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Too soon to have another
baby?Short inter-pregnancy interval in
women attending an abortion service
Dr Catriona Melville
Unplanned Pregnancy and Abortion in Australia Conference,
Brisbane, 3-4 August 2017
Overview Abortion in Scotland
Background to research study
Methods and results
Findings and recommendations
Abortion in Scotland Pioneers in medical abortion
1967 Abortion act
Provided by NHS (public, free)
Standards in place to ensure access
Legal limit 24 weeks however >70% under 9 weeks gestation (majority medical abortions)
Legal requirement to notify Chief Medical Officer of all abortions
Ayrshire & Arran
NHS Ayrshire and Arran
Background Anecdotally infants and babies seen in waiting room
Women requesting abortion were stating that they couldn’t continue with the pregnancy as their baby was too young
Research in Lothian showed almost 1 in 13 women presenting for an abortion or delivery had conceived within a year of a previous birth (almost 1 in 8 among parous women)
Heller R, et al. J Fam Plann Reprod Health Care 2016;42:93–98.
Optimal pregnancy spacing Adverse outcomes increased with short inter-
pregnancy interval (< 12 months)
preterm delivery
low birthweight
stillbirth
neonatal death
WHO recommends ≥24 months after a live birth before conceiving again
Report of a WHO Technical Consultation on Birth Spacing Geneva, Switzerland 13–15 June 2005
Our research
Retrospective audit of all parous women attending the abortion service
5 month period (Jan- May 2015)
Electronic hospital record searched
Live birth within preceding 12 months at same hospital
Results
23%
0.5%
76.5%
live birth in past 12months
ectopic pregnancy
no live birth in past 12months
47 out of 205 women had a live birth in the preceding 12 months
Why?
Not meeting women’s postnatal contraceptive needs despite postnatal implanon service
High competing demands on maternity staff
Postnatal period challenging for mothers and contraception not a priority
Recommendations
Educate women and health care providers
Start contraceptive discussion in the antenatal period
Undertake similar audit of women at booking visit (continuing with their pregnancy)
Timely reliable postnatal contraception (LARC)
Postnatal contraception
“Maternity service providers should ensure that all women after pregnancy have access to the full range of contraceptives, including the most effective LARC methods, to start immediately after childbirth”
Contraception After Pregnancy. Faculty of Sexual & Reproductive Healthcare (FSRH) 2017
Insertion of intrauterine contraception (IUC) at caesarean section
IUC provision at caesarean section The insertion of IUC immediately after childbirth is
associated with higher expulsion rates but also higher continuation rates 6–12 months postpartum, regardless of IUC type or mode of delivery
IUC at elective caesarean section : recent study in Edinburgh
Heller R, Johnstone A, Cameron ST . Routine provision of intrauterine contraception at elective cesarean section in a national public health service: a service evaluation. Acta Obstet Gynecol Scand 2017
Acknowledgements
Staff at AMU, NHS Ayrshire and Arran
Sharon Cameron and Rebecca Heller , NHS Lothian, Chalmers Centre, & University of Edinburgh, UK