CJMA AWARE

Post abortion problems CJMA

Letter to the editor of the Canadian Medical Association Journal     (Dr. John Hoey),

     There are at least thirty-three studies reporting that the most common elective surgery for women in Canada and the United States significantly increases the risk of a subsequent preterm or low birth weight delivery.1-33  The March 6, 2001 issue of CMAJ identified fear of malpractice litigation as a cause of family physicians delivering fewer newborn.34  Preterm newborn are at much increased risk for handicaps such as asthma, blindness, deafness, low IQ, CP (Cerebral Palsy), etc.  When the public becomes aware that the most common elective surgery boosts prematurity risk, malpractice law suits may proliferate.  Specifically, more parents of newborn with cerebral palsy may initiate malpractice law suits against gynecologists.35 How to stem this potential litigation 'wave'?  Surgeons must seriously consider abstaining from elective surgeries that raise a woman's future risk of premature delivery.  Doctors have a legal duty to protect women's health, not recklessly endanger it.36  Let's assure that legal duty is fulfilled.  Elective  pregnancy 'terminations' carry a high litigation risk through the future premature delivery exposure.  "First, do no harm" is written into Canadian and U.S. law.

Brent Rooney (Independent Medical Researcher) Reduce Preterm Risk Coalition Vancouver, Canada

References

 1 Zhou W, Sorenson HT, Olsen H. Induced Abortion    and Subsequent Pregnancy Duration. Obstetrics &    Gynecology 1999;94:948-953

 2 Berkowitz GS. An Epidemiologic Study of Preterm    Delivery. American J Epidemiology 1981;113:81-92

 3 Lang JM, Lieberman E, Cohen A.  A  Comparison    of Risk Factors for Preterm Labor and Term    Small-for-Gestational-Age Birth. Epidemiology    1996;7:369-376

 4 Lieberman E, Ryan KJ, Monson RR, Schoenbaum SC.    Risk Factors Accounting For Racial Differences    in the rate of premature birth. NEJM 1987;317:    743-748

 5*Hillier SL, Nugent RP, Eschenbach DA, Krohn MA,    et al. Association Between Bacterial Vaginosis    And Preterm Delivery Of A Low-Birth-Weight    Infant. NEJM 1995;333:1737-1742

 6 Schoenbaum LS, Monson RR. No association between    coffee consumption and adverse outcomes of pregnancy.    NEJM 1982;306:141-145

 7 Mueller-Heubach E, Guzick DS. Evaluation of    risk scoring in a preterm birth prevention    study of indigent patients. Am J Obstetrics    & Gyn  1989;160:829-837

 8 Shiono PH, Lebanoff MA.  Ethnic  Differences    and  Very Preterm Delivery. Am J Public Health    1986;76:1317-1321

 9 Pantelakis SN, Papadimitriou GC, Doxiadis SA.    Influence of induced and spontaneous abortions    on the outcome of subsequent pregnancies. Amer    J Obstet Gynecol. 1973;116:799-805

10 Lumley J. The association between prior spon-    taneous abortion, prior induced abortion and    preterm birth in first singleton births.    Prenat Neonat Med 1998;3:21-24.

11 Van Der Slikke JW, Treffers PE. Influence of    induced abortion on gestational  duration in    subsequent pregnancies. BMJ 1978;1:270-272    [>95% confident of preterm risk for gestation    less than 32 weeks]

12 Richardson JA, Dixon G. Effect of legal termin-    ation on subsequent pregnancy. British Med J    1976;1:1303-1304

13 Pickering RM, Deeks JJ. Risks of Delivery during    20th to the 36th Week of Gestation. Intl. J    Epidemiology 1991;20:456-466

14 Koller O, Eikhom SN. Late Sequelae of Induced    Abortion in Primigravidae. Acta Obstet Gynecol    Scand 1977;56:311-317

15 Papaevangelou G, Vrettos AS, Papadatos D, Alexiou    C. The Effect of Spontaneous and Induced Abortion    on Prematurity and Birthweight. The J Obstetrics    and Gynaecology of the British Commonwealth. May    1973;80:418-422

