Background: Fetal imaging for congenital anomalies increases pregnancy terminations late in gestation. Objectives: We assessed whether late-pregnancy terminations can accidentally result in live births, and how these births impact infant mortality rates over time. Methods: We carried out a population-level analysis of 12,141 infant deaths in Quebec, Canada from 1986 to 2012. We calculated the proportion of infants born alive who died following pregnancy termination. The exposure was pregnancy termination with or without congenital anomaly recorded on death certificates. The main outcome was mortality on the first day of life by the hour. Results: Pregnancy termination was the cause of 19.4 infant deaths per 100,000 in 2000-2012, compared with 1.0 per 100,000 in 1986-1999. Most deaths after termination occurred in the first 3 h of life among infants with anomalies who weighed <500 g. In 2000-2012, infants who died following pregnancy termination led to an excess of 0.2 deaths per 1,000 on the first day of life, i.e. an 8.6% increase in the infant mortality rate (p value = 0.002). Conclusions: Pregnancy termination in mid-gestation carries the risk of accidental live birth. These neonates increasingly affect infant mortality rates. Better recording is needed, including data on the prevention and management of accidental live births after pregnancy termination.

1.
Sedgh G, Singh S, Shah IH, Ahman E, Henshaw SK, Bankole A: Induced abortion: incidence and trends worldwide from 1995 to 2008. Lancet 2012;379:625-632.
2.
Peller AJ, Westgate MN, Holmes LB: Trends in congenital malformations, 1974-1999: effect of prenatal diagnosis and elective termination. Obstet Gynecol 2004;104:957-964.
3.
American College of Obstetricians and Gynecologists. Practice Bulletin No. 135: second-trimester abortion. Obstet Gynecol 2013;121:1394-1406.
4.
Cargill Y, Morin L, Bly S, Butt K, Denis N, Gagnon R, Hietala-Coyle MA, Lim K, Ouellet A, Racicot MH, Salem S: Content of a complete routine second trimester obstetrical ultrasound examination and report. J Obstet Gynaecol Can 2009;31:272-275.
5.
Royal College of Obstetricians and Gynaecologists: Termination of Pregnancy for Fetal Abnormality in England, Scotland and Wales: Report of a Working Party, London, 2010.
6.
Graham RH, Robson SC, Rankin JM: Understanding feticide: an analytic review. Soc Sci Med 2008;66:289-300.
7.
Jansen RP: Unfinished feticide. J Med Ethics 1990;16:61-65.
8.
Wyldes MP, Tonks AM: Termination of pregnancy for fetal anomaly: a population-based study 1995-2004. BJOG 2007;114:639-642.
9.
Joseph KS, Liu S, Rouleau J, Lisonkova S, Hutcheon JA, Sauve R, Allen AC, Kramer MS: Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population-based retrospective study. BMJ 2012;344:e746.
10.
Auger N, Denis G: Late pregnancy abortions: an analysis of Quebec stillbirth data, 1981-2006. Int J Public Health 2012;57:443-446.
11.
MacDorman MF, Martin JA, Mathews TJ, Hoyert DL, Ventura SJ: Explaining the 2001-2002 infant mortality increase in the United States: data from the linked birth/infant death data set. Int J Health Serv 2005;35:415-442.
12.
Ehrenthal DB, Wingate MS, Kirby RS: Variation by state in outcomes classification for deliveries of less than 500 g in the United States. Matern Child Health J 2011;15:42-48.
13.
Public Health Agency of Canada: What Mothers Say: The Canadian Maternity Experiences Survey. Ottawa, Minister of Health, 2009.
14.
Society of Obstetricians and Gynaecologists of Canada: Induced Abortion Guidelines. J Obstet Gynaecol Can 2006;184:1014-1027.
15.
Collège des médecins du Québec: L'interruption volontaire de grossesse: lignes directrices du Collège des médecins du Québec, Montréal, 2012.
16.
Vadeyar S, Johnston TA, Sidebotham M, Sands J: Neonatal death following termination of pregnancy. BJOG 2005;112:1159-1162.
17.
Bourke J, Bower C, Blair E, Charles A, Knuiman M: The effect of terminations of pregnancy for fetal abnormalities on trends in mortality to one year of age in Western Australia. Paediatr Perinat Epidemiol 2005;19:284-293.
18.
van der Pal-de Bruin KM, Graafmans W, Biermans MC, Richardus JH, Zijlstra AG, Reefhuis J, Mackenbach JP, Verloove-Vanhorick SP: The influence of prenatal screening and termination of pregnancy on perinatal mortality rates. Prenat Diagn 2002;22:966-972.
19.
Liu S, Joseph KS, Wen SW, Kramer MS, Marcoux S, Ohlsson A, Sauve R: Secular trends in congenital anomaly-related fetal and infant mortality in Canada, 1985-1996. Am J Med Genet 2001;104:7-13.
20.
Liu S, Joseph KS, Kramer MS, Allen AC, Sauve R, Rusen ID, Wen SW: Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada. JAMA 2002;287:1561-1567.
21.
Gissler M, Fronteira I, Jahn A, Karro H, Moreau C, Oliveira da Silva M, Olsen J, Savona-Ventura C, Temmerman M, Hemminki E: Terminations of pregnancy in the European Union. BJOG 2012;119:324-332.
22.
Gourbin G, Masuy-Stroobant G: Registration of vital data: are live births and stillbirths comparable all over Europe? Bull World Health Organ 1995;73:449-460.
23.
Papiernik E, Zeitlin J, Delmas D, Draper ES, Gadzinowski J, Kunzel W, Cuttini M, Di Lallo D, Weber T, Kollée L, Bekaert A, Bréart G: Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population-based cohorts in the MOSAIC study. BJOG 2008;115:361-368.
24.
Sedgh G, Singh S, Henshaw SK, Bankole A: Legal abortion worldwide in 2008: levels and recent trends. Int Perspect Sex Reprod Health 2011;37:84-94.
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