Private Maternity Hospitals Research Articles

Adverse outcomes of labour in public and private hospitals in Australia: a population‐based descriptive study

Almost all women in Australia have free access to public hospitals, where intrapar- tum care is usually provided by a mixture of midwives, junior medical officers, specialty trainees, and specialist obstetricians. In con- trast, women choosing to deliver in private hospitals have their care directly managed by specialist obstetricians. Compared with public hospitals, birth in Australian private hospitals is characterised by a higher rate of obstetric interventions such as induction of labour, episiotomy, instrumental delivery, ABSTRACT Objective: To compare the rate of serious adverse perinatal outcomes of term labour between private and public maternity hospitals in Australia. Design, setting and participants: A population-based study of 789 240 term singleton births in public and private hospitals in 2001-2004, using data from the National Perinatal Data Collection. Main outcome measures: Third- and fourth-degree perineal injury, requirement for high level of neonatal resuscitation, Apgar score < 7 at 5 minutes, admission to neonatal intensive care unit or special care nursery, and perinatal death. Results: 31.4% of the term singleton births occurred in private hospitals. After adjusting for maternal age, Indigenous status, parity, smoking status, diabetes, hypertension, remoteness of usual residence, and method of birth, the rates of all adverse outcomes studied were higher for public hospital births. For women, the adjusted odds ratio (AOR) for third- or fourth-degree perineal injury was 2.28 (95% CI, 2.16-2.40). For babies, the odds of a high level of resuscitation (AOR, 2.37; 95% CI, 2.17-2.59), low Apgar score (AOR, 1.75; 95% CI, 1.65-1.84), intensive care requirement (AOR, 1.48; 95% CI, 1.45-1.51) and perinatal death (AOR, 2.02; 95% CI, 1.78-2.29) were all higher in public hospitals. Conclusion: For women delivering a single baby at term in Australia, the prevalence of

Effects of HIV/AIDS on Maternity Care Providers in Kenya

To explore the impact of HIV/AIDS on maternity care providers in labor and delivery in a high HIV-prevalence setting in sub-Saharan Africa. Qualitative one-on-one in-depth interviews with maternity care providers. Four health facilities providing labor and delivery services (2 public hospitals, a public health center, and a small private maternity hospital) in Kisumu, Nyanza Province, Kenya. Eighteen maternity care providers, including 14 nurse/midwives, 2 physician assistants, and 2 physicians (ob/gyn specialists). The HIV/AIDS epidemic has had numerous adverse effects and a few positive effects on maternity care providers in this setting. Adverse effects include reductions in the number of health care providers, increased workload, burnout, reduced availability of services in small health facilities when workers are absent due to attending HIV/AIDS training programs, difficulties with confidentiality and unwanted disclosure, and maternity care providers' fears of becoming HIV infected and the resulting stigma and discrimination. Positive effects include improved infection control procedures on maternity wards and enhanced maternity care provider knowledge and skills. A multifaceted package including policy, infrastructure, and training interventions is needed to support maternity care providers in these settings and ensure that they are able to perform their critical roles in maternal healthcare and prevention of HIV/AIDS transmission.

Elective caesarean delivery at maternal request: A preliminary study of motivations influencing women's decision‐making

There is an extensive literature concerning caesarean section at maternal request, where no obstetric indication exists, yet little information about what motivates women to request such a delivery. This paper aims to ask women who had undergone maternal-request primary elective caesarean delivery about the reasons for their choice, their level of satisfaction with the delivery and their future childbearing plans. Anonymous postal survey of women who have undergone maternal-request primary caesarean section in private maternity hospitals in the eastern states of Australia. The response rate was 68%, and 78 completed surveys were included in the study. The most common reason given was, 'I was concerned about risks to the baby' (46%). On a scale from 1 (totally unsatisfied) to 10 (completely satisfied), the mean satisfaction rating reported was 9.25/10 (95% confidence interval: 8.89, 9.60). Only eight respondents (10%) stated an intention for more than two caesarean deliveries. Women who underwent maternal-request caesarean delivery most commonly did so from concerns for the baby. Respondents were highly satisfied with their delivery, and few wished for more than two children.

