Second-trimester abortion and risk of live birth - 28/11/23

Doi : 10.1016/j.ajog.2023.11.004

Nathalie Auger, MD, MSc, FRCPC ^a,^b,^c,^⁎ , Émilie Brousseau, MSc ^a, Aimina Ayoub, MSc ^a, William D. Fraser, MD, MSc, FRCSC ^d
^a Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Canada
^b Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
^c Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada
^d Department of Obstetrics and Gynecology, Sherbrooke University Hospital Research Centre, Sherbrooke, Canada

^∗Corresponding author: Nathalie Auger, MD, MSc, FRCPC.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Tuesday 28 November 2023

Abstract

Background

Second-trimester abortion may result in a live birth, but the extent to which this outcome occurs is unknown.

Objective

This study aimed to examine rates of live birth after pregnancy termination in the second trimester and identify associated risk factors.

Study Design

We conducted a retrospective cohort study of 13,777 second-trimester abortions occurring in hospital settings between April 1, 1989 and March 31, 2021 in Quebec, Canada. The exposure was induced abortion between 15 and 29 weeks of gestation, including the indication for (fetal anomaly, maternal emergency, other) and use of feticidal injection (intracardiac/intrathoracic or intraamniotic). The primary outcome was live birth following abortion. We measured the rate of live birth per 100 abortions and used adjusted log-binomial regression models to estimate risk ratios and 95% confidence intervals for the association of fetal and maternal characteristics with the risk of live birth. We assessed the extent to which feticidal injection reduced the risk.

Results

Among 13,777 abortions between 15 and 29 weeks of gestation, 1541 (11.2%) led to live birth. Fetal anomaly was a common indication for termination (48.1%), and most abortions were by labor induction (72.2%). Compared with abortion between 15 and 19 weeks, abortion between 20 and 24 weeks was associated with 4.80 times the risk of live birth (95% confidence interval, 4.20–5.48), whereas abortion between 25 and 29 weeks was associated with 1.34 times the risk (95% confidence interval, 1.00–1.79). Feticidal injection reduced the risk of live birth by 57% compared with no injection (risk ratio, 0.43; 95% confidence interval, 0.36–0.51). Intracardiac or intrathoracic injection was particularly effective at preventing live birth (risk ratio, 0.02; 95% confidence interval, 0.01–0.07).

Conclusion

Second-trimester abortion carries a risk of live birth, especially at 20 to 24 weeks of gestation, although feticidal injection may protect against this outcome.

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Video

(5.58 Mo)Video 1Video 1.

Auger. Termination of pregnancy and live birth. Am J Obstet Gynecol 2023.

Le texte complet de cet article est disponible en PDF.

Key words : autopsy, congenital abnormalities, gestational age, induced abortion, live birth, neonatal intensive care, palliative care, perinatal mortality, pregnancy complications

Plan

Introduction

Materials and Methods

Results in the context of what is known

Implications

Strengths and limitations

Conclusions

	The authors report no conflict of interest.
	This study was funded by the Canadian Institutes of Health Research (PJT-162300) and the Fonds de recherche du Québec - Santé (296785). The funding sources had no involvement in the study design; the collection, analysis, or interpretation of data; the writing of the report; or the decision to submit the article for publication.
	Cite this article as: Auger N, Brousseau É, Ayoub A, et al. Second-trimester abortion and risk of live birth. Am J Obstet Gynecol 2023;XX:x.ex–x.ex.