Transactions of the Twenty-Fifth Annual Meeting of the Society for Maternal-Fetal Medicine
Obstetric outcomes after surgical abortion at ≥20 weeks' gestation

https://doi.org/10.1016/j.ajog.2005.05.078Get rights and content

Objective

The purpose of this study was to describe obstetric outcomes after surgical abortion at ≥20 weeks, and to identify risk factors for subsequent spontaneous preterm birth.

Study design

Patients who had surgical abortion at ≥20 weeks' gestation from 1996 to 2003 and received subsequent prenatal care at The New York Weill Cornell Medical Center were identified. Indication for abortion, operative technique, and subsequent pregnancy outcomes were reviewed. Student t test, Fisher exact test, and Mann-Whitney U were used where appropriate.

Results

One hundred and twenty pregnancies in 89 women were identified. Thirteen (10.8%) ended with early miscarriage, and 5 were electively terminated. Of the remaining 102 pregnancies, 7 ended with spontaneous preterm birth. Those who experienced preterm birth were more likely to have undergone abortion due to cervical dilation and/or preterm premature rupture of membranes (PPROM) (27.3% vs 4.4%; P = .03). Those with a multifetal pregnancy in the subsequent pregnancy were more likely to have preterm birth (75.0% vs 4.3%; P < .001). In patients who underwent dilation and evacuation (D&E) for reasons other than cervical dilation and/or PPROM, rates of spontaneous preterm birth were identical between those who had intact dilation and extraction (D&X) and D&E using forceps (4.2% vs 4.5%; P = 1.0).

Conclusion

In those who have undergone D&E at ≥20 weeks, only a history of midtrimester cervical dilation and/or PPROM or a current multifetal pregnancy were associated with spontaneous preterm birth.

Section snippets

Material and methods

Patients who underwent dilation and evacuation at our hospital at ≥20 weeks' gestation from 1996 to 2003, and who received subsequent prenatal care at The New York Weill Cornell Medical Center were identified by searching computerized hospital records using the appropriate procedure codes. Gestational age had been confirmed by ultrasound in all cases. Medical records were reviewed to collect data about the terminated pregnancies, including the technique of surgical abortion, and the outcomes of

Results

There were 120 pregnancies in 89 women included in the study. These pregnancies were identified from a group of 383 patients who underwent surgical abortion at ≥20 weeks' gestation from 1996 to 2003. The outcomes of 62 of these pregnancies were briefly summarized in a previous publication that focused on operative techniques of surgical abortion late in the second trimester.7

The median maternal age at the time of surgical abortion was 33 years (interquartile range 29-37 years), and the median

Comment

D&E is the most common procedure used to terminate a pregnancy in the second trimester in the United States. Lower complication rates have been described for D&E compared with medical induction.1, 2 D&E may also be preferable to some patients because it is typically done on an outpatient basis, and women do not have to endure labor. When Grimes et al attempted to perform a randomized clinical trial to compare D&E with medical induction using misoprostol and mifepristone, most women did not

References (11)

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Cited by (16)

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  • Is induced abortion with misoprostol a risk factor for late abortion or preterm delivery in subsequent pregnancies?

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    Second trimester surgical abortions that use dilatation and evacuation may be associated with a higher risk of subsequent premature delivery [22,23]. Uncontrolled and small series [24–27] suggest, however, that this method is not a risk factor for midtrimester pregnancy loss or spontaneous preterm birth. These conflicting results can be at least partly explained by differences or weaknesses in their methods, including their use of registries or databases, small series with a consequent lack of power, retrospective studies, absence of a control group, heterogeneity in abortion techniques, differences in gestational age at abortion, and possibly uncontrolled biases, despite the use of logistic regression analysis to control the potential confounders.

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  • Cervical function and prematurity

    2007, Best Practice and Research: Clinical Obstetrics and Gynaecology
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    Additionally, the method of abortion in both studies was largely surgical and both studies found that induced abortion was associated with an increased risk of idiopathic preterm labour and preterm premature rupture of membranes (PPROM) but not preterm birth due to pregnancy-induced hypertension, lending weight to the hypothesis that the mechanism of preterm birth in this scenario is due to cervical damage. In contrast, in a prospective study from the US on surgical abortion at ≥ 20 weeks' gestation, the association between abortion and increased risk of preterm delivery was limited to those in whom the indication for induced abortion was cervical dilation and/or PPROM.24 In other words, in this latter study, it appears that women who were predisposed to spontaneous cervical dilation and PPROM such that induced abortion had been required, were more likely to deliver preterm in a subsequent pregnancy.

  • Management Options for Women with Midtrimester Fetal Loss: A Case Report

    2007, Journal of Midwifery and Women's Health
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    Complications associated with D&E included hemorrhage, infection, cervical laceration, and uterine perforation. Additionally, several other studies conducted by one group of researchers found no increased risk of midtrimester loss or preterm birth in future pregnancies for women who have a midtrimester D&E.6–8 Best practices for the use of misoprostol are not available.

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Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nev.

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