Skip to main content

Advertisement

SpringerLink
Log in

Risk of preterm birth and low birthweight following consecutive surgical and medical abortions

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To examine the effect of consecutive surgical compared to medical uterine evacuations on spontaneous preterm birth (SPTB) and low birthweight (LBW) rates in the immediate subsequent delivery.

Methods

Retrospective study, conducted at a teaching hospital on data from January 2000 to March 2016. First study group consisted of all women who had ≥2 consecutive medical evacuations (ME-Group); second study group consisted of women who had ≥2 consecutive surgical evacuations (SE-Group). Both had a subsequent singleton delivery. Control group consisted of women without previous evacuations (unexposed group). The groups were matched for year of birth and ethnicity. The primary outcome was a composite that included SPTB (<37 weeks) and LBW (<2500 g).

Results

All 70 women found eligible in the ME-Group during the study period were included. SE-Group and the unexposed group consisted of 140 and 210 women, respectively. Primary outcome occurred in 4.3, 11.4, and 2.4% in the ME-Group, SE-Group, and the unexposed group, respectively (p = 0.002). After adjusting for variables that differed between the groups in univariate analysis, the primary outcome incidence was significantly higher among the SE-Group compared to the unexposed group (adjusted OR 6.8, 95% CI 1.7–26.3, p = 0.006). The difference was insignificant between the ME-Group and the unexposed group (adjusted p = 0.31). In the SE-Group, 7.1% women required fertility treatments to achieve a desired pregnancy compared to 1.4% in the ME-Group (p = 0.04).

Conclusion

Two or more consecutive surgical evacuations were associated with an increased risk of both SPTB and LBW compared to unexposed group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goldenberg RL, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371:75–84

    Article  PubMed  Google Scholar 

  2. McCormick MC (1985) The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 312:82–90

    Article  CAS  PubMed  Google Scholar 

  3. Hamilton BE, Hoyert DL, Martin JA, StrobinoDM Guyer B (2013) Annual summary of vital statistics: 2010–2011. Pediatrics 1:548–558

    Article  Google Scholar 

  4. Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R et al (2012) National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 379:2162–2172

    Article  PubMed  Google Scholar 

  5. Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S et al (2013) Born Too Soon preterm prevention analysis group. Preventing preterm births: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 381:223–234

    Article  PubMed  Google Scholar 

  6. Slattery MM, Morrison JJ (2002) Preterm delivery. Lancet 360:1489–1497

    Article  PubMed  Google Scholar 

  7. Oliver-Williams C, Fleming M, Wood A, Smith G (2015) Previous miscarriage and the subsequent risk of preterm birth in Scotland, 1980–2008: a historical cohort study. BJOG 122:1525–1534

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Lemmers M, Verschoor MA, Hooker AB, Opmeer BC, LimpensJ Huirne JA et al (2016) Dilatation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysis. Hum Reprod 31:34–45

    Article  CAS  PubMed  Google Scholar 

  9. Shah PS, Zao J (2009) Knowledge Synthesis Group of Determinants of preterm birth/LBW birth. Induced termination of pregnancy and low birth weight and preterm birth: a systematic review and meta-analyses. BJOG 116:1425–1442

    Article  CAS  PubMed  Google Scholar 

  10. Lowit A, Bhattacharya S, Bhattacharya S (2010) Obstetric performance following induced abortion. Best Pract Res Clin Obstet Gynaecol 24:667–682

    Article  PubMed  Google Scholar 

  11. Zhou W, Sorensen HT, Olsen J (1999) Induced abortion and subsequent pregnancy duration. Obstet Gynecol 94:948–953

    CAS  PubMed  Google Scholar 

  12. Henriet L, Kaminski M (2001) Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey. BJOG 108:1036–1042

    CAS  PubMed  Google Scholar 

  13. Bhattacharya S, Lowit A, Bhattacharya S, Raja EA, Lee AJ, Mahmood T et al (2012) Reproductive outcomes following induced abortion: a national register-based cohort study in Scotland. BMJ Open 2:e000911

    Article  PubMed  PubMed Central  Google Scholar 

  14. Thorp JM, Hartmann KE, Shadigian E (2002) Long-term physical and psychological health consequences of induced abortion: review of the evidence. Obstet Gynecol Surv 58:67–79

    Article  Google Scholar 

  15. Koifman A, Levy A, Zaulan Y, Harley A, Mazor M, Wiznitzer A et al (2008) The clinical significance of bleeding during the second trimester of pregnancy. Arch Gynecol Obstet 278:47–51

