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Late-Term Abortion Ups Repeat Pregnancy Termination Risk

Women who have an abortion in the second trimester of pregnancy are more likely than women who terminate their pregnancies earlier to have repeat abortions, new research shows.

And women who initially have a late abortion are also substantially more likely to have a second late abortion, Dr. Oskari Heikinheimo of Helsinki University Hospital in Finland and colleagues found. They also found that being younger than 20 sharply increased a woman's risk of having repeat abortions, and of having repeat late abortions.

The further along a woman is in her pregnancy the more risky it is to terminate the pregnancy, the researchers note in the American Journal of Obstetrics & Gynecology.

"Several studies have shown that the later the abortion is performed, the greater the risk of complications is," Heikinheimo explained in an email to Reuters Health. "The most common complications are bleeding and infection."

Abortion is still very common around the world even though birth control options have improved in recent years. Late termination of pregnancy — meaning abortion at 13 weeks gestation or later — represents 5 to 10 percent of all abortions, the researchers note, while from 30 to 47 percent of women who have an abortion will have another later on.

To better understand factors associated with repeat abortion, as well as risk factors for having an abortion after the first trimester, Heikinheimo and colleagues looked at 41,750 Finnish women who had an abortion between 2000 and 2005 — 1,900 of whom terminated their pregnancies in the second trimester.

Compared with women who had first trimester abortions, those who had second-trimester abortions were 40 percent more likely to have had a second abortion by the end of 2006, the researchers found, while they were nearly four times as likely to have a second late abortion, and five times as likely to have an abortion after 16 weeks' gestation.

And women younger than 20 years old were seven times as likely as older women to have repeat abortions, and more than 12 times as likely to have a second abortion during their second trimester of pregnancy.

Lack of access to abortions was unlikely to be a factor in whether or not women had late abortions, the researchers note, given that by Finnish law there must be "no unnecessary delays" in performing abortion once a woman decides to apply for one; also, almost all of the abortions in the study were done in public hospitals.

"Late abortion might also be a 'marker' for difficulty in a young woman's ability to manage her own life," Heikinheimo told Reuters Health.

SOURCE:  [page not found; link incorrect] (10)00291-7/abstract
American Journal of Obstetrics & Gynecology (AJOG), online May 4, 2010.
[2June 2010, Anne Harding, New York, Reuters Health,

Young Age and Termination of Pregnancy During the Second Trimester are Risk Factors for Repeat Second-Trimester Abortion

The objective of the study was to characterize women undergoing a termination of pregnancy (TOP) during the second trimester and to evaluate the risk factors and timing of repeat TOP.
Study Design

This nationwide retrospective cohort study investigated 41,750 women who underwent TOP during the first (n = 39,850) or second (n = 1900) trimester in Finland in 2000-2005. The follow-up time was until repeat TOP or until Dec. 31, 2006.

TOP during the second trimester increases the risk of repeat TOP (hazard ratio [HR], 1.4; 95% confidence interval [CI], 1.3–1.6), repeat second-trimester TOP (HR, 3.8; 95% CI, 2.9–5.1), and repeat TOP after 16 weeks of gestation (HR, 5.0; 95% CI, 3.3–7.7). The other risk factor for these is young age (HR, 7.0, 95% CI, 5.3–9.3; and HR, 12.5; 95% CI, 3.1–50.4 for age <20 years).

Conclusion: Second-trimester TOP and young age are risk factors for repeat second-trimester TOP. Special focus on these women might be effective in decreasing repeat abortions.
[American Journal of Obstetrics and Gynecology, Volume 203, Issue 2, August 2010, Pages 107.e1-107.e7
doi:10.1016/j.ajog.2010.03.004 ; Maarit J. Mentula MDa, Maarit Niinimäki MD, PhDd, Satu Suhonen MD, PhDb, Elina Hemminki MD, PhDc, Mika Gissler MSocSc, PhDc, e and Oskari Heikinheimo MD, PhDa, Available online 1 May 2010]