Preterm
birth(PTB) is the birth of an infant before 37 weeks of pregnancy, according to
WHO statistics an estimated 15 million babies born preterm out of whom 1
million succumb. PTB is also responsible for long term neurological
complications in children like cerebral palsy, learning disabilities and visual
and hearing problems.
The current global preterm birth rate
is 5% to 18% and statistic shows a steady increase recently.
Three
forth of these births could be prevented, saving lives and money across the
globe.
CDC data quotes that in the year 2014, every
1 in 10 infants was born preterm in US. For physician across the globe, PTB remains
a challenge as the factors leading to preterm births are numerous, complex and
not well understood. Among various contributing factors prior uterine surgery, especially
those performed on cervix (induced termination of pregnancy (I-TOP) or
spontaneous abortion (SAB)) has been implicated in its causation. Studies till
now have shown mixed results.
The current research published in May 2016 issue of American Journal of Obstetrics and Gynecology evaluated the risk
of PTB in women with a history of uterine evacuation for I-TOP or SAB.
For the data source electronic
databases (MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, and Sciencedirect) were searched from their
inception until January 2015. Women with prior history of uterine evacuation
for either I-TOP or SAB, compared with a control group without a history of
uterine evacuation were included in the study.
Total 36 case control studies involving
1,047,683 women (31 studies for I-TOP, 5 studies for SAB) met the inclusion
criteria and were included in the analysis.
The primary outcome was relationship between
prior evacuation and subsequent preterm births while the secondary outcome studied
were low birthweight (LBW) and small for gestational age (SGA).
Relationship between
PTB and prior H/O surgical vs spontaneous evacuation was studied separately and
combined both.
The study found that:
- When all procedures combined there were increased odds of having a preterm birth, LBW and SGA babies being born after a history of surgical evacuation.
- Vacuum evacuation and sharp curettage were associated with PTB when analyzed in combination. When analyzing separately sharp curettage was associated with higher risk.
- Medical termination was found quite safe and did not result in PTB in subsequent surgery.
- Women with a prior history of spontaneous abortion(SAB) have a higher risk of PTB, as compared to those with no history of SAB.
- A very important observation as a result of meta-analysis is evacuation before 14 weeks of pregnancy (Spontaneous or induced) was not associated with increased risk for PTB.
- Expectant management of missed abortion is an option with ending in spontaneous loss, but sometimes may end up in heavy bleeding requiring immediate evacuation.
References:
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