Subsequent Abortion Research Articles

Preventing repeat abortion in Canada: is the immediate insertion of intrauterine devices postabortion a cost-effective option associated with fewer repeat abortions?

Background In 2005, 97,254 abortions were performed in Canada, of which 38% were repeat abortions. The objective of this research was to determine if provision of free intrauterine devices (IUDs) postabortion is associated with a reduction in health-care costs and repeat abortions in a Canadian population compared with provision of oral contraceptives (OCPs) or depo-medroxyprogesterone acetate (DMPA). Study Design A retrospective cohort study was conducted by intention-to-treat chart review in a facility providing the majority of abortions in a Canadian health region. All ( n=1782) residents of this region who underwent abortion in 2003, 2004 and 2008 were included. One- and 5-year rates of repeat abortion were calculated, and a cost-effectiveness analysis was conducted to compare health-care system costs of providing patients with IUDs, OCPs or DMPA and subsequent repeat abortions. Results In 2003 and 2004, 1101 index abortions occurred. The main contraceptive cohorts were immediate IUD insertion ( n=117, 10.6%), immediate OCP ( n=413, 37.5%) and immediate DMPA administration ( n=357, 32.4%). After 5 years repeat abortion rates in the respective cohorts were: IUD, 9.4%, OCP, 17.4%, DMPA, 16.2% (p=.05). One-year rates of repeat abortion were not significantly different. Costs of providing contraception and subsequent abortions over 5 years were $142.63 (IUD), $385.61 (OCP) and $384.81 (DMPA) per user. Conclusion The immediate insertion of IUDs postabortion is associated with a lower 5-year rate of repeat abortion than provision of OCPs or DMPA. A cost reduction to the health-care system occurs when providing IUDs postabortion vs. alternate contraception of equivalent duration.

Who presents more than once? Repeat abortion among women in Britain

Background and methodologyAround one in three sexually active women in Britain will have an abortion during their lifetime and a third of those women will experience more than one. Using...

Subsequent pregnancy outcome of women with a previous mid-trimester loss

The objective of this retrospective cohort study was to analyse the prevalence of associated pathologies with mid-trimester loss (MTL) (12–24 weeks) and to determine the subsequent spontaneous abortion rate.Methods543 consecutive...

Trends in selective abortions of girls in India: analysis of nationally representative birth histories from 1990 to 2005 and census data from 1991 to 2011

India's 2011 census revealed a growing imbalance between the numbers of girls and boys aged 0-6 years, which we postulate is due to increased prenatal sex determination with subsequent selective abortion of female fetuses. We aimed to establish the trends in sex ratio by birth order from 1990 to 2005 with three nationally representative surveys and to quantify the totals of selective abortions of girls with census cohort data.We assessed sex ratios by birth order in 0·25 million births in three rounds of the nationally representative National Family Health Survey covering the period from 1990 to 2005. We estimated totals of selective abortion of girls by assessing the birth cohorts of children aged 0-6 years in the 1991, 2001, and 2011 censuses. Our main statistic was the conditional sex ratio of second-order births after a firstborn girl and we used 3-year rolling weighted averages to test for trends, with differences between trends compared by linear regression.The conditional sex ratio for second-order births when the firstborn was a girl fell from 906 per 1000 boys (99% CI 798-1013) in 1990 to 836 (733-939) in 2005; an annual decline of 0·52% (p for trend=0·002). Declines were much greater in mothers with 10 or more years of education than in mothers with no education, and in wealthier households compared with poorer households. By contrast, we did not detect any significant declines in the sex ratio for second-order births if the firstborn was a boy, or for firstborns. Between the 2001 and 2011 censuses, more than twice the number of Indian districts (local administrative areas) showed declines in the child sex ratio as districts with no change or increases. After adjusting for excess mortality rates in girls, our estimates of number of selective abortions of girls rose from 0-2·0 million in the 1980s, to 1·2-4·1 million in the 1990s, and to 3·1-6·0 million in the 2000s. Each 1% decline in child sex ratio at ages 0-6 years implied 1·2-3·6 million more selective abortions of girls. Selective abortions of girls totalled about 4·2-12·1 million from 1980-2010, with a greater rate of increase in the 1990s than in the 2000s.Selective abortion of girls, especially for pregnancies after a firstborn girl, has increased substantially in India. Most of India's population now live in states where selective abortion of girls is common.US National Institutes of Health, Canadian Institute of Health Research, International Development Research Centre, and Li Ka Shing Knowledge Institute.

