Elsevier

Contraception

Volume 71, Issue 1, January 2005, Pages 31-34
Contraception

Original research article
Can we identify women at risk of more than one termination of pregnancy?

https://doi.org/10.1016/j.contraception.2004.07.003Get rights and content

Abstract

One in five women will have more than one abortion in her lifetime. This study was designed to identify risk factors in women requesting termination of pregnancy (TOP) after previous TOPs so that women at risk of recurrence, attending for the first time, could be identified. A retrospective case note review of 358 women undergoing TOP during October and November 2000 was performed. Twenty-six percent of women had had a previous TOP. Women undergoing a second or subsequent therapeutic abortion were more likely to be older and have experienced more pregnancies to full term, but these two factors were confounded. When women were both parous and deprived, the risk of them having had more than one TOP was over 50%.

Introduction

The abortion rate in Scotland in 2000 was 11 per 1000 women aged 15–44 years, and for England and Wales, it was 15.6 per 1000 [1]. The recurrent pregnancy termination rate varies (i.e., women who undergo a second abortion) around the country but is between 20% and 30%. This rate rose in England and Wales, from 18% in 1987 to around 25% in 1999 [2].

Contraceptive care following abortion has been explored in a number of studies [3], [4], [5]. It appears that most women who undergo repeat termination of pregnancy (TOP) have used some form of contraception but seem to fail to integrate knowledge with situational and social factors.

If it were possible to identify, at the time they attended for the first abortion, those women who are more likely to return for repeat TOP, we may be able to provide them with special contraceptive counseling (such as encouraging the use of a long-acting contraceptive method) and follow-up.

Around 200 pregnancies are terminated each month in the Royal Infirmary of Edinburgh. Because of these high numbers, it was considered that a retrospective case note review might identify recurring features in those women who returned for abortion after previous TOPs.

An audit project was constructed with the aim of identifying risk factors in women attending for repeat TOP.

Section snippets

Methods

The Royal Infirmary of Edinburgh serves a varied patient population. It is a secondary referral center for the city of Edinburgh, Midlothian and East Lothian, and a tertiary referral center for West Lothian. The overall rate of unemployment in Scotland for June–August 2002 was 6.5%, and for women alone, 5.3% [6]. In Edinburgh, 69% of houses are owner occupied. Twenty-three percent of the population are students. The majority (40%) describe themselves as having no religion, 35% describe

Results

A total of 371 TOPs (160 MTOP and 211 STOP) were performed during October and November 2000. The case notes of 13 women could not be found leaving 358 for review. In case notes of 49 women, detailed information on previous TOPs was not available either because the patient had been treated in a hospital elsewhere or because the abortion occurred before 1994 (before which time, case notes are routinely destroyed).

Of the 358 case notes examined, 96 (26%) had had a previous abortion. There was no

Discussion

Examination of repeat TOP rates internationally [9] suggests that the rising rate of repeat TOP requests seen over the decades, following liberalization of abortion laws, should reach a plateau as the number of women who had a TOP stabilizes. This Canadian review showed that in 1993, less than 2% of abortions were obtained by women who had had three or more previous procedures, suggesting that abortion is not widely used as a primary method of fertility regulation.

The UK National Survey of

Acknowledgments

The following are acknowledged: Gynaecolgy Day Bed Unit nursing staff, The Royal Infirmary of Edinburgh; Catherine Schunman, Research Fellow Family Planning and Well Women Services; and Dr. Robert Elton, Honorary Fellow of The University of Edinburgh and Statistician.

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