Defeitos congênitos no Município do Rio de Janeiro, Brasil: uma avaliação através do SINASC (2000-2004)

To evaluate the occurrence of birth defects in the city of Rio de Janeiro, Brazil, using the Live Birth Information System (SINASC), we performed a cross-sectional study on all live newborns with birth defects from January 1, 2000, to December 31, 2004. The variables referred to birth defects (presence and system affected), type of health service, mothers, gestations, live births, and deliveries. Prevalence of birth defects was 83/10,000 live births. The most frequent birth defects involved the musculoskeletal system, central nervous system, cleft lip and palate, and chromosomal anomalies. The majority of cases were born in public (municipal) and private maternity hospitals, with the highest prevalence in the Fernandes Figueira Insitute, Oswaldo Cruz Foundation. Older women and those with less schooling had more live born infants with birth defects. The proportion of reports with missing information was high, reaching 21% in some institutions. Wider dissemination of SINASC data on birth defects should be encouraged. Reliability studies are recommended for better use of these reports.

Women's experiences of labor, surgery and first postnatal week by an emergency cesarean section

PurposeThis study investigated the experiences of Japanese women who underwent emergency cesarean sections (c-sections), including their experiences during labor before to the decision for surgery, during surgery, and during the first postnatal week.MethodsEleven Japanese women who delivered live babies by emergency c-section at a private maternity hospital were interviewed in a semi-structured manner on the second and seventh postpartum days. Interviews were tape-recorded, and transcripts and participant observation in the postnatal ward assisted the interpretation. Data were analyzed qualitatively and inductively.ResultsEleven women (seven primiparas, four multiparas) participated in the study. The main reasons for surgery were fetal distress (n=9) and arrest of labor (n=2). The time between making the decision to perform surgery and birth ranged from 15 to 69 minutes. Six themes were evident from the women's experiences: shock of disappointed expectations, unavoidable fear and responsibility, release from pressure, re-experience of fear and pain, being saved by the baby, and getting out of a vicious cycle. Trying labor pain, shock, fear of their babies' or their own deaths, and feeling powerless and guilty contributed to the women's negative feelings about their birth experiences by emergency c-section. After surgery, however, women felt loving toward their babies, who had been born safely as a result of the surgery, and eagerly breast-fed or took care of the infants with midwifery/nursing support.ConclusionsThe findings suggest that prenatal childbirth classes need to include information on and discussion of possible emergency c-section and that emotional support from midwives and nursing staff in the operating room/postpartum unit helps to decrease a woman's negative feelings about birth experiences by emergency c-section and enhance her experiences as a mother. In addition, medical staff should be more aware of the birth trauma felt by the expectant mother surrounding emergency c-section.

Integrated system for e-health advisory web services provision using broadband networks

In this work an integrated system of electronic reports of laboratorial examinations results from electronic ultrasonograph and cardiotokograph, documents exchange and health advisory services provision is presented. The integrated system was developed for the private maternity hospital of Patras under the action Medical Enterprises Financing for Specialized Informatics Applications Provision and Installation of 'Information Society'. Its aim is to supply enhanced health services and information exchange services among health services provision organisations. Benefits from its usage are the direct exploitation of the enhanced Health Services and the cooperation and interaction between health organisations.

Fathers' feelings and thoughts when their partners require an emergency cesarean section: Impact of the need for surgery