Number of Oral Contraceptive Pill Packages Dispensed and Subsequent Unintended Pregnancies

To estimate how number of oral contraceptive pill packages dispensed relates to subsequent pregnancies and abortions. We linked 84,401 women who received oral contraceptives through the California family planning program in January 2006 to Medi-Cal pregnancy events and births conceived in 2006. We compared pregnancy rates for women who received a 1-year supply of oral contraceptive pills, three packs, and one pack. Women who received a 1-year supply were less likely to have a pregnancy (1.2% compared with 3.3% of women getting three cycles of pills and 2.9% of women getting one cycle of pills). Dispensing a 1-year supply is associated with a 30% reduction in the odds of conceiving an unplanned pregnancy compared with dispensing just one or three packs (confidence interval [CI] 0.57-0.87) and a 46% reduction in the odds of an abortion (95% CI 0.32-0.93), controlling for age, race or ethnicity, and previous pill use. Making oral contraceptives more accessible may reduce the incidence of unintended pregnancy and abortion. Health insurance programs and public health programs may avert costly unintended pregnancies by increasing dispensing limits on oral contraceptives to a 1-year supply.

Conduct disorder symptoms and subsequent pregnancy, child-birth and abortion: A population-based longitudinal study of adolescents

Research on teenage pregnancy and abortion has primarily focused on socio-economic disadvantage. However, a few studies suggest that risk of unwanted pregnancy is related to conduct disorder symptoms. We examined the relationship between level of conduct disorder symptoms at age 15 and subsequent pregnancy, child-birth and abortion. A population-based, representative sample of Norwegian adolescent girls ( N = 769) was followed from early adolescence until their mid-20s. Even with control for socio-demographic and family variables, conduct disorder symptoms at age 15 were strongly associated with pregnancy in the 15–19 age group, and a weaker association persisted in the 20–28 age group. Similar results were obtained for abortions, but here a strong relationship with conduct disorder symptoms was found even after age 20. After adjustment, no significant association between conduct disorder symptoms and subsequent child-birth was observed. More targeted preventive programmes aimed at girls with conduct disorder symptoms may be warranted.

Number of oral contraceptive pill packages dispensed and subsequent unintended pregnancies

OBJECTIVE: To estimate how number of oral contraceptive pill packages dispensed relates to subsequent pregnancies and abortions. METHODS: We linked 84,401 women who received oral contraceptives through the California family planning program in January 2006 to Medi-Cal pregnancy events and births conceived in 2006. We compared pregnancy rates for women who received a 1-year supply of oral contraceptive pills, three packs, and one pack. RESULTS: Women who received a 1-year supply were less likely to have a pregnancy (1.2% compared with 3.3% of women getting three cycles of pills and 2.9% of women getting one cycle of pills). Dispensing a 1-year supply is associated with a 30% reduction in the odds of conceiving an unplanned pregnancy compared with dispensing just one or three packs (confidence interval [CI] 0.57–0.87) and a 46% reduction in the odds of an abortion (95% CI 0.32–0.93), controlling for age, race or ethnicity, and previous pill use. CONCLUSION: Making oral contraceptives more accessible may reduce the incidence of unintended pregnancy and abortion. Health insurance programs and public health programs may avert costly unintended pregnancies by increasing dispensing limits on oral contraceptives to a 1-year supply.

Chorionic villus sampling and the risk of hypertensive disorders of pregnancy

BackgroundThere is conflicting evidence about whether chorionic villus sampling (CVS) increases the risk of hypertensive disorders of pregnancy (HTD). Our aim was to ascertain whether CVS affects the risk of...

Post abortion contraception and its effect on repeat abortions in Auckland, New Zealand

Background Many misconceptions still prevail about the appropriateness of use of the intrauterine device (IUD), particularly for younger women. This study examines the factors associated with post abortion IUD use as compared to the combined oral contraceptive pill (COC). It then examines the effect of type of post abortion contraception with the likelihood of seeking subsequent abortions. Study design This prospective cohort study followed, for a period of 3 years, 1422 women who had a first trimester surgical abortion between November 2004 and January 2005 in Auckland's public abortion clinic. Results Compared to women who left the clinic with COC, those leaving with an IUD (OR 0.3) at baseline were less likely to return for a subsequent abortion. Among women who had not had a previous termination, younger women were less likely than older women to have had an IUD inserted post abortion. With every additional live birth, women were three times as likely to have left the abortion clinic with an IUD. Among women who had had a previous termination, age was no longer significantly associated with post abortion IUD insertion. However, parity was still significantly associated, as was having a negative sexually transmitted infection test. Conclusions Young and nulliparous women are less likely to use an IUD as a method of contraception following an abortion. However, those women who have an IUD inserted following an abortion are much less likely to return for a subsequent abortion. IUDs are a safe and effective method of contraception that are currently still underused among the younger population.

