Subsequent risk of preterm birth after second-trimester medical termination of pregnancy
Year: 2025
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Medical termination of pregnancy (using mifepristone and misoprostol) is a commonly performed health intervention. High-quality cohort studies are warranted to investigate the association between second-trimester medical termination of pregnancy and subsequent pregnancy outcomes. OBJECTIVE: This study aimed to assess the risk of subsequent spontaneous preterm birth after second-trimester medical termination of pregnancy. STUDY DESIGN: This was a cohort study performed at the Amsterdam University Medical Center of the University of Amsterdam. All individuals who underwent a second-trimester medical termination of pregnancy between 2008 and 2023 using mifepristone and/or misoprostol and had a known subsequent pregnancy up to 2024 were included. The exclusion criteria were other methods of termination (eg, cesarean delivery, hysterectomy, curettage, or Foley catheter) and indication for medical termination of pregnancy due to intrauterine fetal demise or preterm premature rupture of membranes. The primary outcome was spontaneous preterm birth at <37 weeks of gestation in the subsequent pregnancy. The secondary outcomes included subsequent miscarriage at <16 weeks of gestation, repeated termination, and rates of total, spontaneous, and iatrogenic preterm births at <37, <32, and <28 weeks of gestation. Subgroup analyses were performed on the interpregnancy interval, gestational age at medical termination of pregnancy, and postpartum surgical interventions using logistic regression estimating odds ratios and 95% confidence intervals, with adjustment for confounders. Subsequent singleton and multiple pregnancies were assessed separately. RESULTS: =0.31; P=.04). CONCLUSION: Second-trimester medical termination of pregnancy can be considered safe with regard to subsequent spontaneous preterm birth risk. As recommended after preterm and term births, patient counseling should include the importance of allowing time for cervical remodeling to mitigate preterm birth risks, particularly for those with a medical termination of pregnancy at higher gestational ages.
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,410
OpenAlex ID: W4410486273