AbstractAim: This study sought to identify fathers' feelings and thoughts about their partners, babies, and medical staff when an emergency cesarean section (c‐section) is required. Information was gathered on fathers' reactions when they first learned of the need for surgery, during surgery, and on first seeing their babies and partners post‐surgery.Methods: Japanese men whose partners delivered a live baby by emergency c‐section, without having planned to, at a private maternity hospital were interviewed. The men had semistructured interviews within 1 week post‐partum, alone or together with their partners, according to the couples' wishes. The interviews were recorded, transcribed, and analyzed both descriptively and inductively.Results: All participants had their first babies with their present partners. The indications for a c‐section were classified into two groups: a fetal distress group and a prolonged labor group. Although the fathers understood the need for surgery when the decision was made, they were anxious and felt that the lives of both their partner and baby were at risk. Moreover, they were frustrated that they could do nothing. In general, they also tried to remain calm so that their partners would not become agitated. The indications for surgery seemed to produce different feelings among the fathers and research interviews with the couples might provide a better opportunity to review and share birth experiences.Conclusion: Midwives who care for women prior to surgery must be aware of fathers' complex feelings and needs in emergency c‐section cases. Knowing their reactions to this type of surgery might help to strengthen the support from fathers and facilitate an understanding of couples' concerns and needs.

THE ASSOCIATION BETWEEN HLA-DR, -DQ GENES AND SUSCEPTIBILITY TO ATOPY IN A BIRTH COHORT

ISEE-202 Introduction: Atopic disease in early childhood plays a major role in the development of asthma in childhood or adolescence. Different human leukocyte antigen (HLA) class II alleles have been associated with the development of atopic asthma and responsiveness of allergen exposure. HLA class II molecules were found in neonates’ immune system. However, the relationship between the atopic disease in early childhood and HLA-DR and -DQ genes remains unclear. Aim: Our aim is to determine the association between HLA-DR and -DQ genes and susceptibility to atopy in a birth cohort at one year follow-up. Methods: Four private maternity hospitals were randomly selected to participate and recruit pairs of mothers and neonates. A questionnaire was administered to collect demographic data, home environment, family disease histories, and information about atopic symptoms including early-onset transient wheezing, atopic dermatitis, and eczema, diagnosed by paediatricians. The questionnaire was completed by neonates’ parents when neonates were followed up to the age of 1 year by telephone interview. The levels of cord blood IgE (cIgE) and maternal total IgE (sIgE) and allergen-specific IgE were determined by the Pharmacia UniCAP IgE assay test system. HLA-DR and -DQ alleles were typed using the Dynal AllSet+™ “low resolution” SSP kit. Results: Between July 2001 and May 2003, 187 mother and neonate pairs participated in this study. A total of 184 neonates completed the HLA-DR and -DQ genotyping. The frequencies of HLA-DR and -DQ genes, maternal sensitization, sIgE > 100 IU/ml, and cIgE ≥ 0.35 IU/ml were not different between the four areas. No association was found between cIgE and HLA-DR and -DQ genes or atopic symptoms. Physician diagnosed atopic symptoms were associated with the HLA-DQB1*02 allele (X2= 10.38, p<0.0013). After adjusting for possible potential risk factors, the sIgE > 100 IU/ml (Odds Ratio (OR) =5.01, 95% ci= [1.22, 27.14]), and HLA-DQB1*02 (OR = 8.09, 95% CI= [1.91, 36.74]) were risk factors for atopic symptoms in children at one year follow-up. Conclusion: Although, no allergen-specific IgE data were found in infants, we suggest that HLA-DQB1*02 and maternal atopy are important risk factors for atopic symptoms in early stage of childhood. Elucidating this interaction at the molecular level may allow for more targeted treatment and prevention of atopic diseases.

Qualidade da atenção ao parto em maternidades do Rio de Janeiro

To evaluate the quality of birth care based on the World Health Organization guidelines. A case-control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections) and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections). Data was collected through interviews with puerperal women and review of medical records. A summarization score of quality of delivery care was constructed. There was low frequency of practices that should be encouraged, such as having an accompanying person (1% in the private hospital for both vaginal delivery and C-sections), freedom of movements throughout labor (9.6% of C-sections in the public hospital and 9.9% of vaginal deliveries in the private hospital) and breastfeeding in the delivery room (6.9% of C-sections in the public hospital and 8.0% of C-sections in the private hospital). There was a high frequency of known harmful practices such as enema administration (38.4%); routine pubic shaving; routine intravenous infusion (88.8%); routine use of oxytocin (64.4%), strict bed rest throughout labor (90.1%) and routine supine position in labor (98.7%) in vaginal deliveries. The best summarizing scores were seen in the public maternity hospital. The two maternity hospitals have a high frequency of interventions during birth care. In spite of providing care to higher risk pregnant women, the public maternity hospital has a less interventionist profile than the private one. Procedures carried out on a routine basis should be pondered based on evidence of their benefits.

