Effect of contraception provided at termination of pregnancy and incidence of subsequent termination of pregnancy

Abstract

Objective: To determine the incidence of subsequent termination of pregnancy (TOP) within a 2-year period in relation to the method of contraception provided to women following the index TOP.

Design: Case note review.

Setting: NHS hospital TOP service, Edinburgh, UK.

Population: Nine hundred and eighty-six women requesting a TOP in 2008.

Methods: Case notes were reviewed to determine the contraception provided at index TOP and whether women had subsequent TOP at the same hospital within 2 years.

Main outcome measures: Incidence of subsequent TOP within 2 years amongst women receiving different contraceptive methods.

Results: One hundred and twenty-one women (12.3%) of the 986 who attended the clinic requesting a TOP returned requesting another TOP in the subsequent 2 years. Both intrauterine contraception and the progestogen-only implant were associated with the lowest incidence of subsequent TOP. Using the combined oral contraceptive pill as the reference method, the odds ratios (ORs) and 95% confidence intervals (CIs) of a further TOP within 2 years with intrauterine contraception and the implant were OR = 0.05 (95% CI, 0.01-0.41; P < 0.001) and OR =0.06 (95% CI, 0.01-0.23; P < 0.001), respectively. Women choosing the implant were significantly younger than those choosing the intrauterine method (P < 0.001).

Conclusion: Women undergoing a TOP who wish to avoid another unintended pregnancy should consider immediate initiation of either intrauterine contraception or the progestogen-only implant. Service providers should be trained and supported to provide these methods to women at the time of TOP.