采用不同方法进行人工终止妊娠后的围产期结局：基于芬兰1996 - 2013年首次分娩情况的全国登记研究
Perinatal outcomes after induced termination of pregnancy by methods: A nationwide register-based study of first births in Finland 1996-2013.
作者信息
Kc Situ, Hemminki Elina, Gissler Mika, Virtanen Suvi M, Klemetti Reija
机构信息
School of Social Sciences, University of Tampere, Tampere, Finland.
Department of Health and Social Care Systems, National Institute for Health and Welfare, Helsinki, Finland.
出版信息
PLoS One. 2017 Sep 1;12(9):e0184078. doi: 10.1371/journal.pone.0184078. eCollection 2017.
BACKGROUND
Women with previous terminations of pregnancy (TOPs) before their first birth have been associated with poorer perinatal outcomes. However, previous studies on the perinatal outcomes by the method in previous TOPs are inconsistent.
OBJECTIVE
To examine the perinatal outcomes of the first-time mothers with singleton births, by the method of previous TOP (medical and surgical vs no TOP, and surgical vs medical).
METHOD
This is a nationwide register-based study including 419,879 first-time Finnish mothers with singleton birth during the time period 1996-2013. Mothers having their first birth were identified from the Medical Birth Register and linked to the Abortion Register by their identification numbers. Multinomial logistic regression analysis was performed to examine the risk for preterm birth, low birth weight, small for gestational age and perinatal death by the method in previous TOPs.
RESULTS
Among the first-time mothers, 87.0% had no history of TOPs, 3.2% had a history of medical TOP(s), 9.2% had a history of surgical TOP(s) and 0.6% had a history of both (medical and surgical) TOP(s). No significant differences in perinatal outcomes were found among the women with surgical TOPs, compared to the women with no TOPs. In unadjusted analysis, increased odds for preterm birth and low birth weight were found when comparing women having previous surgical TOPs with medical TOPs. Even after the adjustment of potential confounders, odds for preterm birth < 37 weeks (OR = 1.19, 95% CI = 1.04-1.36) and low birth weight < 2500 g (OR = 1.16, 95% CI = 1.00-1.35) remained significant. After restricting data to the single TOP, the results were similar; OR for both preterm birth and low birth weight was 1.18 (95% CIs = 1.02-1.36 and 1.01-1.38).
CONCLUSION
Perinatal outcomes did not differ among the mothers with surgical TOPs compared to the mothers with no TOPs, while the outcomes were poorer after surgical TOP(s) than after medical TOP(s).
背景
首次生育前有过终止妊娠（TOPs）经历的女性，其围产期结局较差。然而，既往关于既往TOPs方法的围产期结局的研究结果并不一致。
目的
通过既往TOPs的方法（药物流产和手术流产与未进行TOPs，以及手术流产与药物流产），研究首次单胎分娩母亲的围产期结局。
方法
这是一项基于全国登记册的研究，纳入了1996年至2013年期间芬兰419,879名首次单胎分娩的母亲。首次分娩的母亲从医疗出生登记册中识别出来，并通过其身份证号码与堕胎登记册相链接。采用多项逻辑回归分析，以既往TOPs的方法研究早产、低出生体重、小于胎龄儿和围产期死亡的风险。
结果
在首次分娩的母亲中，87.0%无TOPs病史，3.2%有药物流产病史，9.2%有手术流产病史，0.6%有药物流产和手术流产病史。与未进行TOPs的女性相比，进行手术流产的女性围产期结局无显著差异。在未调整分析中，将既往进行手术流产的女性与药物流产的女性相比，早产和低出生体重的几率增加。即使在调整潜在混杂因素后，孕周<37周的早产几率（OR = 1.19，95%CI = 1.04 - 1.36）和出生体重<2500g的低出生体重几率（OR = 1.16，95%CI = 1.00 - 1.35）仍然显著。将数据限制为单次TOPs后，结果相似；早产和低出生体重的OR均为1.18（95%CI分别为1.02 - 1.36和1.01 - 1.38）。
结论
与未进行TOPs的母亲相比，进行手术流产的母亲围产期结局无差异，但手术流产后的结局比药物流产后的结局更差。
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