Late Abortion Research Articles

Interruption volontaire de grossesse et COVID-19 : ce que la pandémie a modifié en 2020

ObjectiveThe management measures to contain the SARS-CoV-2 pandemic in 2020 has upset the organization of society, particularly the organization of the health system. We aimed to analyze the evolution of induced abortions in the Paris region in 2020 and to highlight the impact of the first confinement. MethodData from the National Health Insurance plan was analyzed to study abortion during the pandemic period (2020) compared to the previous four years (2016–2019). In 2020 the indicators of induced abortion were studied monthly to highlight the impact of the confinement. The age of women, the method used to terminate the pregnancy, the gestational age at the time of the abortion and the area of residence of women were analyzed. ResultsAfter five consecutive years of increasing abortion rates, our result showed that the number of abortions declined from 53,601 in 2019 to 50,615 in 2020 (decline of 5.6%). The abortion rate was 17.3 per 1,000 women aged 15–49 in 2019 and 16.3‰ in 2020. This drop was observed within 4 weeks following the first confinement. It concerned particularly abortions carried out in the hospital context and abortions of young women (< 25 years old). In 2020 the rate of medical abortions increased compared to the 4 years preceding the pandemic. The use of local anesthesia for surgical abortions also increased in the Paris region during the first confinement. Our study showed a fewer proportion of late abortion (over 12 weeks of amenorrhea) in 2020. This analysis also showed a drop in the number of births in the eight to nine months that followed the first confinement in the Paris region. Discussion and ConclusionThe COVID-19 pandemic has had health consequences not directly attributable to the virus. In terms of reproduction, the pandemic, particularly the first lockdown, has been associated to a decrease in conceptions resulting in a decrease in the number pregnancies including those ending in induced abortion or childbirth. The reduction of abortions is observed in the four weeks following the first confinement and the fall in the birth rate in the following 8 to 9 months.

Late termination of pregnancy at a major Queensland tertiary hospital, 2010–2020

To review rates of and indications for late pregnancy feticide at a major Queensland tertiary perinatal centre over the past decade. Retrospective cohort study. The Centre for Advanced Prenatal Care at the Royal Brisbane and Women's Hospital, a tertiary perinatal centre; feticides of singleton pregnancies of at least 22 weeks' gestation, 1 January 2010 - 31 December 2020. Indications for feticide; median gestational age at feticide; referral source; time between referral, maternal-fetal medicine review, and feticide. During 2010-2020, 305 feticides were undertaken at 22 weeks' gestation or later. The annual number of feticides increased from 20 in 2010 to 54 in 2020. The median gestational age at feticide was consistent across the decade (24+6 weeks; range, 17+0 to 37+1 weeks). The most frequent fetal indications for feticide were neurological abnormalities (110 of 305, 36%), aneuploidy or genetic syndromes (67, 22%), and cardiac malformations (59, 19%). Most women were seen for review within seven days of referral for feticide (154 of 197 for whom this information was available, 78%; median, five days; range, 0-34 days), and 136 of 197 feticides (69%) were undertaken within seven days of the initial maternal-fetal medicine review. Most late pregnancy feticides were performed because of fetal indications, primarily structural malformations or genetic abnormalities. Despite advances in prenatal imaging and diagnosis, late termination of pregnancy remains a necessary option in some pregnancies with maternal or fetal indications, and equitable access to late termination of pregnancy services is a vital component of reproductive health care.

Bacteremia and Late-Term Abortion Secondary to Salmonellosis in a Dog.

A 5 yr old, 54-day-pregnant whippet presented for hyperthermia, lethargy, and spontaneous abortion of multiple fetuses. Blood work and clinical signs raised concern for uterine sepsis; therefore, the dog underwent an emergency ovariohysterectomy. Blood and uterine samples cultured a Salmonella species. Following ovariohysterectomy and oral antibiotic therapy, the dog had no further systemic signs. Repeat blood cultures and Salmonella testing were negative. To the authors' knowledge, this is the first report of a Salmonella species causing bacteremia in conjunction with late-term abortion in a dog.

