University of Oulu

Kemppainen, V, Niinimäki, M, Bloigu, A, et al. Fear of childbirth after medical vs surgical abortion. Population‐based register study from Finland. Acta Obstet Gynecol Scand. 2021; 100: 743– 750.

Fear of childbirth after medical vs surgical abortion : population‐based register study from Finland

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Author: Kemppainen, Venla1; Niinimäki, Maarit2; Bloigu, Aini2;
Organizations: 1Department of Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
2Department of Obstetrics and Gynecology, PEDEGO Research Unit and Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
3Finnish Institute of Health and Welfare (THL), Helsinki, Finland
4Karolinska Institute, Stockholm, Sweden
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.9 MB)
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Language: English
Published: John Wiley & Sons, 2021
Publish Date: 2021-05-10


Introduction: To evaluate the effect of method of induced abortion and other abortion‐associated variables on the incidence of fear of childbirth in subsequent pregnancy.

Material and methods: This population‐based register study cohort includes all nulliparous women with their first pregnancy ending in an induced abortion in 2000‐2015 and subsequent pregnancy with live singleton delivery between 2000 and 2017 (n = 21 479). Data were derived from three national registers maintained by the Finnish Institute for Health and Welfare. We divided the study population in three cohorts: (a) medical and (b) surgical abortion during first trimester (≤84 days of gestation), and (c) medical abortion during second trimester (85‐168 days of gestation). Primary outcome measures were the incidence of registry‐identified fear of childbirth and cesarean delivery related to it.

Results: The overall incidence of fear of childbirth was 5.6% (n = 1209). Altogether, 19.2% (n = 4121) of women underwent cesarean delivery. The odds were elevated especially for elective cesarean delivery (odds ratio [OR] 9.30, 95% CI 7.95‐10.88, P < .001) in women with fear of childbirth. In multivariable analysis, the odds for fear of childbirth (adjusted OR [aOR] 0.80, 95% CI 0.68‐0.94) and cesarean delivery (aOR 0.66, 95% CI 0.84‐0.90) were decreased in women with a history of first‐trimester medical abortion compared with those with first‐trimester surgical abortion. Second‐trimester medical abortion had no effect on the odds for fear of childbirth (aOR 1.04, 95% CI 0.71‐1.50). Maternal age of 30‐39 years and interpregnancy interval over 2 years were additional risk factors for both fear of childbirth and cesarean delivery, but surgical evacuation of uterus after the abortion was not.

Conclusions: One first‐ or second‐trimester medical abortion does not increase the odds for fear of childbirth, and cesarean delivery related to it in subsequent pregnancy when compared with first‐trimester surgical abortion. Older maternal age and longer interpregnancy interval emerged as risk factors for fear of childbirth.

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Series: Acta obstetricia et gynecologica Scandinavica
ISSN: 0001-6349
ISSN-E: 1600-0412
ISSN-L: 0001-6349
Volume: 100
Issue: 4
Pages: 743 - 750
DOI: 10.1111/aogs.14078
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This study was funded by research funds from the Hospital District of Helsinki and Uusimaa, Finland.
Copyright information: © 2021 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.