First-trimester prenatal diagnosis performed on pregnant women with fetal ultrasound abnormalities: The reliability of interphase fluorescence in situ hybridization (FISH) on mesenchymal core for the main aneuploidies

Objectives To examine the reliability of interphase FISH analysis of the main aneuploidies performed on mesenchymal core when prenatal diagnosis was performed on pregnant women with first-trimester fetal abnormalities on ultrasound. Study design 386 first-trimester prenatal examinations were investigated from chorionic villus samplings for increased nuchal translucencies or other fetal ultrasound abnormalities. Interphase fluorescence in situ hybridization (FISH) for the main aneuploidies (trisomies 13, 18, 21 and gonosomal aneuploidies) was performed on the mesenchymal core of villi. Molecular cytogenetic results were always complemented by conventional cytogenetic results on long-term cultured villi (LTC-villi). Short-term cultured villi (STC-villi) preparations were retrospectively performed only when a chromosomal abnormality was observed with interphase FISH and/or LTC-villi. Results 88 chromosomal abnormalities (88/386 = 22.8% of first-trimester diagnoses) which could discuss subsequent abortions were observed after LTC-villi preparations. All cases possibly detectable by interphase FISH were detected. Thus, 85 aneuploidies (85/386 = 22.0% of first-trimester diagnoses; 85/88 = 96.6% of chromosomal abnormalities) were detected by interphase FISH, allowing early abortion by curettage before week 14 amenorrhea. No discrepancy occurred between interphase FISH and LTC-villi results for the aneuploidies studied. Three false-negative results (3/386 = 0.77% of first-trimester diagnoses; 3/88 = 3.41% of chromosomal abnormalities) were observed with STC-villi. Conclusion We observed a high rate of false-negative results on cytotrophoblast cells. Conversely, interphase FISH of the main aneuploidies on the mesenchymal core provided rapid and reliable results, and therefore should be preferred to STC-villi in first-trimester prenatal diagnosis performed on pregnant women with fetal abnormalities on ultrasound.

14. Ascending listeria monocytogenes infection in a pregnant woman causing foetal death in utero

A 33-year-old pregnant woman, G1P0 at 30 weeks gestation, presented to her obstetrician with abdominal tightness associated with fever. On examination, she was febrile (388C) and her full blood count showed leukocytosis with neutrophi-lia. Abdominal ultrasound examination revealed a foetal death <i>in utero</i> (FDIU). She had a spontaneous vaginal delivery. The liquor was heavily meconium stained. The autopsy examination found a mildly macerated male foetus with features suggestive of oligohydramnios. The placental disc was small (241g) and showed multiple yellow cream lesions (3–18mm) on the maternal surface. There was absent coiling of the umbilical cord. Multiple microbiological swabs from the placenta, foetal abdomen and pleura, as well as culture of foetal blood, all showed a heavy growth of <i>Listeria mono-cytogenes</i>. Light microscopy showed vasculitis and funisitis of the umbilical cord as well as grade 3 (of 3) acute chorioamnionitis. Multiple microabscesses and necrotising granulomata were identified in the placental disc, liver and lung. Gram stains confirmed the presence of extracellular Gram positive bacilli within the placenta and liver. Thus there was microbiological and histological evidence of disseminated granulomatous septicaemia, a known and almost always fatal outcome for this infection. Listeriosis is an uncommon and perhaps under-diagnosed cause of FDIU. It frequently occurs in the third trimester secondary to a decline in cell-mediated immunity. Symptomatic pregnant women frequently present with a febrile episode, as in our case, following a history of ingestion of contaminated food, e.g., raw soft cheese, raw vegetables, meat or sausage. Treatment and follow up of this patient is crucial as persistent vaginal colonisation by <i>Listeria</i> may cause subsequent abortions or stillbirths in future pregnancies.