Fetal adverse effects following NSAID or metamizole exposure in the 2nd and 3rd trimester: an evaluation of the German Embryotox cohort

BackgroundNon-steroidal anti-inflammatory drugs (NSAID) are frequently used to treat pain, fever and inflammatory conditions. Due to evidenced fetotoxicity, treatment with NSAID and metamizole should be avoided in the 3rd trimester of pregnancy. There is an ongoing debate on fetotoxic risk of 2nd trimester use which is why we have conducted this study.MethodsIn this observational cohort study outcome of pregnancies with NSAID and/or metamizole exposure in the 2nd and/or 3rd trimester (study cohort n = 1092) was compared with pregnancies exposed to NSAID and/or metamizole in the 1st trimester only (comparison cohort, n = 1154). The WHO-UMC system was used to assess causality between study medication and study endpoints. Prenatal study endpoints were constriction of ductus arteriosus Botalli, oligohydramnios, late spontaneous abortion (SAB) or stillbirth. Postnatal study endpoints were patent ductus arteriosus (PDA), anomalies of the right heart ventricle, primary pulmonary hypertension (PPHT), and neonatal impairment of kidney function.ResultsDuctus arteriosus constriction was diagnosed in 5/1092 (0.5%) in the study cohort versus 0/1154 pregnancies in the comparison cohort. In one fetus, ductus arteriosus constriction and oligohydramnios occurred already in the late 2nd trimester after long-term NSAID exposure. Oligohydramnios was diagnosed in 41/1092 (3.8%) in the study cohort versus 29/1154 (2.5%) cases in the comparison cohort [RR, 1.5 (95% CI 0.9–2.4)]. Limited to 2nd trimester, oligohydramnios occurred in 8/904 (0.9%) versus 2/1154 (0.2%) pregnancies [RR, 5.1 (95% CI 1.1–24.0)]. At least in four of the 2nd trimester exposed pregnancies NSAID exposure lasted several weeks. Late SAB or stillbirth occurred in 14/1092 (1.3%) versus 17/1154 (1.5%). Postnatal cardiovascular or renal pathology did not differ between the cohorts.ConclusionsNSAID use in the 2nd trimester limited to a few days does not appear to pose a relevant risk. Use for longer periods in the advanced 2nd trimester, however, may cause oligohydramnios and ductus arteriosus constriction similar to effects observed after 3rd trimester use.

Targeted timing of hairy vetch cover crop termination with roller crimper can eliminate glyphosate requirements in no-till sunflower

No-till cropping systems with cover crops can improve soil health, but often rely on glyphosate, which is a contentious herbicide. In this study, we investigated whether a system based on the direct sowing of sunflower (Helianthus annuus) in the dead mulch of a roller-crimped hairy vetch (Vicia villosa) could be competitive with a system where glyphosate is also sprayed to terminate the cover crop and to control weeds. We hypothesized that optimum timing of roller-crimping would be key to eliminate glyphosate requirements while maintaining sunflower performance. In a 3-year on-farm experiment, we compared three vetch termination stages (early: pre-flowering; Intermediate: beginning of flowering; late: 70% flowering) and three glyphosate rates (Nil, half and full, i.e. 1440 g of active ingredient per hectare). Vetch biomass increased progressively from early to late termination stages, and ranged between 414 and 658 g m−2. Higher vetch biomass was correlated with lower weed biomass. Treatments had inconsistent effects on weed diversity and composition, largely determined by the interactions between treatments and seasonal (different years) or local factors (different fields). Glyphosate-based treatments seemed to select for aggressive weed species, but no clear species filtering effect based on ecological or functional traits was detected. Shannon H’ was positively correlated with sunflower grain yield below a weed dry biomass threshold of 150 g m−2. Crop yield with early termination stage was a failure without glyphosate application. However, crop yield with late vetch termination was acceptable, being at par or 15% higher (mean of first and second years) in no-glyphosate compared with glyphosate-based treatments. Crop gross margins showed the same trend (+33% for no-glyphosate compared with glyphosate-based treatments). This study, for the first time, shows that targeted timing of roller-crimped hairy vetch in no-till sunflower can result in equal agronomic and economic performances as addition of glyphosate.

Effects of donor sperm on perinatal and neonatal outcomes resulting from in vitro fertilization-intracytoplasmic sperm injection and embryo transfer cycles: a retrospective cohort study.