    Article  PubMed  Google Scholar 

  16. Ananth CV, Smulian JC, Vintzileos AM (1997) The association of placenta previa with history of cesarean delivery and abortion: a metaanalysis. Am J Obstet Gynecol 177:1071–1078

    Article  CAS  PubMed  Google Scholar 

  17. Bracken M, Hellenbrand K, Holford T, Bryce-Buchanan C (1986) Low birth weight in pregnancies following induced abortion: no evidence for an association. Am J Epidemiol 123:604–613

    Article  CAS  PubMed  Google Scholar 

  18. Hogue CJ, Cates W Jr, Tietze C (1982) The effects of induced abortion on subsequent reproduction. Epidemiol Rev 4:66–94

    Article  CAS  PubMed  Google Scholar 

  19. Saccone G, Perriera L, Berghella V (2016) Prior uterine evacuation of pregnancy as independent risk factor for preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol 214:572–591

    Article  PubMed  Google Scholar 

  20. Woolner A, Bhattacharya S, Bhattacharya S (2014) The effect of method and gestational age at termination of pregnancy on future obstetric and perinatal outcomes: a register-based cohort study in Aberdeen, Scotland. BJOG 121:309–318

    Article  CAS  PubMed  Google Scholar 

  21. Molin A (1993) Risk of damage to the cervix by dilatation for first-trimester-induced abortion by suction aspiration. Gynecol Obstet Investig 35:152–154

    Article  CAS  Google Scholar 

  22. Ancel PY, Lelong N, Papiernik E, Saurel-Cubizolles MJ, Kaminski M (2004) History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey. Hum Reprod 19:734–740

    Article  PubMed  Google Scholar 

  23. Hahn KA, Wise LA, Rothman KJ, Mikkelsen EM, Brogly SB, Sørensen HT et al (2015) Caffeine and caffeinated beverage consumption and risk of spontaneous abortion. Hum Reprod 30:1246–1255

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Raatikainen K, Heiskanen N, Heinonen S (2006) Induced abortion: not an independent risk factor for pregnancy outcome, but a challenge for health counseling. Ann Epidemiol 16:587–592

    Article  PubMed  Google Scholar 

  25. Weintraub AY, Sergienko R, Harlev A, Holcberg G, Mazor M, Wiznitzer A et al (2011) An initial miscarriage is associated with adverse pregnancy outcomes in the following pregnancy. Am J Obstet Gynecol 205:286e1–5

    Article  Google Scholar 

  26. Atrash HK, Hogue CJ (1990) The effect of pregnancy termination on future reproduction. Baillieres Clin Obstet Gynaecol 4:391–405

    Article  CAS  PubMed  Google Scholar 

  27. Sullivan E, Tietze C, Dryfoos JG (1977) Legal abortion in the United States, 1975–1976. Fam Plann Perspect 9:116–129

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Gavriel Gilad, MD, Emek Medical Center, Afula, Israel for data collection and sorting; and Naama Schwartz, biostatistician, PhD, Emek Medical Center, Afula, Israel, for statistical guidance and assistance.

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Emek Medical Center, 18101, Afula, Israel

    Noah Zafran, Sivan Zuarez-Easton, Gali Garmi, Shabtai Romano & Raed Salim

  2. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel

    Noah Zafran, Marian Musa, Gali Garmi, Shabtai Romano & Raed Salim

Authors
  1. Noah Zafran
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marian Musa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sivan Zuarez-Easton
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gali Garmi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shabtai Romano
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Raed Salim
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

NZ: assisting in protocol development, data collection and management, data analysis, assisting in manuscript writing, and approval of the final version. MM: assisting in protocol development, data collection and management, and approval of the final version. SZ-E: data collection and analysis, and approval of the final version. GG: data collection and analysis, and approval of the final version. SR: assisting in protocol development, data collection and management, and approval of the final version. RS: project development, data analysis and manuscript writing.

Corresponding author

Correspondence to Raed Salim.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval

IRB no: 0123-14-EMC. Emek Medical Center, Afula, Israel.

Human and animal rights statement

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zafran, N., Musa, M., Zuarez-Easton, S. et al. Risk of preterm birth and low birthweight following consecutive surgical and medical abortions. Arch Gynecol Obstet 296, 763–769 (2017). https://doi.org/10.1007/s00404-017-4474-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-017-4474-x

Keywords

Search

Navigation