Evidence for high levels of vertical transmission in Toxoplasma gondii

Toxoplasma gondii is a highly ubiquitous and prevalent parasite. Despite the cat being the only definitive host, it is found in almost all geographical areas and warm blooded animals. Three routes of transmission are recognised: ingestion of oocysts shed by the cat, carnivory and congenital transmission. In natural populations, it is difficult to establish the relative importance of these routes. This paper reviews recent work in our laboratory which suggests that congenital transmission may be much more important than previously thought. Using PCR detection of the parasite, studies in sheep show that congenital transmission may occur in as many as 66% of pregnancies. Furthermore, in families of sheep on the same farm, exposed to the same sources of oocysts, significant divergent prevalences of Toxoplasma infection and abortion are found between different families. The data suggest that breeding from infected ewes increases the risk of subsequent abortion and infection in lambs. Congenital transmission rates in a natural population of mice were found to be 75%. Interestingly, congenital transmission rates in humans were measured at 19.8%. The results presented in these studies differ from those of other published studies and suggest that vertical transmission may be much more important than previously thought.

Trends in prenatal sonography use and subsequent urologic diagnoses and abortions in the United States

Prenatal sonography has enabled fetal diagnosis of urologic conditions and is now commonly used in the US. The impact of this technology on the incidence of pediatric urological diagnoses is unknown. We sought to assess trends in prenatal sonography and resulting urologic diagnoses and/or abortions. Using administrative codes in Ingenix, a claims database of individuals with employer-based insurance, we identified women undergoing prenatal ultrasounds (1998-2005). These were linked to claims for subsequent abortions, live births, and postnatal urologic diagnoses in resulting offspring. 99.07% of women underwent ultrasound and childbirth. Ultrasound use among women whose pregnancies proceeded to birth increased from 90,568 to 96,866 per 100,000 mother-infant pairs from 1998 to 2005. Of women who did or did not undergo ultrasounds, 1.25% and 0.66% had infants with urologic diagnoses, respectively. The rates of prenatal ultrasound-detected urinary tract anomalies increased from 1032.26 per 100,000 live births in 1999 to 1225.71 per 100,000 live births in 2005. Prenatal ultrasound is widely used, but increased utilization of this diagnostic modality did not seem to be associated with abortions. The rate of pediatric urologic diagnoses in infants who had received prenatal ultrasound did not rise significantly over time.

Commentary to “Trends in prenatal sonography use and subsequent urologic diagnoses and abortions in the United States”

Commentary to “Trends in prenatal sonography use and subsequent urologic diagnoses and abortions in the United States”

Coerced sexual debut and lifetime abortion attempts among women in Rakai, Uganda

Objective To assess whether reported coercion at sexual debut is associated with a greater lifetime risk of attempting an abortion among women in Rakai, Uganda. Methods Analysis of data from sexually experienced, ever-pregnant women in a longitudinal, population-based, open cohort study in 56 rural communities in Rakai, Uganda (n = 4784). For univariate analysis, the t test was used for continuous variables and the Pearson χ 2 or Fisher exact tests for categorical variables. Multivariate logistic regression was used to control for potential confounding. Results Twenty percent of women reported coercion at sexual debut. Compared with women who reported consensual sexual debut, the adjusted odds ratio (OR) of subsequent abortion attempts among coerced women was 1.57 (95% CI, 1.11–2.20). Conclusion There is a need to protect women from sexual coercion, implement policies for prevention of violence, and provide comprehensive reproductive health care, including prevention of unwanted pregnancy and unsafe abortions.

Abortion and anxiety: What's the relationship?

Using data from the United States National Survey of Family Growth (NSFG) and the National Comorbidity Survey (NCS), we conducted secondary data analyses to examine the relationship of abortion, including multiple abortions, to anxiety after first pregnancy outcome in two studies. First, when analyzing the NSFG, we found that pre-pregnancy anxiety symptoms, rape history, age at first pregnancy outcome (abortion vs. delivery), race, marital status, income, education, subsequent abortions, and subsequent deliveries accounted for a significant association initially found between first pregnancy outcome and experiencing subsequent anxiety symptoms. We then tested the relationship of abortion to clinically diagnosed generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), and social anxiety disorder, using NCS data. Contrary to findings from our analyses of the NSFG, in the NCS analyses we did not find a significant relationship between first pregnancy outcome and subsequent rates of GAD, social anxiety, or PTSD. However, multiple abortions were found to be associated with much higher rates of PTSD and social anxiety; this relationship was largely explained by pre-pregnancy mental health disorders and their association with higher rates of violence. Researchers and clinicians need to learn more about the relations of violence exposure, mental health, and pregnancy outcome to avoid attributing poor mental health solely to pregnancy outcomes.

