Termination Of Pregnancy Effects On Subsequent Pregnancy Outcomes Among Advanced Maternal Age Women:a Retrospective Cohort Study In China

Objectives:The main objective of the study was to determine whether the presence of previous induced abortion among advanced maternal age Chinese women, negatively affects subsequent pregnancy or perinatal outcomes.Methods:This is a retrospective cohort study. Clinical data were collected from three public hospitals in Wuhan city namely Tongji, Xihe, and Wuhan central hospitals. Hospital records for4574women who were admitted during the period between1st of March2012and1st of January2013were reviewed for eligibility and any woman who had twin pregnancy or previous history of spontaneous abortion, congenital abnormality in the uterus based on clinical records, any multiparous woman or if her age younger than35years of age were not included in the study. Only216primiparous women were eligible whose their aged35years or above, with a singleton pregnancy with or without history of induced abortion and were included in the analysis. Each eligible woman have interviewed and monitored during her postpartum stay in hospital.Data were entered and checked for consistency and completeness using Microsoft excel2010then imported into IBM Spss19for further analysis. Statistical analysis of differences in outcomes and complications between groups was performed using IBM Spss software version19. Mann-Whitney-Wilcoxon test was used for compares between two means. We used a binary logistic regression analyses (multivariate logistic regression analyses) for each outcome of interest to adjust for potential confounders. Confidence intervals (CI) were evaluated at95%. Level of significance throughout the study analysis were considered at a P value level of<0.5.Results:Repeated induced abortion exerts excess risk to develop threatening miscarriage, premature rupture of membrane and preterm delivery compared to women without any previous induced abortion of advanced maternal age for the same age group over all adjusted OR (95%CI)3.32(1.16-9.49),2.94(0.90-9.57),1.51(0.24-9.24), respectively. Previous induced abortion also associated with increased risk for intrauterine growth retardation, low Birth weight<2500g, fetal asphyxia and very low Apgar score at1minute, OR (95%CI)2.01(0.81-4.97),3.55(1.12-11.28),2.03(0.61-15.8),3.11(0.61-15.8), respectively.Differential analysis for the number of previous induced abortion show a dose response effect on the development of adverse perinatal and obstetric complications.No any significant difference of the obstetric and perinatal outcomes was observed between medical and surgical induced abortion except for threatened miscarriage complication which was more prevalent among medical group OR (95%CI)4.17(1.34-12.89).Conclusion:This study suggests that a history of induced abortion increases the risk of adverse obstetric and perinatal outcomes, particularly for women who have had repeated abortions.The respective role of the surgical and medical techniques used for induced abortions have been explored and no significant difference in outcomes was found except for threatened miscarriage, which was more prevalent among medical induced abortion rather than surgical one.