Original research articleAge, parity, history of abortion and contraceptive choices affect the risk of repeat abortion
Introduction
The incidence of repeat induced abortion varies greatly from country to country. In 2005, the rate of repeat abortion was 32% in England and Wales [1], whereas corresponding figures were somewhat lower in Finland (30%) [2], but higher in Sweden (38%) [3] and in the USA (47%) [4]. However, many countries lack reliable statistics on abortion.
Apart from the personal trauma and cost to the woman or society, repeat abortion has been linked to increased risk of adverse outcome in future pregnancies. Namely, increased risks of ectopic pregnancy [5], fetal loss [6] and low birth weight and preterm delivery [7] have been reported. Thus, repeat abortion remains an important public health dilemma.
Risk factors of repeat abortion are poorly understood and are likely to vary in different societies. The rate of repeat abortion is likely to be related to the overall incidence of abortion. The current abortion rate in Finland is 9.0/1000 women aged 15–49 years [2], and it is 17.2 in Sweden [3] and 17.8 in England and Wales [1]. In previous cross-sectional studies performed in Canada, Scotland and USA, women seeking repeat abortion were older, more often parous, had a history of domestic violence and alcohol/drug abuse and were of lower socioeconomic status (SES) [8], [9], [10].
The influence of contraceptive use and counseling on the risk of repeat abortion is unclear [11], [12]. Oral contraceptive (OC) use has been reported to be more prevalent among Canadian women seeking repeat abortion(s) [9]. Similarly, in a recent study from California, the use of depot medroxyprogesterone acetate was more common among women requesting repeat abortion [10]. However, in a prospective study from Scotland, specialist counseling and provision of contraceptives did not have an effect on the rate of repeat abortion [13].
The objective of this study was to gain further insight into factors affecting the risk of repeat abortion by using prospective follow-up study material. A cohort of 1269 women established at the time of introduction of medical abortion in the Helsinki metropolitan area between 2000 and 2002 [14], [15] was followed until the end of 2005. The follow-up was performed by means of the Finnish Registry of Induced Abortions [2], to which all induced abortions performed in Finland are to be reported [16]. The effects of various demographic and abortion-related variables, as well as the contraceptive choices made at the time of abortion on the risk of repeat abortion, were assessed.
Section snippets
Materials and methods
Between August 2000 and December 2002, a total of 1269 women requested medical termination of first trimester pregnancy (up to 9 weeks of gestation) at Helsinki University Central Hospital, Helsinki, Finland. The detailed management and clinical outcomes of these women have been reported previously [14], [15]. The subjects received extensive contraceptive counseling both by nurses/midwives and by physicians at the time of abortion. Post-abortal contraception was planned and prescribed. The
Results
Of all index abortions (n=1269), 1258 (99%) were initially recognized in the Registry of Induced Abortions. The remaining 11 cases were added to the registry before further analysis. The follow-up time (mean±SD) was 49.2±8.0 months.
During the follow-up period of August 2000 to December 2005, a total of 179 women (14.1%) out of the cohort of 1269 requested repeat abortion(s). Of the 1238 subjects assessed at the control visit, 171 (13.8%) requested abortion(s) during the follow-up period. The
Discussion
In the present study, repeat abortion was fairly common, with 14% of the women having another abortion within the follow-up period (mean almost 50 months). Several demographic factors, namely, history of abortion, being parous, young age and smoking, were associated with increased risk of repeat abortion. In addition, contraceptive choices made at the time of termination had a significant impact on the risk of repeat abortion. Intrauterine contraception was associated with the lowest rate of
Acknowledgments
We wish to thank Dr Riikka Gunnar (née Leminen) and Ms Marjatta Tevilin for their help in data collection and analysis. We also thank Ms Nina Hedkrok for her expert secretarial assistance. Dr Pasi Korhonen of StatFinn Oy (Espoo, Finland) is to be thanked for expert help with the statistical analysis. Financial support from Helsinki University Central Hospital Research Funds is gratefully acknowledged.
References (26)
- et al.
Effectiveness of preabortion counseling on postabortal contraceptive use
Contraception
(2004) - et al.
Risk factors for repeat elective abortion
Am J Obstet Gynecol
(2007) - et al.
Counseling in the clinical setting to prevent unintended pregnancy: an evidence-based research agenda
Contraception
(2003) - et al.
The learning curve is rapid in medical termination of pregnancy — first-year results from the Helsinki area
Contraception
(2003) - et al.
Termination of early pregnancy using flexible, low-dose mifepristone–misoprostol regimens
Contraception,
(2007) - et al.
Measuring contraceptive effectiveness: a conceptual framework
Obstet Gynecol
(1996) - et al.
Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems immediately after abortion, with 5 years' follow-up
Contraception
(2003) - et al.
Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons
Am J Obstet Gynecol
(1998)
Induced abortions and risk of ectopic pregnancy
Hum Reprod
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