Consumo de medicamentos no período de internação para o parto

Drug use in birth delivery has not been enough explored in the literature. It is a significant issue to be discussed on the theme of rational drug use. The objective was to study drug use during birth delivery stay in maternity hospitals. A cross-sectional study was carried out using medical records of two private and public maternity hospitals of Belo Horizonte, Brazil. Data were collected on pregnant women's identification, pregnancy, delivery and drug prescribed from medical records of public hospitals and medical records and billing invoice of private maternity hospitals. Statistical analysis was conducted using odds ratio by the Chi-square test and means by t-Student test. Mean in-hospital stay was 2.2 days and it was lower in the private maternity hospital. Cesarean sections were performed in 52.7% of all births, 31.3% in the public hospital and 64.5% in the private hospital. Peridural anesthesia was used in 72.8% of births and local anesthesia in 22.4% (25.3% and 63.7% of births in the public and 98.2% and 0.4% in the private hospital). All women received drugs (minimum of 3 and maximum of 19 different drugs) during their hospital stay. Eighty-three medications (97 active ingredients) were utilized at a total frequency of 3,429. The higher average drug use was 8.5 drugs per woman, in the private maternity hospital. There was a significant difference in drug use between the two maternity hospitals, being it higher in pre- and during birth delivery procedures. The results suggest a preeminent drug use compared to those of other few studies available in the literature. The disproportionate number of cesarean sections and anesthesia explain the differences observed.

Decreasing test time in newborn hearing screening.

This study examined the effect of reducing the number of accepted responses in transiently evoked otoacoustic emissions based on the results of a universal neonatal hearing screening program. Our intention was to decrease the test time of newborns. A total of 464 ears were examined by using a universal newborn hearing-screening program implemented in a private maternity hospital. ILO88 Otodynamics Analyzer Quickscreen program was used for all testing and a two-stage procedure was adopted. In the first stage, the results were continuously evaluated for the 'pass' criteria, during the test, after at least 20 low-noise sweeps had been presented. As soon as the criteria were met, the test was interrupted and the results were recorded. In the second stage of the procedure, the test was continued and finally terminated after 260 quiet samples had been recorded. The results of each stage of this procedure were compared and evaluated. A total of 402 ears had normal otoacoustic emissions and only 62 ears had absent emissions. It was concluded that after a minimum of 20 averaged quiet responses, which we consider necessary in order to record reliable emissions and as soon as the 'pass' criteria were fulfilled the test could be terminated without affecting the 'pass-fail' rates which were similar in both stages. However, we believe that for diagnostic and clinical purposes, all 260 quiet samples must be used, because the results after the second stage indicated statistically better scores in response and reproducibility measures.

C677T polymorphism of the MTHFR gene and variant hemoglobins: a study in newborns from Salvador, Bahia, Brazil.

The C677T polymorphism in the methylenetetrahydrofolate reductase gene (MTHFR) is associated with an increase in total homocysteine serum levels (tHcy), described as a risk factor for cardiovascular disease. Eight hundred forty-three neonates from two different maternity hospitals, one public and another private, in Salvador, Bahia, Brazil were screened for this polymorphism by PCR and RFLP. The T-allele frequency in the total sample was 0.23, and the prevalence rates of heterozygous and homozygous carriers were 36.2% and 5.3%, respectively. The T-allele frequency differed and the T/T genotype was more prevalent at the private maternity hospital. The hemoglobin (Hb) profile was investigated by HPLC in 763 newborns. The frequency of variant Hb was higher at the public than at the private maternity hospital. The association of the C677T polymorphism and the Hb profile was investigated in 683 newborns, showing a relatively high frequency of variant Hbs and the T allele. These data could provide an important basis for further studies focusing on potential risks of vaso-occlusive events in these individuals.