16 Bognar Z, Czeizel A.  Mortality  and  Morbidity    Associated with Legal Abortions in Hungary, 1960-    1973. AJPH 1976;66:568-575

17 Martius JA, Steck T, Oehler MK, Wulf K-H. Risk    factors associated with preterm (<37+0 weeks) and    early preterm (<32+0 weeks): univariate and multi-    variate analysis of 106 345 singleton births from    1994 statewide perinatal survey of Bavaira.    European J Obstetrics & Gynecology Reproductive    Biology 1998;80:183-189

18 Vasso L-K, Chryssa T-B, Golding J. Previous    obstetric history and subsequent preterm delivery    in Greece. European J Obstetrics & Gynecology    Reproductive Biology   1990;37:99-109

19*Ancel P-V, Saurel-Cubizolles M-J, Renzo GCD,    Papiernik E, Breart G. Very and moderate preterm    births: are the risk factors different? British    J Obstetrics and Gynaecology 1999;106:1162-1170

20 Lumley J. The epidemiology of preterm birth.    Bailliere's Clin Obstet Gynecology. 1993;7(3):    477-498

21*Michielutte R, Ernest JM, Moore ML, Meis PJ,    Sharp PC, Wells HB, Buescher PA. A Comparison of    Risk Assessment Models for Term and Preterm Low    Birthweight. Preventive Medicine 1992;21:98-109

22 Grindel B, Lubinski H, Voigt M. Induced abortion    in primigravidae and subsequent pregnancy, with    particular attention of underweight. Zentralbl    Gynaekol 1979;101:1009-1114

23 Kreibich H, Ludwig A. Early and late complications    of abortion in juvenile primigravidae (including    recommended measures). Z Aerztl Fortbild (Jena)    1980;74:311-316.

24 Zwahr C, Voigt M, Kunz L, et al. Relationships    between interruption abortion, and premature birth    and low birth weight. Zentrabl Gynaekol 1980;102:    738-747.

25 Pickering RM, Forbes J. Risk of preterm delivery    and small-for-gestational age infants following    abortion: a population study. British J Obstet-    rics and Gynecology 1985;92:1106-1112.

26 Obel E. Pregnancy Complications Following    Legally Induced Abortion With Special Reference to    Abortion Technique. Acta Obstet Gynecol Scand    1979;58:147-152.

27 Levin A, Schoenbaum S, Monson R, Stubblefield P,    Ryan K. Association of Abortion With Subsequent    Pregnancy Loss. JAMA 1980;243(24):2495-2499.

28 Legrillo V. Quickenton P, Therriault GD, et al.    Effect of induced abortion on subsequent reproductive    function. Final report to NICHD. Albany, NY: New    York State Health Department, 1980.

29 World Health Organization Task Force on the Sequelae    of Abortion. Gestation, birthweight and spontaneous    abortion. Lancet 1979;1:142-145.

30 Ratten G et al. Effect of Abortion on Maturity of    Subsequent Pregnancy. Med J Australia June 1979:    479-480

31 Roht LH, Aoyama H, Leinen GE, et al. The association    of multiple induced abortions with subsequent    prematurity and spontaneous abortion. Acta Obstet    Gynaecol Jpn 1976;23:140-145

32 Harlap S, Davies AM. Late sequelae of induced abortion:    Complications and Outcome of Pregnancy and Labor. Amer    J Epidemiology  1975;102:219-224

33 Seidman DS, Ever-Hadani P, Slater PE, Harlap S, et al.    Child-bearing after induced abortion: reassessment of    risk, J Epidemiology Community Health 1988;42:294-298

34 Buske L. A crisis aborning in maternity and newborn care?    CMAJ 2001;164(4):681

35 Rooney B. Elective Surgery boosts Cerebral Palsy risk.    European Journal of Obstetrics & Gynecology and    Reproductive Biology  2001;96(2):739-740

36 Rooney B.  Having an induced abortion increases risk    in future pregnancies. British Medical Journal    2001;322:430

*  studies that included spontaneous and induced abortions    but did not report PB risk separately for each