Auger Nathalie, Bilodeau-Bertrand Marianne, Sauve Reg
Institut national de santx00E9; publique du Qux00E9;bec, Montreal, Que., Canada.
Neonatology. 2016;109(2):147-53. doi: 10.1159/000442279. Epub 2016 Jan 5.
Fetal imaging for congenital anomalies increases pregnancy terminations late in gestation.
We assessed whether late-pregnancy terminations can accidentally result in live births, and how these births impact infant mortality rates over time.
We carried out a population-level analysis of 12,141 infant deaths in Quebec, Canada from 1986 to 2012. We calculated the proportion of infants born alive who died following pregnancy termination. The exposure was pregnancy termination with or without congenital anomaly recorded on death certificates. The main outcome was mortality on the first day of life by the hour.
Pregnancy termination was the cause of 19.4 infant deaths per 100,000 in 2000-2012, compared with 1.0 per 100,000 in 1986-1999. Most deaths after termination occurred in the first 3 h of life among infants with anomalies who weighed <500 g. In 2000-2012, infants who died following pregnancy termination led to an excess of 0.2 deaths per 1,000 on the first day of life, i.e. an 8.6% increase in the infant mortality rate (p value = 0.002).
Pregnancy termination in mid-gestation carries the risk of accidental live birth. These neonates increasingly affect infant mortality rates. Better recording is needed, including data on the prevention and management of accidental live births after pregnancy termination.
针对先天性异常的胎儿成像增加了妊娠晚期的终止妊娠情况。
我们评估了妊娠晚期终止妊娠是否会意外导致活产，以及随着时间推移这些活产对婴儿死亡率有何影响。
我们对1986年至2012年加拿大魁北克省的12141例婴儿死亡进行了人群水平分析。我们计算了终止妊娠后存活出生但死亡的婴儿比例。暴露因素为死亡证明上记录有或无先天性异常的终止妊娠情况。主要结局是按小时计算的出生第一天的死亡率。
2000 - 2012年，每10万人中有19.4例婴儿死亡是由终止妊娠导致的，而1986 - 1999年这一数字为每10万人中有1.0例。终止妊娠后的大多数死亡发生在出生体重<500g且有异常的婴儿出生后的前3小时内。在2000 - 2012年，终止妊娠后死亡的婴儿导致出生第一天每1000例中有0.2例额外死亡，即婴儿死亡率增加了8.6%（p值 = 0.002）。
妊娠中期终止妊娠存在意外活产的风险。这些新生儿对婴儿死亡率的影响日益增加。需要更好地进行记录，包括终止妊娠后意外活产的预防和管理数据。
