Monier Isabelle, Lelong Nathalie, Ancel Pierre-Yves, Benachi Alexandra, Khoshnood Babak, Zeitlin Jennifer, Blondel Béatrice
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France; Antoine Beclere Maternity Unit, Department of Obstetrics and Gynaecology, University Paris Sud, AP-HP, Paris, France.
Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in pregnancy, Paris Descartes University, Paris, France.
Eur J Obstet Gynecol Reprod Biol. 2019 Feb;233:12-18. doi: 10.1016/j.ejogrb.2018.11.021. Epub 2018 Dec 3.
To estimate the prevalence and indications of terminations of pregnancy (TOP) between 22 and 31 weeks of gestational age in France and to examine the characteristics of women by indication of TOP.
From the EPIPAGE 2 population-based cohort study of preterm births in France in 2011, we selected 5009 singleton live births, stillbirths and TOP that occurred between 22 and 31 weeks. We estimated the proportion of TOP by gestational age. We then classified terminations by indications into 4 categories: fetal anomalies (TOPFA), preterm premature rupture of the membranes (PPROM), maternal conditions and fetal growth restriction (FGR). We also classified TOPFA by type of anomaly. Maternal characteristics were compared between TOPFA and TOP for maternal or fetal conditions without congenital anomaly.
23.1% of all births and 54.3% of stillbirths were terminations. The proportion of terminations was 36.9% of all births at 22 weeks, 50.2% at 24 weeks and <10% at 30-31 weeks. 85.8% of terminations were for fetal anomaly, 4.4% for PPROM, 6.1% for maternal complications and 3.7% for severe FGR. Compared to women with a TOPFA, those with a termination for maternal or fetal conditions were more often nulliparous, single, African, obese, smokers and covered by non-standard insurance for women in socially deprived circumstances.
In France, there is a high proportion of TOP of which 14% are for indications other than congenital anomalies. Because rates of terminations have an impact on very preterm birth and perinatal mortality rates, studies on pregnancy outcome should report all terminations, not only those for congenital anomalies.
评估法国孕22至31周妊娠终止(TOP)的患病率及指征,并按TOP指征检查女性特征。
从2011年法国基于人群的EPIPAGE 2早产队列研究中,我们选取了5009例孕22至31周发生的单胎活产、死产和TOP。我们按孕周估算TOP的比例。然后将终止妊娠按指征分为4类:胎儿异常(TOPFA)、胎膜早破(PPROM)、母体疾病和胎儿生长受限(FGR)。我们还按异常类型对TOPFA进行分类。比较了TOPFA与因母体或胎儿疾病(无先天性异常)导致的TOP之间的母体特征。
所有分娩中有23.1%以及死产中有54.3%为妊娠终止。妊娠终止比例在孕22周时占所有分娩的36.9%,24周时为50.2%,30 - 31周时<10%。85.8%的妊娠终止是由于胎儿异常,4.4%是由于PPROM,6.1%是由于母体并发症,3.7%是由于严重FGR。与TOPFA的女性相比,因母体或胎儿疾病而终止妊娠的女性更常为初产妇、单身、非洲裔、肥胖、吸烟者,且在社会贫困环境中由非标准女性保险覆盖。
在法国,妊娠终止比例较高,其中14%是由先天性异常以外的指征导致。由于终止妊娠率会影响极早产和围产儿死亡率,关于妊娠结局的研究应报告所有妊娠终止情况,而不仅仅是那些因先天性异常导致的情况。