Are maternal psychosocial factors associated with cord immunoglobulin E in addition to family atopic history and mother immunoglobulin E?

Atopy in maternal and family histories is known to be a risk factor for elevated umbilical cord immunoglobulin E (cIgE). However, the association between cIgE and psychosocial factors remains under investigation. To explore whether psychosocial factors in addition to atopy contribute to elevated cIgE. Four private maternity hospitals fitting the quantile levels of SO(2) in 2000 cooperated with us by recruiting participants for this study: pairs of mothers and neonates living within 3-km catchment areas of air-monitoring stations. We used a questionnaire to collect exposure data, and the Pharmacia UniCap IgE assay test system to determine the levels of IgE in gravidas and cord blood. Between July 2001 and March 2003, 334 mother and neonate pairs participated in this study. The frequencies of sensitization, serum IgE (sIgE)>100 IU/mL, or cIgE> or =0.35 IU/mL were not different between the four different hospitals. By multi-variate logistic regression analysis adjusted for environmental factors, genetic factors, and psychosocial factors, the risk factors for elevated cIgE were being a male neonate (odds ratio (OR)=3.5, 95% confidence interval (CI)=[1.5, 8.5]), carpets at home (OR=3.0, 95% CI=[1.02, 8.4]), maternal allergy to dog dander (OR=9.7, 95% CI=[1.2, 98.8], maternal total serum IgE>100 IU/mL (OR=5.1, 95% CI=[2.2, 12.8]), maternal regularly/mostly/often self-reported nervousness (OR=4.0, 95% CI=[1.3, 12.8]), family income 11,574-17 361 US dollars/year (OR=3.7, 95% CI=[1.3, 11.5]), incense burning (OR=4.0, 95% CI=[1.4, 13.3]), and atopy in maternal grandparents (OR=4.8, 95% CI=[1.7, 14.0]). By principle component analysis and logistic regression, psychosocial stress (beta +/- standard error=0.26+/-0.13, P=0.04) was associated with increased cIgE. Psychosocial factors are potentially important risk factors for elevated cIgE.

Fatores associados à morbi-mortalidade perinatal em uma amostra de maternidades públicas e privadas do Município do Rio de Janeiro, 1999-2001

This study compares socio-demographic factors, mothers' biological characteristics, and quality of care at maternity hospitals in the City of Rio de Janeiro, Brazil. A sample of 10,072 post-partum women in 47 hospitals was selected. Data were collected by interviewing mothers in the immediate post-partum and from medical records. The chi2 test was used to analyze homogeneity of ratios. Significant differences were found between patients in public and private hospitals in relation to family support, healthy habits during pregnancy, reproductive history, access to and satisfaction with prenatal care and delivery, and particularly adverse effects in the newborns. Private maternity hospitals showed better results, although they displayed excessive cesarean and neonatal inter-hospital transfer rates. The stratum consisting of public Federal and State maternity hospitals received women with greater morbidity, had lower neonatal transfer rates, and received a more positive assessment by clients of the Unified National Health System (SUS). Private maternity centers contracted out by the SUS were the ones that most refused treatment to patients, leading to delays in patient care for delivery.

