Late abortion ups later 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. “So these women need special care, such as easy access to reproductive services and provision of free of charge contraception.”

The best strategy to helping at-risk women avoid having repeat abortions, he added, would include counseling and making free, long-acting reversible methods of contraception easily available.

“Sexually active and highly fertile young people need high quality services and effective contraception,” he added. “The services must be provided so that they are easy to access and reach.”

SOURCE: American Journal of Obstetrics & Gynecology, online May 4, 2010.

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