中孕期流产与活产风险。

Second-trimester abortion and risk of live birth.

机构信息

Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada; Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada.

Health Innovation and Evaluation Hub, University of Montreal Hospital Research Centre, Montreal, Canada.

出版信息

Am J Obstet Gynecol. 2024 Jun;230(6):679.e1-679.e9. doi: 10.1016/j.ajog.2023.11.004. Epub 2023 Nov 7.

DOI:10.1016/j.ajog.2023.11.004

PMID:37939985

Abstract

BACKGROUND

Second-trimester abortion may result in a live birth, but the extent to which this outcome occurs is unknown.

OBJECTIVE

This study aimed to examine rates of live birth after pregnancy termination in the second trimester and identify associated risk factors.

STUDY DESIGN

We conducted a retrospective cohort study of 13,777 second-trimester abortions occurring in hospital settings between April 1, 1989 and March 31, 2021 in Quebec, Canada. The exposure was induced abortion between 15 and 29 weeks of gestation, including the indication for (fetal anomaly, maternal emergency, other) and use of feticidal injection (intracardiac/intrathoracic or intraamniotic). The primary outcome was live birth following abortion. We measured the rate of live birth per 100 abortions and used adjusted log-binomial regression models to estimate risk ratios and 95% confidence intervals for the association of fetal and maternal characteristics with the risk of live birth. We assessed the extent to which feticidal injection reduced the risk.

RESULTS

Among 13,777 abortions between 15 and 29 weeks of gestation, 1541 (11.2%) led to live birth. Fetal anomaly was a common indication for termination (48.1%), and most abortions were by labor induction (72.2%). Compared with abortion between 15 and 19 weeks, abortion between 20 and 24 weeks was associated with 4.80 times the risk of live birth (95% confidence interval, 4.20-5.48), whereas abortion between 25 and 29 weeks was associated with 1.34 times the risk (95% confidence interval, 1.00-1.79). Feticidal injection reduced the risk of live birth by 57% compared with no injection (risk ratio, 0.43; 95% confidence interval, 0.36-0.51). Intracardiac or intrathoracic injection was particularly effective at preventing live birth (risk ratio, 0.02; 95% confidence interval, 0.01-0.07).

CONCLUSION

Second-trimester abortion carries a risk of live birth, especially at 20 to 24 weeks of gestation, although feticidal injection may protect against this outcome.

摘要

背景

妊娠中期流产可能导致活产，但这种结局发生的程度尚不清楚。

目的

本研究旨在检查妊娠中期终止妊娠后活产的发生率，并确定相关的危险因素。

研究设计

我们对加拿大魁北克省 1989 年 4 月 1 日至 2021 年 3 月 31 日期间在医院环境中进行的 13777 例妊娠中期流产进行了回顾性队列研究。暴露因素为妊娠 15-29 周时的诱导性流产，包括流产原因（胎儿异常、母亲紧急情况、其他）和使用胎儿杀伤性注射（心内/胸内或羊膜内）。主要结局是流产后活产。我们测量了每 100 例流产中活产的比例，并使用调整后的对数二项式回归模型估计胎儿和母体特征与活产风险的关联的风险比和 95%置信区间。我们评估了胎儿杀伤性注射降低风险的程度。

结果

在 13777 例妊娠 15-29 周的流产中，有 1541 例（11.2%）导致活产。胎儿异常是终止妊娠的常见原因（48.1%），大多数流产是通过引产（72.2%）。与妊娠 15-19 周的流产相比，妊娠 20-24 周的流产活产风险增加 4.80 倍（95%置信区间，4.20-5.48），而妊娠 25-29 周的流产活产风险增加 1.34 倍（95%置信区间，1.00-1.79）。与未注射相比，胎儿杀伤性注射可降低 57%的活产风险（风险比，0.43；95%置信区间，0.36-0.51）。心内或胸内注射在预防活产方面特别有效（风险比，0.02；95%置信区间，0.01-0.07）。