Factors associated with inadequacy of prenatal care utilization

To identify factors associated with inadequacy of prenatal care utilization in urban community. A cross-sectional study of a systematic sample stratified by maternity hospital, consisting of hospital births in the municipality of São Luís, Brazil, was carried out from March 1997 to February 1998. Socioeconomic and demographic factors, reproductive health, morbidity during pregnancy, and utilization of prenatal care services were studied. Mothers answered a standardized questionnaire before hospital discharge. The adequacy of prenatal care utilization was analyzed by means of two indexes: APNCU (Adequacy of Prenatal Care Utilization) and a new index based on the recommendations of the Brazilian Ministry of Health. There were interviewed 2,831 women who delivered at 10 public and private maternity hospitals. The inadequacy of prenatal care utilization was 49.2% according to the APNCU index and 24.5% when determined by the Brazilian index. Prenatal care at public services, low maternal schooling, low income, having no partner, and absence of maternal diseases during pregnancy were associated with inadequacy of prenatal care use according to both indexes. High parity and maternal age of 35 years or more were also associated with inadequacy, whereas primiparity, morbidity, and young maternal age (<20 years) seemed to protect from inadequacy when the Brazilian index was used. Prenatal care showed low coverage in the municipality of São Luís. The inadequacy of prenatal care utilization was associated with several factors linked to social inequality.

The National Sentinel caesarean Section Audit in the UK

Concern over the rapidly rising rate of caesarean section led the World Health Organisation, in 1985, to release a statement suggesting that a caesarean section rate greater than 10–15% was excessive. This recommendation was based on the figures from countries with caesarean section rates of under 10% that also had some of the lowest perinatal mortality rates. It had little impact on the global trend. The UK Department of Health commissioned an audit into caesarean sections from the Royal College of Obstetricians and Gynaecologists (RCOG). This was undertaken in collaboration with the Royal College of Anaesthetists (RCA), the Royal College of Midwives and the National Childbirth Trust. Clinical audit standards were drawn up from stringently scrutinised reviews, published guidelines and other evidence-based sources. A questionnaire was produced that recorded clinical information, sought clinicians’ views and maternal opinions. The audit booklet was circulated to over 250 National Health Service consultant-led maternity units, 20 midwife-led units and three private maternity hospitals in the UK. Scotland was not included. The audit captured 99% of all births in a 3-month period between 2000 and 2001. Supplementary organisational surveys examined midwifery, obstetric and anaesthetic data. Nearly 92% of the organisations and 77% of the consultants surveyed responded. Over 30% of the mothers contacted returned survey material. The National Caesarean Section Audit Report,1 presented at the RCOG in October 2001, showed that the national caesarean section rate in the UK had risen to 22%, in line with the developed world and similar to the rate in the United States of America (USA) and Italy. France and Scandinavian countries have lower rates (see Table 1). This report gives a detailed insight into current practice related to caesarean section in one country.

A survey of the incidence of neonatal sepsis by group B Streptococcus during a decade in a Brazilian maternity hospital.

Group B Streptococcus (GBS) is the main etiological agent of neonatal sepsis in developed countries, however there is no detailed information on its incidence in Brazil. We registered the incidence and lethality of GBS infection in a Brazilian private maternity hospital from April 1991 to March 2000. Maternal risk factors contributing to neonatal infections were also scored. The rate of infection was determined by checking for GBS in the blood and liquor of symptomatic neonates within 72 hours of birth. Sepsis and/or early onset meningitis were diagnosed in 43 neonates (32 cases in blood, 1in liquor and 10 in blood and liquor). The overall incidence was 0.39 per thousand neonates and remained quite constant throughout the period, ranging from 0.25-0.63. Septic shock occurred in 33 neonates within 1 to 36 hours of birth (mean 15 hours). Among those patients, 26 (60%) died between the 5th and the 85th hour after birth. Maternal risk factors, according to CDC criteria, included: gestational age below 37 weeks in 26 cases (60%), amniorrhexis equal or superior to 18 hours in 7 cases (16%), and maternal temperature equal or superior to 38(o)C in 4 cases (9%). None of the mothers had received prophylactic antibiotics during labor nor were urine, rectal or vaginal swabs screened for GBS. Although the incidence of GBS infection in the population in this study was lower than that found in developed countries, its rate of mortality was higher. The death rate could be reduced through recognition of the risk factors and prophylactic antibiotics during labor.