BackgroundThe impact of donor sperm on pregnancy outcomes is controversial. The aim of this study was to investigate whether donor sperm in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) treatment could reduce the rate of live births or increase the incidence of adverse pregnancy outcomes and birth defects in neonates.MethodsThis single-centre, retrospective cohort study included 1,559 patients with infertility who received donor sperm at our hospital from 2015 to 2019. All the patients received fresh embryos and underwent first-cycle transfer. After propensity score matching, 4,677 controls who received their partners’ sperm were matched at 1:3. Clinical pregnancy, perinatal, and neonatal outcomes were compared between the donor sperm and partner sperm groups.ResultsThe embryo development was better in the donor sperm group than in the partner sperm group. The high-quality embryo and available embryo rates were significantly higher in the donor sperm group (P<0.05 for both groups). The rate of high-quality embryos transferred from the donor sperm group was higher than that from the partner sperm group (P<0.05). The clinical pregnancy (62.99% vs. 59.65%; P=0.02) and live birth (54.65% vs. 51.59%; P=0.036) rates were higher in the donor sperm group. After adjusting for confounding factors, no significant difference in live birth rates was observed between the two groups (adjusted P=0.057). The low birthweight (18.21% vs. 21.39%; P=0.023) and small for gestational age (SGA) (7.60% vs. 11.97%; P<0.001) rates were lower in the donor sperm group. To exclude the effect of multiple pregnancies, we evaluated neonatal outcomes of singleton pregnancies. No significant differences were noted in preterm and very preterm birth, SGA, mean birthweight, high birthweight, and low birth weight (LBW) and very low birth weight (VLBW) rates (P>0.05 for both groups). Further, no significant between group differences were observed in the ectopic pregnancy rate, early and late spontaneous abortion rates, gestational age, rate of large for gestational age (LGA), and neonatal defects.ConclusionsCompared with partner sperm, donor sperm did not reduce live birth rate and did not increase neonatal LBW or low birth defects.

Late fetal demise, a risk factor for post-traumatic stress disorder

Late-term fetal demise including fetal death in utero, late miscarriage and late termination of pregnancy are relatively frequent occurrences. Post-traumatic stress disorder (PTSD) is a pathology that finds its roots in exposure to a life-threatening event or an event related to death. Exposure to fetal death during a late-term fetal demise is, therefore, a situation at risk of trauma. The objective of this study was to assess the prevalence of PTSD symptoms in the short term among patients faced with late fetal demise, and to identify potential risk factors. All women were assessed at 15 days, one month, and three months after late fetal demise using the Impact of Event Scale-Revised (IES-R) and the Peritraumatic Dissociative Experiences Questionnaire (PDEQ). At 15 days, 44.2% of patients presented a pathological score on the IES-R (≥ 33). At one month and three months, this figure was 34.1% and 9.1% respectively. Factor associated with PTSD symptoms were: peritraumatic dissociation (p = 0.014), seeing the fetus during hospitalization (p = 0.035), holding the fetus in one’s arms (p = 0.046), and the organization of a funeral service (p = 0.025). Patients experiencing late fetal demise are at significant risk of trauma. Care providers should remain vigilant to identify high-risk situations to offer appropriate care.Clinical trials registration number: NCT03433989.

Prognosis of Congenital Anomalies in Conceptions Following In Vitro Fertilization: A Multicenter Retrospective Cohort Study in China.

BackgroundConceptions following in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) have an increased risk of congenital anomalies. Few studies have explored the prognosis of fetuses with congenital anomalies. This study aimed to investigate the prevalence and prognosis of congenital anomalies in IVF/ICSI pregnancies, and to analyze the influencing factors contributing to poor prognosis.MethodsIn this multicenter retrospective cohort study, we followed 405,473 embryo transfer cycles at 15 reproductive centers between January 2010 and December 2019 and enrolled 2,006 intrauterine pregnancies with congenital anomalies. The relatively positive prognosis group with one or more live births and neonatal survival for more than 7 days was compared with the poor prognosis group with poorer outcomes.ResultsAmong the 168,270 ongoing intrauterine pregnancy cycles, the prevalence of congenital anomalies was 1.19%, wherein the malformation rates of cycles with late abortion and delivery were 2.37% (716/30,202) and 0.93% (1,290/138,068), respectively. Among all IVF/ICSI cycles with congenital anomalies, the relatively positive prognosis rate was 61.39%. Moreover, the fertilization failure rate (2 pro-nuclei rate < 25%) in the poor prognosis group was significantly higher than that in the relatively positive prognosis group (10.89% vs. 5.09%, p < 0.001). Multivariate logistic regression analysis revealed no significant differences in the relatively positive prognosis rate among the various IVF/ICSI protocols. The relatively positive prognosis rate of fertilization failure cycles was 0.180 times that of normal fertilization cycles.ConclusionPoor fertilization rates during IVF/ICSI treatments are more likely to have poor prognosis in fetuses or neonates with congenital anomalies, and obstetric management should be strengthened in pregnant women, with which pregnant women should be recommended to strengthen obstetric management.