Failure of Sterilization After Clip Placement

Tubal sterilization is a common method of contraception used worldwide. The Filshie clip is a device designed to occlude the fallopian tubes. It is common practice to apply the clips across the isthmus using laparoscopy. It is often suggested that failures occur due to problems with the technique used to occlude the fallopian tubes. After insertion of an intrauterine device, a patient experienced an unplanned pregnancy and subsequent abortion. The intrauterine device was removed, and bilateral Filshie clips were applied by an experienced surgeon. After this procedure, the patient experienced a second unplanned pregnancy and subsequent abortion. A partial salpingectomy was performed after the fallopian tubes were examined, and it was confirmed that the Filshie clips were applied appropriately. It is important to understand why sterilization clips lead to contraceptive failure and to inform patients of this risk. Contraceptive failure after female sterilization remains a medical issue.

Repeated induction of abortion in bitches and the effect on plasma concentrations of relaxin, progesterone and estradiol-17β

The aim of the present study was to investigate the effects of two medications on two subsequent abortions and plasma hormone concentrations of dogs. For this purpose, two groups of bitches ( n = 5 each), received the antiprogesterone aglepristone (Alizine ®) at 10 mg/kg body weight on two subsequent days around day 30 after mating. In group II, the antiprolactin cabergoline (Galastop ®) was additionally administered po at 5 μg/kg body weight until the start of abortion. The plasma concentrations of relaxin, progesterone (P4) and estradiol-17β (E2) were measured before, during and after each abortion. During the next cycle after the abortion, the same bitches were mated again and in pregnant animals, induction of abortion was performed as before. During the third cycle, pregnant bitches were allowed to whelp. Termination of first pregnancy occurred significantly earlier after the combined treatment (6.8 versus 10.6 days, p < 0.05). In both groups and during both abortions, relaxin varied between individuals; however, there was a continuous decrease after the abortions and no significant differences between groups ( p > 0.05). In one bitch with high relaxin concentrations before treatment (11.6 ng/ml), a cystic endometrial hyperplasia was diagnosed. In the aglepristone only group, P4 concentrations increased significantly after the first application ( p < 0.05), then decreased continuously until day 45 after the beginning of abortion. In the combined group, there was a continuous decrease until day 45 ( p > 0.05). At this time, P4 concentrations between 0.47 and 84.9 nmol/l were measured in both groups. The level of E2 over time was not influenced by any medication. We therefore note that the two medications mainly influenced plasma concentrations of P4 in different ways, probably due to specific treatment-hormone interactions. However, all measurements fell within the range considered normal.

Arsenic Exposure in Pregnant Mice Disrupts Placental Vasculogenesis and Causes Spontaneous Abortion

Arsenic is an abundant toxicant in ground water and soil around areas with extractive industries. Human epidemiological studies have shown that arsenic exposure is linked to developmental defects and miscarriage. The placenta is known to utilize vasculogenesis to develop its circulation. The hypothesis tested here states the following: arsenic exposure causes placental dysmorphogenesis and defective placental vasculogenesis resulting in placental insufficiency and subsequent spontaneous abortion. To test this hypothesis, pregnant mice were exposed to sodium arsenite (AsIII) through drinking water from conception through weanling stages. Neonatal assessment of birth rates, pup weights, and litter sizes in arsenic exposed and control mothers revealed that AsIII-exposed mothers had only 40% the fecundity of controls. Preterm analysis at E12.5 revealed a loss of fecundity at E12.5 from either 20 ppm or greater exposures to AsIII. There was no loss of fecundity at E7.5 suggesting that spontaneous abortion occurs during placentation. Histomorphometry on E12.5 placentae from arsenic-exposed mice revealed placental dysplasia especially in the vasculature. These results suggest that arsenic toxicity is causative for mammalian spontaneous abortion by virtue of aberrant placental vasculogenesis and placental insufficiency.

Contraceptive Discontinuation and Failure and Subsequent Abortion in Romania: 1994–99

This study examines the levels and correlates of contraceptive failure and discontinuation in Romania, together with the consequences of contraceptive method failure in terms of induced abortion. Of special interest are women who rely on the traditional method of withdrawal and the proportion of withdrawal failures resulting in abortion. Our analysis is based on multiyear calendar data concerning women's contraceptive use and monthly reproductive behaviors collected in the 1999 Romanian Reproductive Health Survey. Weibull regression models are estimated to analyze the determinants of discontinuation and failure for all methods combined and for withdrawal. Overall, 19 and 28 percent of women became pregnant within the first year of using any contraceptive method and of practicing withdrawal, respectively. About 57 and 59 percent of failures from use of all methods and from withdrawal ended in abortion, accounting for 30 percent and 22 percent, respectively, of all abortions reported between 1994 and 1999. These findings suggest that high rates of contraceptive discontinuation and failure contributed significantly to the widespread reliance on induced abortion among Romanian women during this period.