RCOG World Congress 2023

Repeat pregnancies within 1 year ending in abortion – Are we missing opportunities for prevention?

Dr C Kelsey, Dr G Forbes

Introduction

1 in 3 pregnancies in the UK end in abortion.
1 in 13 women present for abortion within a year of a previous birth¹.
Increasing numbers of women presenting for abortion with young children (<1 year old) or within 1 year of previous abortion.

Objective

To identify opportunities within women’s health to provide pregnancy prevention for women who have had a pregnancy in the previous year.

National Guidance:

Abortion providers should ensure that a full range of reversible contraceptive options are available for women on the same day as their abortion².
Advice and information about contraception should be given within the first week after delivery³.

Methods

Prospective study looking at women presenting for abortion between January and March 2022 within Aneurin Bevan Health Board in Wales.
Inclusion criteria - abortion or live birth within prior 12 months (105 women in total over our time period).
Exclusion criteria - other pregnancy outcomes.

Results

40% of women were on no contraception following their initial pregnancy.
Following initial pregnancy 1/3 of women opted for a long-acting reversible contraceptive (LARC), which included sub-dermal implant, intrauterine system/device or Depo-Provera injection. This increased to 2/3 for women opting for a LARC after abortion within 12 months.
Women were four times more likely to attend to fitting of LARC if given an appointment at time of abortion.

Conclusions

LARC preference increases with repeat pregnancies.
Women presenting within 12 months of pregnancy should be prioritised.
Maternity services have a big role to play in provision of contraception postpartum.

Future Steps

Public Health Wales and the Welsh government are motivated to improve post-natal contraception nationally.
Cards with fast track codes for all women immediately postpartum and post-abortion to allow swift appointments for contraception.
Aim to train more midwives to fit sub-dermal implant for women immediately postnatal.

Repeat pregnancies within 1 year ending in abortion – Can we prevent this?