Previous obstetric history and subsequent preterm delivery in Greece

doi:10.1016/0028-2243(90)90103-8

European Journal of Obstetrics & Gynecology and Reproductive Biology

Volume 37, Issue 2, November 1990, Pages 99-109

https://doi.org/10.1016/0028-2243(90)90103-8 Get rights and content

Abstract

A total population sample of 6524 multigravid women who were certain of the date of their last menstrual period was obtained from the population-based Greek National Perinatal Survey of April 1983. The sample was used to determine the associations between features of the maternal obstetric history and preterm delivery.

There were significant associations between preterm delivery and previous fetal losses, whether early (miscarriages and/or induced abortions) or late (stillbirths). For mothers who had experienced miscarriage(s), induced abortion(s) or stillbirth(s) the odds ratios were 1.40, 1.36 and 1.15, respectively, compared with mothers without any fetal loss. The odds ratio increased substantially with the increasing number of losses and reached 5.60 for the small group of mothers who had had prior miscarriage, termination and stillbirths. The results changed very little when the socioeconomic characteristics of the family were taken into account.

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Cited by (11)

Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: A systematic review and metaanalysis
2016, American Journal of Obstetrics and Gynecology
Citation Excerpt :
In the overall population, women with a history of uterine evacuation for either I-TOP or SAB had a significantly higher risk of PTB (5.7% vs 5.0%; OR, 1.44, 95% CI, 1.09–1.90; Figure 4A; 34 studies, 1,031,320 women), low birthweight (7.3% vs 5.9%; OR, 1.41, 95% CI, 1.22–1.62; Figure 4B; 11 studies, 675,197 women), and small for gestational age (10.2% vs 9.0%; OR, 1.19, 95% CI, 1.01–1.42; Figure 4C; 3 studies, 43,411 women) compared with controls (ie, women without a history of uterine evacuation). Of the 31 studies reporting data regarding I-TOP, 28 included 913,297 women with a history of surgical I-TOP,16-33,35-39,41,44-47 whereas 3 included 10,253 women with a prior medical I-TOP (Tables 2 and 3).48-50 Women with a history of uterine evacuation for I-TOP had a significantly higher risk of PTB (5.5% vs 4.4%; OR, 1.52, 95% CI, 1.09–2.13; Figure 5A, 29 studies, 907,187 women), low birthweight (7.3% vs 5.9%; OR, 1.41, 95% CI, 1.22–1.62; Figure 5B; 11 studies, 675,197 women), and small for gestational age (10.2% vs 9.0%; OR, 1.19, 95% CI, 1.01–1.42; Figure 5C; 3 studies, 43,411 women) compared with controls (ie, women without history of uterine evacuation for I-TOP).
Preterm birth (PTB) is the number one cause of perinatal mortality. Prior surgery on the cervix is associated with an increased risk of PTB. History of uterine evacuation, by either induced termination of pregnancy (I-TOP) or spontaneous abortion (SAB), which involve mechanical and/or osmotic dilatation of the cervix, has been associated with an increased risk of PTB in some studies but not in others.
The objective of the study was to evaluate the risk of PTB among women with a history of uterine evacuation for I-TOP or SAB.
Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, and Sciencedirect) were searched from their inception until January 2015 with no limit for language.
We included all studies of women with prior uterine evacuation for either I-TOP or SAB, compared with a control group without a history of uterine evacuation, which reported data about the subsequent pregnancy.
The primary outcome was the incidence of PTB < 37 weeks. Secondary outcomes were incidence of low birthweight (LBW) and small for gestational age (SGA). We planned to assess the primary and the secondary outcomes in the overall population as well as in studies on I-TOP and SAB separately. The pooled results were reported as odds ratio (OR) with 95% confidence interval (CI).
