumes of blood lost were also compared.ResultsCompared with the control group, the duration of the third stage of labor was significantly reduced in the 3 study groups (P < 0.001), and the maximum reduction was in the group that received 30 IU of oxytocin. Blood loss and hematocrit values followed the same pattern.ConclusionAdministering 30 IU of oxytocin intraumbilically in 50 mL of a normal saline solution after fetal delivery is a simple, noninvasive, and effective method for active management of the third stage of labor.     

Management of the third stage of labor

Management of the third stage of labor has been an issue of discussion, concern, and continued debate for the past two decades. Despite the many strategies employed and the divergent approaches to care and philosophies espoused, there has not been a significant, consistent reduction in the postpartum hemorrhage rates reported in industrialized countries in recent times. This article explores the strategies that have been and are currently being used in an effort to reduce the risk of postpartum hemorrhage.     

Oral misoprostol in the third stage of labor.

OBJECTIVE: To compare the efficacy of intravenous ergometrine, intramuscular oxytocin, and oral misoprostol in the control of postpartum hemorrhage. METHODS: Mean blood loss, rates of blood loss between 500 and 1000 ml, hematocrit fall greater than 10%, and need for additional oxytocic agents and nature and rates of adverse effects were assessed in this prospective, randomized, controlled study. RESULTS: All outcomes were similar in the 3 groups. The main adverse effects in the misoprostol group were temperatures higher than 99 degrees F, which normalized within 2 h and shivering, which was mild and self-limiting. CONCLUSIONS: Oral misoprostol is as effective as conventional oxytocic agents in preventing postpartum hemorrhage and can be recommended for use in low-resource settings.     

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.     

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.     

药物流产对再次妊娠孕产期及新生儿的影响

目的:探讨药物流产对再次妊娠的影响。方法:采用回顾性研究,分析年龄在23-33岁有药流史再次妊娠的健康妇女138例和无流产史的健康妊娠妇女91例,对孕期(妊娠反应、妊娠贫血、前置胎盘、胎盘早剥、妊高症、胎儿窘迫、羊水异常)、产时(产后出血、第三产程>15min、产钳、剖腹产)以及新生儿的各种情况进行比较。结果:药物流产组与无流产组孕产期及新生儿各项情况均无显著性差异(P>0.05)。结论:药物流产对再次妊娠孕产期及新生儿无明显不良影响,是一种安全、方便、有效的避孕失败补救措施。