Abortion outbreak in a sheep flock caused by Toxoplasma gondii clonal type III.

Toxoplasma gondii is a major cause of reproductive losses in small ruminants in several countries. We describe here an outbreak of T. gondii-associated abortion in sheep in Southern Brazil. The flock was comprised of 55 adult sheep, and late-term abortions and stillbirths were detected in 15/36 (41.66%) gestating ewes. Serum samples collected from 45 sheep were tested for T. gondii through indirect immunofluorescence assay; IgM and IgG positive results were detected in 44.44% (20/45) and 86.67% (39/45) of the cases, respectively. Four fetuses and two placentas were pathologically evaluated. Gross changes were restricted to fetal membranes and were characterized by multifocal white areas in the cotyledons. Microscopically, these areas corresponded to necrotic foci affecting the chorionic epithelium accompanied by rare cysts of T. gondii. The main histological change in fetal tissues consisted of well-demarked and sparsely distributed necrotic foci in the central nervous system. Tissue samples from all four fetuses and one placenta had positive PCR results for T. gondii. Restriction fragment length polymorphism (RFLP) genotyping using ten markers (SAG1, 5'-3'SAG2, alt.SAG2, SGA3, BTUB, GRA6, c22-8, c29-2, L358, and PK1) was carried out on one sample, and results were consistent with T. gondii clonal type III (ToxoDB-PCR-RFLP genotype #2, TgCpBr4).

Cover crops maintain or improve agronomic performances of maize monoculture during the transition period from conventional to no-tillage

Maize monoculture systems often cause environmental impacts such as soil erosion, nitrate leaching and pesticide transfer. Conservation tillage and the use of cover crops appear to hold promise for limiting these impacts, but questions about their performance remain, particularly during the transition period after conventional soil tillage ceases. In this study, effects of no-tillage maize and fallow-period management with different cover crop species, either pure or in mixtures, were studied on the agronomic performance of maize and on soil N and water dynamics. The study combined field experiments over three years (2012–2014) and simulation modelling with the STICS model. The biomass of cover crops produced during the fallow period varied from 0.8 to 10.5 t dry matter ha−1 depending on the cover crop species and date of termination. Differences in soil water content were quantified among the treatments studied, with the lowest water content at the beginning of the maize growing season with late termination of a cover crop composed of pure faba bean or a vetch-oat mixture in 2014 (25–50% of plant-water available capacity). Maize grain yields ranged from 8.5 to 13.6 t dry matter ha−1, with the lowest yields in the bare soil treatment. Simulations with STICS were consistent with the observations and indicated a decrease in drainage of 8–38 mm year−1, depending on the year and cover crop. Introducing cover crops into maize systems is a powerful mechanism for maintaining production while improving environmental performances during the transition phase of soil properties in conservation tillage.

Analysis of the Timing of Cervical Cerclage Treatment in Pregnant Women with Cervical Insufficiency and the Effect on Pregnancy Outcome.

