Evaluation of a stillborn fetus is described in Chapter 35 (p. 646). One component is autopsy, which can also be valuable for second-trimester losses or terminations due to anomaly. For example, in a stud) of 486 women of all ages with secondtrimester miscarriage, fetal malformations were identiied in 13 percent 000, 2009). In another, a third of otherwise normal fetuses had associated chorioamnionitis that was judged to have preceded labor (Allanson, 2010). Indeed, according to Srinivas and associates (2008), 95 percent of placentas in midtrimester miscarriages are abnormal. Other abnormalities are vascular thromboses and infarctions.
With either surgical or medical abortion, subsequent autopsy can yield information, but fragmented D & E specimens may provide less information than intact fetuses (Gawron, 2013; Lal, 2014). Karyotyping can be performed on samples from either method (Bernick, 1998).
Legally induced abortion in the United States has a low associated mortality rate, and from 2008 to 2012, the rate was < 1 death per 100,000 procedures Oatlaoui, 2016). Earlyiabortions are safer. For example, Zane and coworkers (2015) found a mortality rate of 0.3 deaths per 100,000 procedures at;8 weeks' gestation; a rate of2.5 at 14 to 17 weeks; and 6.7 at ::18 weeks. As emphasized by Raymond and Grimes (2012), mortality rates are 14-fold greater for pregnancies that are continued.
Data relating abortion to overall maternal health and to subsequent pregnancy outcome are limited. From studies, there is no evidence for excessive mental disorders (Biggs, 2017; Munk-Olsen, 2011). here are few data regarding subsequent reproductive health, although the rates of infertility or ectopic pregnancy are not increased. Exceptions may stem from postabortal infections, especially those caused by C trachomatis. Of subsequent adverse pregnancy outcomes, several studies note an approximate 1.5-fold greater incidence of preterm delivery following surgical evacuation (Lemmers, 2016; Makhlouf, 2014; Saccone, 2016). his risk accrues with the number of terminations (Hardy, 2013; Klemetti, 2012). Subsequent pregnancy outcomes are similar regardless of whether a prior induced abortion was completed medically or surgically (Mannisto, 2013; Virk, 2007).
After medical or surgical management of an early pregnancy termination or loss, ovulation na) resume as early as 8 days, but the average time is 3 weeks (Lahteenmaki, 1978; Stoddard, 2011). Thus, unless another pregnancy is imminently desired, efective contraception is initiated to help lower the unintended pregnancy rate, which was 45 percent in 2011 in the United States (Finer, 2016). In suitable candidates described in Chapter 38 (p. 685), an intrauterine device can be inserted after the procedure or medical abortion is completed (Bednarek, 2011; Korjamo, 2017). Alternatively, any of the various forms of hormonal contraception can be initiated at this time (Curtis, 2016).
For women who desire another pregnancy, conception need not be delayed. Specifically, Wong and colleagues (2015) found similar live-birth rates in groups conceiving within 3 months of first-trimester pregnancy loss compared with groups with later conception. Others have found similarly reassuring results using an interval-to-conception threshold of 6 months (Kangatharan, 2017; Love, 2010).