title: Medical versus surgical termination of pregnancy in primigravid women--is the next delivery differently at risk? A population-based register study.
abstract: OBJECTIVE
  To compare the effect of medical versus surgical termination of pregnancy (TOP), performed in primigravid women, on subsequent delivery.
  
  
  METHODS
  Population-based register study.
  
  
  METHODS
  Finland 2000-2009.
  
  
  METHODS
  All primigravid women (n = 8294) who underwent TOP during first trimester of pregnancy by medical (n = 3441) or surgical (n = 4853) method, and whose subsequent pregnancy resulted in singleton delivery.
  
  
  METHODS
  The women were identified in the Finnish Register of Induced Abortions, and the data were linked to the Medical Birth and the Hospital Discharge Registries.
  
  
  METHODS
  Risk of preterm birth, low birthweight, small-for-gestational-age (SGA) infant and placental complications (placenta praevia, placental abruption, retained placenta, placenta accreta).
  
  
  RESULTS
  No statistically significant differences in the incidences of preterm birth (4.0% in the medical group versus 4.9% in the surgical group), low birthweight (3.4% versus 4.0%), SGA infants (2.6% versus 2.9%) or placental complications (2.6% versus 2.8%) emerged between the two groups. After adjusting for various background factors, medical TOP was not associated with significantly altered risks of preterm birth (odds ratio [OR] 0.87, 95% confidence interval [95% CI] 0.68-1.13), low birthweight (OR 0.90, 95% CI 0.68-1.19), SGA infant (OR 0.87, 95% CI 0.64-1.20) or placental complications (OR 0.98, 95% CI 0.72-1.34) versus surgical TOP. In a sub-analysis excluding women who underwent surgical evacuation following the index TOP, medical TOP was associated with a reduced risk of preterm birth (P < 0.01), but the difference became insignificant after adjusting for gestational age at the time of TOP, inter-pregnancy interval, maternal age, cohabitation status, socio-economic status, residence and smoking during pregnancy.
  
  
  CONCLUSIONS
  A history of one medical versus surgical TOP, performed in primigravid women, is associated with similar obstetric risks in the subsequent delivery.
authors.affiliation: Department of Obstetrics and Gynaecology, University Hospital of Oulu, Oulu, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Männistö
authors.forename: M
authors.initials: M
authors.lastname: Mentula
authors.forename: A
authors.initials: A
authors.lastname: Bloigu
authors.forename: E
authors.initials: E
authors.lastname: Hemminki
authors.forename: M
authors.initials: M
authors.lastname: Gissler
authors.forename: O
authors.initials: O
authors.lastname: Heikinheimo
authors.forename: M
authors.initials: M
authors.lastname: Niinimäki
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000009:adverse effects; D000021:Abortifacient Agents, Steroidal / Q000009:adverse effects; D000028:Abortion, Induced / Q000009:adverse effects / Q000379:methods*; D000293:Adolescent; D000328:Adult; D001721:Birth Intervals; D004107:Dilatation and Curettage / Q000009:adverse effects; D004338:Drug Combinations; D005260:Female; D020073:Gravidity; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008423:Maternal Age; D015735:Mifepristone / Q000009:adverse effects; D016595:Misoprostol / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*; D011261:Pregnancy Trimester, First; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D004338:Drug Combinations; D016595:Misoprostol; D015735:Mifepristone