Purpose To analyze the effect of the choice of timing of cervical cerclage treatment on pregnancy outcome in pregnant women with cervical insufficiency (CI). Methods The case data of 160 pregnant women admitted to our hospital for cervical cerclage due to CI from January 2020 to September 2021 were sampled. They were divided into the early group (14∼18 weeks of pregnancy, n = 86), the middle group (19∼27 weeks of pregnancy, n = 74) according to the different gestational periods of surgical treatment, and into the elective group (elective operation, n = 71) and the emergency group (emergency operation, n = 89) according to the different timings of surgical treatment. To compare the pregnancy outcomes of the four groups and the effects of different treatment timings on pregnant women and newborns. Results After the operation, the intrauterine infection rate in the early group was lower (8.14% (7/86)) than that (71.62% (53/74)) in the middle group, and the intrauterine infection rate (18.31% (13/71)) in the elective group was lower (61.80% (55/89)) than that in the emergency group (P < 0.05). After the operation, the late abortion rate in the early group was 8.14% (7/86) lower than 63.51% (47/74) in the middle group, and the late abortion rate in the elective group was 15.49% (11/71) lower than 61.80% (55/89) in the emergency group (P < 0.05). After the operation, the full-term birth rate (82.56% (71/86)) in the early group was higher (21.62% (16/74)) than that in the middle group, and the full-term birth rate (73.24% (52/71)) of the elective group was higher (24.72% (22/89)) than that in the emergency group (P < 0.05). After the operation, there was no significant difference in the preterm birth rate between the early group and the middle group (8.14% vs 14.86%), and between the elective group and the emergency group (11.27% vs 12.36%) (P > 0.05). There was no significant difference in neonatal Apgar scores between the early group and the middle group (7.30 ± 0.98 vs 7.14 ± 0.91) scores, and between the selective group and the emergency group (7.15 ± 0.82 vs 7.07 ± 1.07) scores (P > 0.05). There was no significant difference in gestational week extension time between the early group and the middle group (6.52 ± 1.77 vs 6.99 ± 1.69) days and between the elective group and the emergency group (6.44 ± 1.37 vs 6.82 ± 1.70) days (P > 0.05). The length of hospital stay was (7.28 ± 1.39 vs 10.89 ± 2.65) days in the early group and the middle group, with the early group being shorter than the middle group (P < 0.05), and the length of hospital stay was (8.72 ± 1.23 vs 9.30 ± 1.39) days in the elective group and the emergency group, with the elective group being shorter than the emergency group (P < 0.05). Conclusions The therapeutic effect and pregnancy outcome of cervical cerclage are affected by the timing of treatment. Among them, the effect of elective operation at 14∼18 weeks of pregnancy is more ideal, which is worthy of clinical promotion.

Salmonella enterica serovar Brandenburg abortions in dairy cattle.

Two separate late-term abortion outbreaks in Jersey heifers in July 2020 and December 2020 were investigated by the Iowa State University Veterinary Diagnostic Laboratory. We evaluated 3 whole fetuses and 11 sets of fresh and formalin-fixed fetal tissues during the course of the outbreaks. The late-term abortions were first identified at a heifer development site and subsequently observed at the dairy farm. Aborted fetuses had moderate-to-marked postmortem autolysis with no gross lesions identified. Observed clinical signs in cows at the dairy farm ranged from intermittent loose stools to acute post-abortion pyrexia and reduced feed intake. Routine histopathology and reproductive bacterial culture revealed acute, suppurative placentitis with moderate-to-heavy growth of Salmonella spp. group B from stomach contents, liver, placenta, and heifer fecal contents. Serotyping identified Salmonella enterica subsp. enterica serovar Brandenburg in all 14 fresh tissue cases, as well as individual and pooled heifer feces. Whole-genome sequencing analysis revealed that all isolates belonged to ST type 873 and possessed typhoid toxin genes, several fimbrial gene clusters, type III secretion system genes, and several pathogenicity islands. Abortions caused by Salmonella Brandenburg have not been reported previously in dairy cattle in the United States, to our knowledge.

COVID-19 mRNA vaccine in pregnancy: Results of the Swiss COVI-PREG registry, an observational prospective cohort study.

