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RCOG World Congress 2023
June 12 - 14, 2023 | London, UK
EP.0498
Contraception following unplanned pregnancy and miscarriage: exploring women's preferences for contraception provision.
Part of Topic
Sexual Health and Contraception
Audio
Contraception following unplanned pregnancy and miscarriage: exploring women’s preferences for contraception provision.
Ms Elise Hayles, EPU/AGU Senior Clinical Fellow, St George's University Hospitals NHS Foundation Trust, London, United Kingdom.
Introduction
•Unplanned pregnancies are associated with
significant costs and impact on mental health1
significant costs and impact on mental health1
•Contraception routinely offered within termination of pregnancy (TOP) services
•Women who miscarry are managed via EPU (Early Pregnancy Units) where contraception is not usually available
Method
•One-month survey in EPU to establish proportion of unplanned pregnancies and views on contraception
•Further survey for women who proceeded to miscarry, giving contraceptive advice and documenting decisions
Results
•251 women surveyed in EPU during 1 month
•90 pregnancies (35.9%) were unplanned
•Mode for parity: nulliparous (n=29, 41.4%)
•Mode for age: 26-30 years (n=24, 34.3%)
Of those with unplanned pregnancies:
•20 (22.2%) wanted to hear about contraception
•18 ( 20.0%) would want to arrange a contraceptive method via EPU if indicated
Of those with unplanned pregnancies, 30 (33.3%) proceeded to have an unsuccessful pregnancy,
so would be eligible for contraception:
•Miscarriage (n=15, 16.7%)
•Ectopic pregnancy (n=2, 2.2%)
•Failed pregnancy of unknown location (n=13, 14.4%)
Contraceptive options were discussed with 11 women following miscarriage:
•7 chose a method and were signposted to contraceptive services
•4 wanted further time to decide
Discussion
•FSRH Hatfield Vision Goal 5: “Enhanced access
to contraception for those experiencing the
worst inequalities”2
to contraception for those experiencing the
worst inequalities”2
•Women who miscarry do not have the same
access to contraception compared to TOP, introducing an additional barrier
access to contraception compared to TOP, introducing an additional barrier
•Insertion of IUS/IUCD at the time of surgical management of miscarriage or ectopic would reduce the need for further health appointments
Conclusion
•One in five women wished to discuss and arrange contraception via EPU
•There is an opportunity for low-cost intervention to ensure effective contraception following unsuccessful pregnancy
Further cost-benefit analysis is warranted
References
1.Montouchet, C., & Trussell, J. (2013). Unintended pregnancies in England in 2010: costs to the National Health Service (NHS). Contraception, 87(2), 149–153. https://doi.org/10.1016/j.contraception.2012.06.008
2. FSRH Hatfield Vision July 2022 - Faculty of Sexual and Reproductive Healthcare. www.fsrh.org. Retrieved May 23, 2023, from https://www.fsrh.org/documents/fsrh-hatfield-vision-july-2022/