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Current Trends Third-Trimester Induced Abortion -- Georgia, 1979 and 1980

During 1979 and 1980, third-trimester induced abortions* reported to Georgia's Department of Human Resources (DHR) accounted for 123.1 per 100,000 legal abortions (86 of 69,876). Because of concern about this reported number and the indications for late abortions, the DHR undertook a medical record review.

The DHR reviewed medical records and verified pregnancy outcome** for 78 (90.7%) of reported third-trimester induced abortions. Of these 78 reports, three were for women who had true third-trimester induced abortions. Two of these were performed to terminate pregnancies involving anencephalic fetuses at 25 and 34 weeks' gestation. The third woman had an abortion at 26 weeks' gestation, but little information was available from which to determine the reason for the procedure. Of the 78 reported to have obtained third-trimester induced abortions, 58 (74.4%) were fetal deaths in utero, while 15 (19.2%) were first- or second-trimester abortions; one was a duplicative report, and one was not an abortion. Thus, the occurrence of true third-trimester-induced abortion was 4.3 per 100,000 legal abortions (3 of 69,876) instead of the reported 123.1. Reported by JW Flynt, MD, M Lavoie, AK Schoenbucher, MD, Georgia State Dept of Human Resources; Program Evaluation Br, Div of Reproductive Health, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: Abortions performed during the third trimester are regulated by Georgia state law, which requires that a physician file an induced-abortion report with the DHR within 10 days of performing an abortion.

It is not clear why women who had fetal deaths in utero were misclassified as having had induced abortions. However, since almost all these women had had labor induced to expel a dead fetus, many attending physicians may report these events as induced abortions rather than as fetal deaths in utero. Misclassification of first- and second-trimester abortions was almost entirely (14/15) due to transcription, coding, or keypunching errors. Of the 15 misclassified abortion reports, 12 represented women who had abortions at less than 14 weeks' gestation.

Underdetection of true third-trimester induced abortions was minimized by defining the third trimester as the period at 25 or more weeks' gestation, as opposed to the DHR's definition of more than 27 weeks' gestation. In addition to reviewing all reported induced abortions at 25 or more weeks' gestation by physician estimate, the DHR attempted to find additional cases by reviewing reports of induced abortions performed 25 or more weeks from the date of the last menstrual period when physicians' estimates were either less than 25 weeks' or unavailable. During 1979 and 1980, the DHR record review found no true third-trimester induced abortions among 143 such reports.

Eight third-trimester abortions with unconfirmed pregnancy outcomes were reported. Classification of these as true third-trimester abortions would increase the rate of such abortions from 4.3 to 15.7 per 100,000 abortions.

True third-trimester induced abortions are rare in Georgia. To decrease overreporting such abortions, the DHR is informing physicians how to report induced pregnancy terminations more accurately. If similar concerns exist in other states, CDC recommends periodic verification of reported data.

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