SummaryBackgroundPregnant individuals with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease, prematurity, and stillbirth. In March 2021, vaccination for at risk pregnant women was recommended in Switzerland, expanding this to all pregnant women in May 2021. Our aim was to assess the safety of mRNA COVID-19 vaccines in pregnancy.MethodsThis multicentre prospective cohort study describes early adverse events and perinatal outcomes in pregnant women who received at least one dose of mRNA vaccine between March 1st and December 27th, 2021 in Switzerland, using the COVI-PREG registry. Early adverse events were collected at least one month following vaccine administration. Pregnancy and neonatal outcomes were extracted from medical records using the maternity discharge letters providing follow-up information up to 5 days after birth.FindingsOf 1012 vaccinated women, 894 (88·3%) received both injections during pregnancy, with BNT162b2 (n = 271) or mRNA-1273 (n = 623) vaccines. Local events (mainly local pain) were reported in 81·3% and 80·5% after the first and second doses. Rates of systemic reactions (mainly fatigue and headache) were similar after the first dose and most frequent after the second dose of mRNA-1273. Of the 1012 women, four (0·4%; 95%CI [0·1-1·0]) severe early adverse events occurred: pulmonary embolism, preterm premature rupture of membranes, isolated fever with hospitalisation, and herpes zoster. Of 107 patients vaccinated before 14 weeks, one (0·9%; 95%CI [0·0-5·1]) early spontaneous abortions was reported (8 weeks). Of 228 vaccinated before 20 weeks one (0·4%; 95%CI [0·0-2·4]) late spontaneous abortion was reported (16 weeks). Of 513 women exposed before 37 weeks, 33 (6·4%; 95%CI [4·5-8·9]) delivered preterm. Among 530 patients exposed in pregnancy, no stillbirth was reported and 25 (4·7%; 95%CI [3·0-6·8]) neonates were admitted to intensive care unit.InterpretationFrequent local and systemic effects were described after exposure to mRNA COVID-19 vaccines during pregnancy but severe events were rare. Women vaccinated during pregnancy did not experience higher adverse pregnancy or neonatal outcomes when compared to historical data on background risks in the obstetric population.FundingThis research was funded by a grant from the Swiss Federal Office of Public Health and the CHUV Foundation.

Reduction in preterm birth rates during and after the COVID-19 lockdown in Queensland Australia.

BackgroundPreventative strategies for preterm birth are lacking. Recent evidence proposed COVID‐19 lockdowns may have contributed to changes in preterm birth.AimsTo determine the prevalence of preterm birth and birth outcomes during and after the COVID‐19 lockdown at the Sunshine Coast University Hospital and the overall state of Queensland, Australia.MethodsRetrospective cohort analysis of all births in Queensland including the Sunshine Coast University Hospital, during two epochs, April 1–May 31, 2020 (lockdown) and June 1–July 31, 2020 (post‐lockdown), compared to antecedent calendar‐matched periods in 2018–2019. Prevalence of preterm birth, stillbirth, and late terminations were examined.ResultsThere were 64 989 births in Queensland from April to July 2018–2020. At the Sunshine Coast University Hospital, there was a significantly higher chance of birth at term during both lockdown (odds ratio (OR) 1.81, 95% CI 1.17, 2.79; P = 0.007) and post‐lockdown (OR 2.01, 95% CI 1.27, 3.18; P = 0.003). At the same centre, prevalence of preterm birth was 5.5% (30/547) during lockdown, compared to 9.1% (100/1095) in previous years, a 40.0% relative reduction (P = 0.016). At this centre during lockdown, emergency caesareans concurrently decreased (P < 0.01) and instrumental vaginal births increased (P < 0.01). In Queensland overall, there was a nonsignificant decrease in the prevalence of preterm birth during lockdown.ConclusionsThere is a link between lockdown and a reduction in the prevalence of preterm birth on the Sunshine Coast. The cause is speculative at present, although increased influenza vaccination rates, decreased transmission of infections, and improved air quality may have been favourable in reducing preterm birth. Further research is needed to determine a causal link.

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The frequency of pregnancy recognition across the gestational spectrum and its consequences in the United States

The effect of stillbirth and late termination of pregnancy on the emergence of post-traumatic symptoms among attending medical personnel

The purpose of this paper was to assess the impact and the post-traumatic potential of late termination of pregnancy (TOP) and stillbirth on medical staff and characterise personal attributes that modulate these possible outcomes. Fifty-one participants involved in the treatment of women undergoing late TOPs and stillbirths answered questionnaires including demographics, Neuroticism subscale of the Big Five Inventory (BFI), Life Orientation Test-Revised (LOT-R), Posttraumatic Diagnostic Scale (PDS), Brief Symptom Inventory (BSI-18) and questions regarding exposure to stillbirths and late TOPs. None of the participants met the full post-traumatic stress disorder (PTSD) criteria. A correlation with a marginal significance was found between the number of TOP's/stillbirths attended during the past year and traumatic symptoms. Neuroticism moderated the association between presence in TOP's/stillbirths and post-traumatic symptoms among those who attended this event over the past month. According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP’s/stillbirths. Impact Statement What is already known on this subject ? There is a very little research on the ways in which medical personnel respond to Stillbirths, late miscarriages and terminations of pregnancy (TOP) of their patients and on the possible effect of their personality traits in this response. What do the results of this study add ? According to our results, medical personnel do not appear to develop long-term and lingering posttraumatic symptoms following attending TOP’s/stillbirths. What are the implications of these findings for clinical practice and/or further research ? Further studies are warranted to better assess the impact of exposure to traumatic events in general and on the effect of late TOP and stillbirths in particular, on medical personnel and to identify interventions that may prevent posttraumatic symptoms among staff members when they happen.

