Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Acta Obstet Gynecol Scand. 2021 Apr;100(4):743-750. doi: 10.1111/aogs.14078. Epub 2021 Jan 23.
To evaluate the effect of method of induced abortion and other abortion-associated variables on the incidence of fear of childbirth in subsequent pregnancy.
This population-based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000-2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85-168 days of gestation). Primary outcome measures were the incidence of registry-identified fear of childbirth and cesarean delivery related to it.
The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95-10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68-0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84-0.90) were decreased in women with a history of first-trimester medical abortion compared with those with first-trimester surgical abortion. Second-trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71-1.50). Maternal age of 30-39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not.
One first- or second-trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first-trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.
评估人工流产方法和其他与流产相关的变量对后续妊娠分娩恐惧发生率的影响。
本基于人群的注册研究队列包括所有 2000 年至 2015 年间首次妊娠因人工流产而终止且 2000 年至 2017 年间后续妊娠为活单胎分娩的初产妇（n=21479）。数据来自芬兰健康与福利研究所维护的三个国家登记处。我们将研究人群分为三组：（a）孕早期（≤84 天妊娠）的医疗和（b）手术流产，以及（c）孕中期（85-168 天妊娠）的药物流产。主要结局指标是登记处确定的分娩恐惧和与之相关的剖宫产发生率。
总体分娩恐惧发生率为 5.6%（n=1209）。共有 19.2%（n=4121）的女性行剖宫产术。在有分娩恐惧的女性中，选择性剖宫产术的比值比（OR）升高（9.30，95%CI 7.95-10.88，P<0.001）。多变量分析显示，与孕早期手术流产相比，孕早期药物流产史的女性发生分娩恐惧（调整后的 OR[aOR]0.80，95%CI 0.68-0.94）和剖宫产（aOR 0.66，95%CI 0.84-0.90）的比值降低。孕中期药物流产对分娩恐惧的比值无影响（aOR 1.04，95%CI 0.71-1.50）。30-39 岁的产妇年龄和两次妊娠间隔超过 2 年是分娩恐惧和剖宫产的额外危险因素，但流产后子宫排空术不是。
与孕早期手术流产相比，一次或两次孕早期药物流产不会增加后续妊娠中分娩恐惧及其相关剖宫产的几率。产妇年龄较大和两次妊娠间隔时间较长是分娩恐惧的危险因素。
