Induced Abortion and Subsequent Pregnancy Loss-Reply

Stephen C. Schoenbaum, MD; Ann Aschengrau Levin, MS; Richard R. Monson, MD; Phillip G. Stubblefield, MD; Kenneth J. Ryan, MD
JAMA. 1981;245(11):1119. doi:10.1001/jama.1981.03310360011006.
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In Reply.—  We agree that there is a potential bias in the risk estimates obtainable from a study such as ours. As Dr Chung points out, if such a bias is occurring, it is unlikely to account for the magnitude of increased risk of pregnancy loss that we observed in women with two or more previous induced abortions.Furthermore, the potential bias would apply almost exclusively to losses experienced in the first trimester. Since more than 90% of induced abortions are performed in the first trimester,1 a woman having a loss in the midtrimester has already had her chance to opt for induced abortion. We did observe a substantial increase in the risk of midtrimester, not just first trimester, losses. The midtrimester losses included missed abortions in which the problem most likely begins in the first trimester even though the loss is experienced in the midtrimester.If the suggested


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