Does abortion procedure influence contraceptive choices and
behaviour?
A. Gairing, S. Tschudin, D. Zanotelli, W. Holzgreve, J.
Bitzer
University Women’s Hospital, Basel, Switzerland
Objectives: To prevent repeated unwanted pregnancies and
abortion, it is crucial to discuss sub-sequent contraception with the patient
and to start it as soon as possible after the abortion. Medical and surgical
abortion explicitly differ in the course of the procedure. With regard to
optimise our pre-abortion contraceptive counselling we wanted to investigate
whether the choice of the contraceptive method and its initiation depend on the
chosen abortion procedure.
Design and methods: We retrospectively collected data of
all patients who underwent either medical or surgical abortion at our clinic
between 1.3. 2002 and 28. 3. 2003. Medical abortion was offered until a
gestational age of 49 days using Mifepriston and Misoprostol, surgical abortion
was performed by suction curettage up to 12 weeks of gestation. The data were
analysed by descriptive statistics.
Results: Of a total of 422 abortions, 184 (43,6%) were
performed surgically, 238 (56,4%) medically. The patients mean age was 32.7
years with a minimum of 16 to a maximum of 50 year. 4,8% of the patients were
younger than 20 years of age, 41,4% between 20 and 30 years, 41,1% between 30
and 40 years and 12,6% over 40 years. The contraceptive method to be used after
abortion was known in 248 (58,8%) cases, in the remaining 174 (41,2%) cases
subsequent contraception was not documented. We know of twice as many patients
with surgical abortion, which method of contraception they used (82%) compared
to the group who underwent medical abortion (40%). This might be due to lost
follow up for patients who went back to their practising gynaecologists and/or
the less clear end point of the medical procedure. In case of suction curettage,
IUD (half copper and half levonorgestrel-containing) was used twice as much
(40,4%) as after medical abortion (20%). The most frequently chosen
contraceptive method after medical abortion was a combined oral contraceptive
(56,7%). A progestogen only preparation (progestogen-only pill, implant or
depot-injection) was chosen by 21,6% after medical and 11,9% after surgical
abortion.
Conclusions: According to our retrospective evaluation
the initiation of post-abortion contraception is better established after
surgical than after medical abortion and IUDs seem to be more frequently chosen
by the ‘surgical group’. This may have an impact on the risk of repeated
unwanted pregnancy and does demand special counselling efforts in the medical
abortion group.
