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      The effect of method and gestational age at termination of pregnancy on future obstetric and perinatal outcomes: a register‐based cohort study in Aberdeen, Scotland

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          Abstract

          Objective

          To determine whether termination of pregnancy ( TOP), including the method used or gestational age at termination, affects future obstetric and perinatal outcomes.

          Design

          Register‐based cohort.

          Setting

          Aberdeen Maternity Hospital, Scotland, UK.

          Population

          From the Aberdeen Maternity and Neonatal Databank ( AMND) we identified 3186 women who had terminated their first pregnancy and then had a second pregnancy of beyond 24 weeks of gestation between 1986 and 2010. We identified 42 446 women who had their first delivery in the same time period, for comparison.

          Methods

          Univariate and multivariate logistic regression was used to compare outcomes between groups. Complete case analysis with adjustment of confounding factors was carried out, and adjusted odds ratios ( aORs) with 99% confidence intervals are presented.

          Main outcome measures

          The primary outcome was spontaneous preterm delivery ( SPTD).

          Results

          No statistically significant association was found between TOP in the first pregnancy and SPTD in the next pregnancy ( aOR 1.05; 99% CI 0.83–1.32). Neither medical ( aOR 1.03; 99% CI 0.72–1.46) nor surgical ( aOR 1.06; 99% CI 0.78–1.44) termination appeared to affect the risk of spontaneous preterm delivery in the subsequent pregnancy. Late termination (≥13 weeks of gestation) did not appear to increase the risk of spontaneous preterm delivery compared with early termination (<13 weeks of gestation) ( aOR 1.65; 99% CI 0.94–2.92), nor compared with primigravid women ( aOR 1.25; 99% CI 0.97–1.62). There was an associated increased risk of antepartum haemorrhage in the next pregnancy following TOP ( < 0.01; aOR 1.26; 99% CI 1.10–1.45).

          Conclusions

          Evidence on obstetric and perinatal outcomes following TOP remains conflicting. This study suggests that TOP is not associated with an increased risk of spontaneous preterm delivery. Neither the method nor the gestational age of TOP has any effect on this lack of association.

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          Most cited references32

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          The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.

          Much of biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.
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            The Environment and Disease: Association or Causation?

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              An overview of mortality and sequelae of preterm birth from infancy to adulthood.

              Survival rates have greatly improved in recent years for infants of borderline viability; however, these infants remain at risk of developing a wide array of complications, not only in the neonatal unit, but also in the long term. Morbidity is inversely related to gestational age; however, there is no gestational age, including term, that is wholly exempt. Neurodevelopmental disabilities and recurrent health problems take a toll in early childhood. Subsequently hidden disabilities such as school difficulties and behavioural problems become apparent and persist into adolescence. Reassuringly, however, most children born very preterm adjust remarkably well during their transition into adulthood. Because mortality rates have fallen, the focus for perinatal interventions is to develop strategies to reduce long-term morbidity, especially the prevention of brain injury and abnormal brain development. In addition, follow-up to middle age and beyond is warranted to identify the risks, especially for cardiovascular and metabolic disorders that are likely to be experienced by preterm survivors.
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                Author and article information

                Journal
                BJOG: An International Journal of Obstetrics & Gynaecology
                BJOG
                Wiley
                1470-0328
                1471-0528
                February 2014
                October 22 2013
                February 2014
                : 121
                : 3
                : 309-318
                Affiliations
                [1 ] Obstetrics &amp; Gynaecology Division of Applied Health Sciences School of Medicine and Dentistry University of Aberdeen Aberdeen UK
                [2 ] Department of Obstetrics &amp; Gynaecology Aberdeen Maternity Hospital and Aberdeen Royal Infirmary NHS Grampian Aberdeen UK
                [3 ] Obstetric Epidemiology Dugald Baird Centre for Research on Women's Health Aberdeen Maternity Hospital Aberdeen UK
                Article
                10.1111/1471-0528.12455
                24148689
                3b8dcb66-0a98-4ca5-aedc-ef127b0c730a
                © 2014

                http://onlinelibrary.wiley.com/termsAndConditions#vor

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