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Objective: To describe the subsequent reproductive outcome for a Danish nationwide cohort of women with peripartum cardiomyopathy (PPCM).Design: Nationwide historic cohort study.Setting: Secondary and tertiary centres across Denmark.Sample: Women with PPCM.Methods: Sixty-one women with PPCM during 2005-2014 were identified in a nationwide, registry-based study and the diagnosis was validated through audit of patient records. A new search for subsequent reproductive outcome in this cohort from 2005-2016 was conducted in the Danish National Birth Registry and the Danish National Patient Registry. Detailed clinical data were obtained from patient records.Main Outcome Measures: Sterilisations and subsequent reproductive outcomes after PPCM, including all pregnancies, miscarriages, terminations and deliveries.Results: Of 61 women with PPCM, 13 (21%) had a total of 16 subsequent pregnancies resulting in one miscarriage, seven early terminations, one ectopic pregnancy and seven liveborn children. There were no maternal deaths or significant cardiac events during pregnancy, but one woman, who gave birth to a liveborn child, had a relapse of PPCM 7 weeks postpartum. None of the six women who had a first trimester termination, experienced relapse of PPCM. Of the 13 women with a subsequent pregnancy, 62% had prior to this been advised against a new pregnancy due to the risk of recurrent PPCM. A total of four women (6.6%) were sterilised.Conclusion: Peripartum cardiomyopathy affects women's reproduction with few subsequent pregnancies resulting in a liveborn child. The finding of a 1/7 relapse among women with recovered LVEF is in accordance with most previous studies.Tweetable Abstract: Outcome in pregnancies after peripartum cardiomyopathy: results from the first nationwide study. [ABSTRACT FROM AUTHOR]

Objective To determine whether termination of pregnancy ( TOP), including the method used or gestational age at termination, affects future obstetric and perinatal outcomes. Design Register-based cohort. Setting Aberdeen Maternity Hospital, Scotland, UK. Population From the Aberdeen Maternity and Neonatal Databank ( AMND) we identified 3186 women who had terminated their first pregnancy and then had a second pregnancy of beyond 24 weeks of gestation between 1986 and 2010. We identified 42 446 women who had their first delivery in the same time period, for comparison. Methods Univariate and multivariate logistic regression was used to compare outcomes between groups. Complete case analysis with adjustment of confounding factors was carried out, and adjusted odds ratios ( aORs) with 99% confidence intervals are presented. Main outcome measures The primary outcome was spontaneous preterm delivery ( SPTD). Results No statistically significant association was found between TOP in the first pregnancy and SPTD in the next pregnancy ( aOR 1.05; 99% CI 0.83-1.32). Neither medical ( aOR 1.03; 99% CI 0.72-1.46) nor surgical ( aOR 1.06; 99% CI 0.78-1.44) termination appeared to affect the risk of spontaneous preterm delivery in the subsequent pregnancy. Late termination (≥13 weeks of gestation) did not appear to increase the risk of spontaneous preterm delivery compared with early termination (<13 weeks of gestation) ( aOR 1.65; 99% CI 0.94-2.92), nor compared with primigravid women ( aOR 1.25; 99% CI 0.97-1.62). There was an associated increased risk of antepartum haemorrhage in the next pregnancy following TOP ( P < 0.01; aOR 1.26; 99% CI 1.10-1.45). Conclusions Evidence on obstetric and perinatal outcomes following TOP remains conflicting. This study suggests that TOP is not associated with an increased risk of spontaneous preterm delivery. Neither the method nor the gestational age of TOP has any effect on this lack of association. [ABSTRACT FROM AUTHOR]

Terminations of pregnancy for fetal anomaly (TOPFAs) were analysed over a 10-year period from a population-based congenital anomaly register covering 646 342 births. A total of 3189 cases of TOPFA were identified, prevalence of 49.3 per 10 000 registerable births. The rate of TOPFA at all gestations and at less than 16 weeks increased significantly. There were 102 cases of liveborn TOPFAs (3.2%). The proportion of liveborn TOPFAs after 22 weeks of gestation decreased significantly but below 22 weeks remains unchanged. TOPFA is increasing in frequency, occurring earlier in pregnancy. Live birth is a possible important outcome. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to examine the association between biological, behavioural and lifestyle risk factors and risk of miscarriage. Design Population-based case–control study. Setting Case–control study nested within a population-based, two-stage postal survey of reproductive histories of women randomly sampled from the UK electoral register. Population Six hundred and three women aged 18–55 years whose most recent pregnancy had ended in first trimester miscarriage (<13 weeks of gestation; cases) and 6116 women aged 18–55 years whose most recent pregnancy had progressed beyond 12 weeks (controls). Methods Women were questioned about socio-demographic, behavioural and other factors in their most recent pregnancy. Main outcome measure First trimester miscarriage. Results After adjustment for confounding, the following were independently associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception; low pre-pregnancy body mass index; regular or high alcohol consumption; feeling stressed (including trend with number of stressful or traumatic events); high paternal age and changing partner. Previous live birth, nausea, vitamin supplementation and eating fresh fruits and vegetables daily were associated with reduced risk, as were feeling well enough to fly or to have sex. After adjustment for nausea, we did not confirm an association with caffeine consumption, smoking or moderate or occasional alcohol consumption; nor did we find an association with educational level, socio-economic circumstances or working during pregnancy. Conclusions The results confirm that advice to encourage a healthy diet, reduce stress and promote emotional wellbeing might help women in early pregnancy (or planning a pregnancy) reduce their risk of miscarriage. Findings of increased risk associated with previous termination, stress, change of partner and low pre-pregnancy weight are noteworthy, and we recommend further work to confirm these findings in other study populations. [ABSTRACT FROM AUTHOR]

Teenage contraceptive use is often perceived as irresponsible, and Government initiatives are aimed at improving this. This prospective observational cohort study examined contraceptive use in 925 women requesting termination of pregnancy (TOP) and found that usage in all women, regardless of age, was poor with no difference between age groups. These findings challenge frequently made assumptions about irresponsible contraceptive use and imply that contraceptive education, and initiatives to tackle the growing number of TOPs, should not be confined to teenagers but should start in early adolescence and must continue well in to adulthood. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of a decision aid to help women choose between surgical and medical methods of pregnancy termination. Design A randomised controlled trial comparing a decision-aid leaflet about termination methods with a control leaflet about contraception. Setting An NHS regional centre for pregnancy termination. Sample All women less than 9 weeks of gestation referred for termination of pregnancy over 7 months in 2002. Methods Participants were given an envelope containing either the decision-aid or the control leaflet prior to choosing between medical and surgical termination methods and completed two questionnaires, one immediately after this consultation and another after the termination procedure. Main outcome measures Choice of termination method; measures of effective decision making including risk perception, attitudes and knowledge of both the medical and surgical methods; decisional conflict; anxiety and usefulness of the leaflet. Results Three hundred and twenty-eight women participated. There was no difference in the method chosen between the groups (60/162 women in the decision-aided group chose a medical method versus 54/164 women in the control group (OR 1.2; 95% CI 0.76–1.9). Women in the decision-aided group had higher knowledge and lower risk-perception scores about both methods, more positive attitudes about the medical method, lower decisional conflict, more stable evaluations of the decision information over time and higher perceived usefulness of information ratings. Anxiety was high but unrelated to leaflet type. Conclusions Women made more informed decisions when provided with an evidence-based decision-aid leaflet preceding a routine consultation about choices of termination method. [ABSTRACT FROM AUTHOR]