Cardiovascular complications following medical termination of pregnancy: An updated review

BACKGROUND Around 1 million cases of medical termination of pregnancy(MTP)take place yearly in the United States of America with around 2 percent of this population developing complications.The cardiovascular(CVD)complications occurring post MTP or after stillbirth is not very well described.AIM To help the reader better understand,prepare,and manage these complications by reviewing various cardiac comorbidities seen after MTP.METHODS We performed a literature search in PubMed,Medline,RCA,and google scholar,using the search terms“abortions”or“medical/legal termination of pregnancy”and“cardiac complications”or“cardiovascular complications”.RESULTS The most common complications described in the literature following MTP were infective endocarditis(IE)(n=16),takotsubo cardiomyopathy(TTC)(n=7),arrhythmias(n=5),and sudden coronary artery dissection(SCAD)(n=4).The most common valve involved in IE was the tricuspid valve in 69%(n=10).The most observed causative organism was group B Streptococcus in 81%(n=12).The most common type of TTC was apical type in 57%(n=4).Out of five patients de veloping arrhythmia,bradycardia was the most common and was seen in 60%(3/5)of the patients.All four cases of SCAD-P type presented as acute coronary syndrome 10-14 d post termination of pregnancy with predominant involvement of the right coronary artery.Mortality was only reported following IE in 6.25%.Clinical recovery was reported consistently after optimal medical management following all these complications.CONCLUSION In conclusion,the occurrence of CVD complications following pregnancy termination is infrequently documented in the existing literature.In this review,the most common CVD complication following MTP was noted to be IE and TTC.

Evaluation of Current Termination of Pregnancy and Related Services at Grimsby(UK) and Recommendations for Service Improvement

Objective To develop local termination of pregnancy （TOP） dataset and to identify ＂hotspots＂ for highest activity and gaps in our fertility control services. Methods This was a retrospective analysis of 305 women who received TOP under section C of the Abortion Act 1967 over a period of 9 consecutive months from 1st March through to 31st October 2012. Results There were 275 （90.2%） British White （BW） and 30 non-BW women. Among 30 non-BW women, 10 （3.3%） were British Asian, 8 （2.6%） were Polish, 6 （2.0%） were British Black or Black, 5 （1.6%） were Chinese and i （0.3%） was White Latvian. The TOP rate was 8.9% in the under 18 years old and 27.9% in the over 30 years old. Totally 240 TOPs （78. 7%） occurred in 〈10 weeks and 276 TOPs （90.5%） occurred under 13 weeks of gestation. Eight-five women who received TOP-service have had one or more previous termination（s） in the last 3 years. The contraception use was low pre-TOP and none of the women were on long-acting reversible contraception （LARCs） pre- TOP, including those who had repeat terminations. Conclusion There are inequalities and gaps in the TOP and related services in Grimsby which must be addressed to reduce the rate of TOP. This is a major challenge involving multiple agencies. Provision of contraception across all age and ethnic groups, improving sex education, engaging with parents and women to improve their negotiation skills for safer sex, supporting vulnerable women, reducing risk factors e.g. alcohol and substance misuse and raising aspirations across the region will contribute to a reduction in termination rate.

Medical Interruption of Pregnancy in the Second Trimester at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF): About 25 Cases

Introduction: Medical termination of pregnancy is a therapy that considerably reduces the number of obstetrical complications that can lead to maternal death and the number of births of children with diseases or malformations that are incompatible with life. Objective: To study the practice of medical termination of pregnancy at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF). Methodology: This was a retrospective and descriptive study conducted at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF) covering the period from May 1st, 2012 to April 30th, 2021, i.e. a period of 9 years. All patients who underwent a medical termination of pregnancy during the study period and whose term of pregnancy was <28 weeks of amenorrhea were included in this study. Information was collected on a survey sheet from the patients’ clinical records, admission and hospitalisation registers, referral forms and operative report registers. Data were entered and analyzed using Excel, World and epi-info 7.2.2. The main variables studied were hospital frequency, diagnostic means, main indications, means of evacuation and maternal prognosis. Result: 25 patients were identified and represented 0.5% of deliveries. Fetal, maternal and obstetric causes were the main indications for medical termination of pregnancy in respectively 28%, 20% and 52%. Obstetrical ultrasound was performed in 100% of patients. These ultrasounds allowed us to determine fetal vitality and to find some fetal malformations (28%) and some anomalies in the fetal appendages (48%). Clinical examination alone was used to diagnose 24% of indications. In 68% of cases, the clinical examination and ultrasound were used to establish the indication. The most commonly used evacuation technique was medication in 88% of cases. Caesarean section was chosen for urgent cases in 12%. Uterine haemorrhage and post-abortion endometritis were the main complications. Conclusion: Medical termination of pregnancy is a delicate subject requiring multidisciplinary management. This series has allowed us to highlight our singularities, and will allow us to improve the management of our patients, in the prevention of haemorrhage and other complications.

Evaluation on the Influence of the Timing of Twin Pregnancy Termi­nation on the Outcome of Mother and Infants

Objective:Objective:To observe the maternal and infant outcomes of pregnant women with twins terminating their pregnancy at different timings.Methods:Among the twin pregnant women admitted to our hospital from August 2019 to August 2020,50 primiparous women who opted to terminate their pregnancies at 5 different timings of“34--34^(+6) weeks”,“35--35^(+6) weeks”,“36--36^(+6) weeks”,“37--37^(+6) weeks”,“38--38^(+6) weeks”were selected as the research subjects.According to the timing of pregnancy termination,they were divided into 5 groups,each with 10 cases of pregnant women,and the impact of the timing of pregnancy termination on the outcome of the mothers and infants were compared.Results:The“37--37^(+6) weeks”group had the largest amount of postpartum hemorrhage,and the difference in Hb level before and after delivery was the largest.With the increase in gestational week,the weight of both large and small fetuses increased.In terms of neonatal diseases,the comparison between“34--34^(+6) weeks”,“35--35^(+6) weeks”,“36--36^(+6) weeks”and“37--37^(+6) weeks”,“38--38^(+6) weeks”,P<0.05,the comparison between“37--37^(+6) weeks”and“38--38^(+6) weeks”,P>0.05.Conclusions:The extension of the gestational week of twin pregnancies has no effect on postpartum hemorrhage,but it can improve the outcome of infants.