Michel Tournaire


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    Physiological and reproductive outcomes

    Michel Tournaire, Sophie Gaudu, Philippe Faucher (France)

    Paris, France

    Surgical abortion. The influence of surgical abortion on subsequent reproductive outcome, reported for several decades in the literature can be summarized with seven criteria.

    1. Fertility. Four studies did not find an increased infertility after surgical abortion and one retrospective study showed a slight increase.
    2. Uterus. Synechiae have been diagnosed by hysteroscopy in 17 to 30% of the cases after curetage and 7.7% after suction.
    3. Miscarriage. In five studies from 1986 to 1998 the incidence of miscarriage after surgical abortion was not significantly increased. In a large series published in 2000 the risk of miscarriage was increased if the interval between abortion and the following pregnancy was lower than three months.
    4. Ectopic pregnancy. In seven studies no association was found between past history of surgical abortion and ectopic pregnancy, but two studies found such an association.
    5. Placental abnormalities. In nine studies there was an inceased risk of placenta praevia (OR 1.7 in a metaanalysis) after curetage but not after suction. The frequency of placenta accreta was not higher in two studies.
    6. Prematurity. In a metaanalysis published in 2003 twelve studies found a higher riskof prematurity (OR 1.3 to 2). In seven studies the risk increased with the number of previous surgical abortions. Eight found an increased risk for severe prematurity (<32w). However in the two most recent studies there was no augmentation of prematurity.
    7. Preeclampsia. In a majority of studies the ratio of pre eclampsia after induced abortion was reduced but only with women conceiving again with the same partner.

    Medical abortion. Despite the increasing proportion of abortion by means of medication, limited information is available regarding the effects of this procedure on subsequent pregnancies.

    A recent (2008) metaanalysis including eight studies on reproductive outcome compared the influence of medical and surgical abortion. The incidence of miscarriage and post partum hemorrage was significantly lower for the pregnancy immediatly following a medical abortion. No other significant difference was found.

    For the outcome of the future pregnancies, medical abortion may thus be safer than the surgical option.

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    Second trimester abortion: medical or surgical abortion?
    Michel Tournaire, M. Bornes, S. Gaudu, F. Lewin
    Hopital Saint Vincent de Paul, Paris, France
    The methods for second trimester abortion vary according to countries and institutions.
    Medical methods using preparation of the cervix and misoprostol are predominant in
    Europe. Surgical dilatation and evacuation requires practitioners trained for this technique.
    It is used for almost all second trimester abortions in the USA and is available in some
    institutions in Australia, England, France and the Netherlands. Complications are more
    frequent with medical method : retention of placenta that needs secondary surgical
    removal, hemorrhage with transfusions and rupture of the uterus, risk that is increased in
    the cases of previous cesarean section. Surgical method can be complicated by
    perforation of the uterus and laceration of the cervix. The risk for premature birth in
    subsequent pregnancies seems to be low for the two methods. Emotional consequences
    have been found identical with both techniques. The choice of the method is not based on
    scientific data but on the practitioner’s experience. If the two methods could be available in the same institution, this would allow, well informed women to participate using their choice.