Perinatal health and mother-child health care in the municipality of São Luís, Maranhão State, Brazil

The purpose of this article was to evaluate socioeconomic and demographic indicators, reproductive health, use of prenatal, childbirth, and neonatal services, and anthropometric data for mothers and infants. The authors performed a cross-sectional analysis of a systematic sample of 2,831 hospital births in São Luís, Maranhão State, from March 1997 to February 1998 at ten public and private maternity hospitals. The sample was stratified proportionally according to the number of births in each maternity hospital. Mothers answered a standard questionnaire. Of the total, 97.9% were live births and 98% were singletons. Prenatal coverage was 89.5%, and prevalence of cesarean sections was 33.8%. A physician provided prenatal care in 75.7% of cases and performed 73.8% of the deliveries. The Unified Health System covered the costs of 76.4% of the prenatal visits and 89.7% of the deliveries. A pediatrician was present in the delivery room in 50.2% of cases. The low birth weight rate was 9.6% and the preterm birth rate 13.9%. Reasons for concern included a high percentage of adolescent mothers, single mothers (or without partners), the high cesarean rate, and the high percentage of births attended by unqualified personnel.

Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey.

To study the impact of previous induced abortions on preterm delivery, small for gestational age and low birthweight in subsequent pregnancies. Survey of a national sample of births in France in 1995. All public and private maternity hospitals in France. 12,432 women who had a singleton live birth during one week. Data were collected during the women's postpartum stay in hospital, partly obtained by interview and partly abstracted from hospital medical records. Rates of preterm delivery, small for gestational age and low birthweight were compared according to existence and number of previous induced abortions. Maternal age, parity, history of previous adverse pregnancy outcome, maternal weight before pregnancy, marital status, educational level, maternal employment status during pregnancy, nationality, smoking during the third trimester of pregnancy and antenatal care were controlled for using multiple logistic regression and polytomous logistic regression. Twelve percent of women reported one previous induced abortion, and 3% two or more. Previous induced abortion was associated with an increased risk of preterm birth (OR 1.4; 95% CI 1.1-1.8); the risk of preterm delivery increased with the number of previous induced abortions (OR 1.3; 95% CI 1.0-1.7 for one previous abortion and OR 1.9; 95% CI 1.2-2.8 for two or more). The relationship was the same for very preterm and moderately preterm deliveries and for spontaneous and indicated preterm deliveries. After controlling for potential confounders, the association between previous induced abortions and small for gestational age and low birthweight infants was no longer significant. This study suggests that a history of induced abortion increases the risk of preterm delivery, particularly for women who have had repeated abortions. The respective role of the surgical and medical techniques used for induced abortions needs to be explored.

Impact of induced abortions on subsequent pregnancy outcome: the 1995 French national perinatal survey

Objective To study the impact of previous induced abortions on preterm delivery, small for gestational age and low birthweight in subsequent pregnancies. Design Survey of a national sample of births in France in 1995. Setting All public and private maternity hospitals in France. Population 12,432 women who had a singleton live birth during one week. Methods Data were collected during the women's postpartum stay in hospital, partly obtained by interview and partly abstracted from hospital medical records. Rates of preterm delivery, small for gestational age and low birthweight were compared according to existence and number of previous induced abortions. Maternal age, parity, history of previous adverse pregnancy outcome, maternal weight before pregnancy, marital status, educational level, maternal employment status during pregnancy, nationality, smoking during the third trimester of pregnancy and antenatal care were controlled for using multiple logistic regression and polytomous logistic regression. Results Twelve percent of women reported one previous induced abortion, and 3% two or more. Previous induced abortion was associated with an increased risk of preterm birth (OR 1.4; 95% CI 1.1–1.8); the risk of preterm delivery increased with the number of previous induced abortions (OR 1.3; 95% CI 1.0–1.7 for one previous abortion and OR 1.9; 95% CI 1.2–2.8 for two or more). The relationship was the same for very preterm and moderately preterm deliveries and for spontaneous and indicated preterm deliveries. After controlling for potential confounders, the association between previous induced abortions and small for gestational age and low birthweight infants was no longer significant. Conclusion This study suggests that a history of induced abortion increases the risk of preterm delivery, particularly for women who have had repeated abortions. The respective role of the surgical and medical techniques used for induced abortions needs to be explored.