Audit of repeat termination of pregnancy
Abacus Clinics for Contraception and Reproductive Health,
Liverpool, England, UK
Introduction: The termination of pregnancy service (TOP)
for Liverpool residents is provided by the Bedford clinic at the Liverpool Women’s
Hospital. Concern had been raised about the number of clients attending for
repeat TOP, in some cases within a short space of time. Although there is
regular contraceptive advice and provision of method of choice on site, repeat
request for TOP is perceived to be a problem. Studies from the United States,
Canada and Europe suggests that between 20–30% of clients requesting TOP have
had at least one or more before.
Aims and Methods: To quantify the percentage of clients
referred to the Bedford clinic who have repeat TOPs and to see how the
proportion having repeat TOP compare with the proportion having repeat TOP in
England and Wales and in other countries. Non-identifying details were collected
from all the case notes of clients requesting TOP who were referred and seen for
their initial assessment visit between 01/04/01 and 31/03/02. Details collected
were; age at the time of current TOP; ethnic origin; postcode; primary care
trust; referring agency; number of children; number of previous TOP;
contraception before and intended contraception after, the last and current TOP.
The data was analysed using the SPSS statistical package to allow identification
of any significant association between repeat TOP and the variables looked at.
Results: The total number of women who had TOP was 2165;
the age range was 13–46 years. Although 30.2% had had one or more previous
TOP, only a minority (1.9%) had had three or more previous TOPs. Increasing age
was found to be significantly associated with having previous TOP, with age
group 30–34 most likely to have had three or more previous TOPs. Women who
were classed as housewife/mother or with three or more children were more likely
to have had three or more TOPs. No other significant associations were
Conclusion: The level of repeat TOP in the year studied
appears to be comparable with levels in many other countries and England and
Wales overall. Results showing evidence of an association with increasing age
and multiparty confirm that only the passage of time determines the likelihood
of requesting repeat TOP as it allows more exposures to the risk of pregnancy.
The reasons for repeat TOP requests are complex but local residents are no
different to those in other countries. Efforts to understand the reasons will
continue with attempts to reduce numbers where possible.