We included 36 studies in this metaanalysis (1,047,683 women). Thirty-one studies reported data about prior uterine evacuation for I-TOP, whereas 5 studies reported data for SAB. In the overall population, women with a history of uterine evacuation for either I-TOP or SAB had a significantly higher risk of PTB (5.7% vs 5.0%; OR, 1.44, 95% CI, 1.09–1.90), LBW (7.3% vs 5.9%; OR, 1.41, 95% CI, 1.22–1.62), and SGA (10.2% vs 9.0%; OR, 1.19, 95% CI, 1.01–1.42) compared with controls. Of the 31 studies on I-TOP, 28 included 913,297 women with a history of surgical I-TOP, whereas 3 included 10,253 women with a prior medical I-TOP. Women with a prior surgical I-TOP had a significantly higher risk of PTB (5.4% vs 4.4%; OR, 1.52, 95% CI, 1.08–2.16), LBW (7.3% vs 5.9%; OR, 1.41, 95% CI, 1.22–1.62), and SGA (10.2% vs 9.0%; OR, 1.19, 95% CI, 1.01–1.42) compared with controls. Women with a prior medical I-TOP had a similar risk of PTB compared with those who did not have a history of I-TOP (28.2% vs 29.5%; OR, 1.50, 95% CI, 1.00–2.25). Five studies, including 124,133 women, reported data about a subsequent pregnancy in women with a prior SAB. In all of the included studies, the SAB was surgically managed. Women with a prior surgical SAB had a higher risk of PTB compared with those who did not have a history of SAB (9.4% vs 8.6%; OR, 1.19, 95% CI, 1.03–1.37).
Prior surgical uterine evacuation for either I-TOP or SAB is an independent risk factor for PTB. These data warrant caution in the use of surgical uterine evacuation and should encourage safer surgical techniques as well as medical methods.
Previous pregnancy loss: Risks related to severity of preterm delivery
2004, American Journal of Obstetrics and Gynecology
The purpose of this study was to examine the association between previous pregnancy losses and subsequent risk of preterm delivery.
A population-based Swedish study including information on all births and womens' hospital admissions for pregnancy loss (n = 601,883) in Sweden between 1987 and 2000 was performed. The risk of preterm delivery after a previous pregnancy loss was estimated using logistic regression models. The risk of preterm premature ruptures of the membranes (PROM), preterm labor, and other reasons for preterm delivery was also assessed.
Previous spontaneous abortions and missed abortions were associated with increased risks of preterm delivery, and the risks increased with severity of preterm delivery. Previous pregnancy loss increased the risk of preterm PROM and preterm labor foremost in deliveries before 32 weeks, but was not associated with other reasons of very preterm delivery.
Our results support the hypothesis that pregnancy loss and early preterm delivery may share etiologic causes.
Induced abortion and subsequent pregnancy duration
1999, Obstetrics and Gynecology
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.
Infant mortality and the risk of small size for gestational age in the subsequent pregnancy: A retrospective cohort study
2013, Maternal and Child Health Journal
Reproductive outcomes following induced abortion: A national register-based cohort study in Scotland
2012, BMJ Open
Infant mortality and subsequent risk of stillbirth: A retrospective cohort study
2011, BJOG: An International Journal of Obstetrics and Gynaecology

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Regular paperPrevious obstetric history and subsequent preterm delivery in Greece

Abstract

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Acta Obstet Gynaecol Jap

The effect of spontaneous and induced abortions on prematurity and birthweight

J Obstet Gynaecol Br Commonw

Pregnancy complications following legally induced abortion: an analysis of the population with special reference to prematurity

Dan Med Bull

Risks of preterm delivery and small for gestational age infants following abortion: a population study

Br J Obstet Gynaecol

The relationship between artificial termination of pregnancy and abortion or premature birth

Association of induced abortion with subsequent pregnancy loss

JAMA

Effects of legal termination on subsequent pregnancy

Br Med J

A prospective study of spontaneous fetal losses after induced abortions

New Eng J Med

The effects of induced abortion on subsequent reproduction

Epidemiol Rev

Gestation, birthweight and spontaneous abortion in pregnancy after induced abortions

Lancet

The Greek National Perinatal Survey: I. Design, methodology, case ascertainment

Paediatr Perinatal Epidemiol

Regular paper
Previous obstetric history and subsequent preterm delivery in Greece