Reproductive Performance following Midtrimester Termination of Pregnancy

Abstract

The aim of the study was to determine the impact of midtrimester abortion with extra-amniotic PGE₂ on future fertility and reproduction. Two hundred and fifteen women were enrolled. The mean induction-to-abortion interval was 21.3 h. The complication rate was 11.7%. Twenty women (9.3%) were lost to follow-up, 82 patients (38.1%) used contraception. Spontaneous pregnancy occurred in 110 out of 113 women who desired fertility (97%). Three patients were defined as infertile but conceived following treatment. The average time between the abortion and the next conception was 15.9 months (range 1–77 months). Seventy patients (63.7%) delivered at term. Premature delivery occurred in 18 patients (16.4%). Eighteen women aborted spontaneously in the first and 3 in the second trimester. One extrauterine pregnancy occurred. Second-trimester abortion with extra-amniotic PGE₂ is a safe procedure with a low rate of complication. Apparently it does not affect future fertility, but may be associated with an increased rate of premature deliveries in future gestations.

Women's awareness and perceptions of delay in childbearing

“…(23,24). A relatively high rate of terminations in our subfertile population thus tends to suggest that these women were able to conceive in the past and could favor an association of subfertility with increased age.…”

Effect of female age on the diagnostic categories of infertility

“…This could be due to the increased risk of acquiring pelvic infection with age (Bewley et al, 2005) or the effect of previous salphingectomy due to ectopic pregnancy. Earlier research has shown that previous terminations per se are not associated with impaired fertility in later life (Lurie et al, 1994;Debby et al, 2003).…”

Late Termination of Pregnancy for Fetal Anomaly

“…Rates vary between 0.77% and 8% for early infection (before day 7) and between 0.3% and 7.9% for late infection (after 8 days). 56,57 However TOP with extra-amniotic PGE2 may be associated with an increased rate of premature births in the next pregnancy. 46 Some complications may influence fertility and the course of subsequent pregnancies, such as uterine rupture, intra-uterine adhesions, pelvic inflammatory disease, or cervical incompetence.…”