Accessing Late-Term Abortion Following Sexual Assault: Looking Inside the Danish Legal Black Box

ABSTRACT This article takes a critical look at potential human rights violations around access to late-term abortion following sexual assault in Danish law. Based on access to decisions from the country’s regional abortion councils combined with interviews with members of the abortion councils, the article sheds light on how national legislation and decision-making practices can lead to additional violations of the integrity of applicants who have survived sexual violence. A systematic failure to apply human rights consideration in the councils’ practices is revealed, and suggestions for changes that would bring Danish law and decision-making practices in line with the human rights framework are proposed.

Late selective termination and the occurrence of placental-related pregnancy complications: A case control study.

Multiple pregnancies are at increased risk of placental-related complications. The aim of the study was to investigate the prevalence and cumulative incidence of placental-related complications in twin pregnancies undergoing a late selective termination, compared to matched singleton and twin controls. A retrospective case-control study of post-selective late termination (≥20 weeks of gestation) singletons performed between 2009 and 2020at a single tertiary center. Each post-termination pregnancy was matched to 2 singleton and 2 dichorionic twin pregnancies for: mode of conception, maternal age group and parity. The prevalence of composite placental related outcome was determined and compared. Kaplan-Meier curves were constructed, and log rank test was performed to compare the cumulative incidence of placental complications among groups. Included were 90 post-selective termination pregnancies and 360 matched singletons and twins. These were subdivided according to trimester at procedure: 1) late 2nd trimester (N=43, 20-27.6 weeks); 2) 3rd trimester (N=47, ≥28 weeks). Placental-related complications presented earlier in the 3rd trimester selective termination group compared to singletons (median 35.5 vs median 37.4 weeks of gestation, P=0.01). The cumulative incidence of placental-related complications in twins and post-selective termination singletons rose significantly earlier compared to singletons (P<0.0001). A late 2nd trimester selective termination resulted in a comparable gestational age and cumulative incidence of placental-related complications as singletons. Compared to singletons, the cumulative incidence of placental complications rises significantly earlier in post-third trimester selective termination singleton pregnancies. While a late 2nd trimester selective termination results in a cumulative incidence comparable to singletons.

Le Planning familial - Ensuring access to sexual and reproductive rights in times of COVID

From the beginning of the first lockdown, Le Planning Familial, a feminist and SRHR delivery service organization, with its 70 local associations have come together to pursue its mission: to ensure access to SRHR and women's rights. The quarantine has had major consequences: it has increased gender-based violence including domestic violence, it has complicated women's lives (in accessing sexual health services, late-term abortions, abortion for minors, renewal of contraception, filing of complaints, etc.) and it has limited access to information and rights (presence of antichoice movements on the internet). In order to respond to those difficulties, Le Planning Familial has been investing in its toll-free hotline "Sexualities, contraception, abortion" 0800 08 11 11. The organization set up a communication campaign to make the information related to the hotline, the access to contraception methods and abortion in times of COVID more visible. Furthermore, the association innovated its means of welcoming and supporting women, youth and LGBTQI people within its SRHR local centers and its advocacy work. The political and democratic life of Le Planning Familial has continued. It has allowed the organization to fulfill its role as a feminist advocate. Currently, its main piece of advocacy has been to ensure access to abortion. Le Planning Familial and its members have been taking part in various actions along with parliamentarians, SRHR and feminist organization and activists at the national, European and international scale.

61 Arabin pessary: 5 Years experience of a terciary hospital

Introduction: Preterm labor is the leading cause of perinatal morbimortality and has a significant socioeconomic impact. Preterm labor can be classified as early (< 28 weeks), intermediate (28-32 weeks) and late (32-37 weeks). Risk factors associated with preterm labor include African women, smoking, previous late abortion and/or preterm labor, cervix interventions, multiple pregnancy, short cervix and urinary and/or vaginal infections. There are several therapeutic strategies: cervical cerclage, progesterone and Arabin pessary.