Association between contraceptive method chosen after induced abortion and incidence of repeat abortion in Northern Portugal

Abstract

Objectives

In Portugal, a country with strong Catholic roots, elective termination of pregnancy at women’s request is still stigmatised, especially if it is a repeat abortion. The objectives of this study were to determine the incidence of repeat abortion, taking into account the contraceptive method chosen after the index abortion event, and characterise the risk factors for repeat abortion.

Methods

This was a retrospective cohort study of 988 women who requested termination of pregnancy during 2015 in a Portuguese tertiary care public hospital. Contraception was given free of charge after the index event. The occurrence of a repeat induced abortion was evaluated during a 24 month follow-up period.

Results

Forty-nine (5.0%) of the 988 women had a repeat abortion. Users of long-acting reversible contraception (LARC) had fewer repeat abortions compared with users of non-LARC methods. Overall repeat abortion was 0.8% in subcutaneous contraceptive implant users, 1.5% in intrauterine contraceptive device (IUCD) users, 2.8% in vaginal ring users and 5.8% in oral contraceptives users (p < 0.05). Cox hazards ratio (HR) analysis showed that method choice after abortion correlated significantly with the probability of repeat abortion (p < 0.05). Using women choosing oral contraception as the reference group, the HRs (95% CIs) for repeat abortion were as follows: IUCD 0.282 (0.084, 0.942), contraceptive implant 0.142 (0.019, 1.050), vaginal ring 0.508 (0.175, 1.477).

Conclusion

Even though highly effective contraceptive methods are freely accessible in Portugal, other challenges must be managed to improve outcomes, such as a timely, patient-centred counselling approach.

摘要

目标：在葡萄牙这个天主教徒根深蒂固的国家, 根据妇女的要求选择性终止妊娠仍然受到污名化, 特别是如果发生再次流产；本研究的目的是确定重复流产的发生率, 考虑到指标流产事件后选择的避孕方法, 并确定重复流产的危险因素。

方法：这是一项回顾性队列研究, 在2015年共有988名妇女在葡萄牙三级医疗公立医院要求终止妊娠。流产事件发生后免费给予避孕指导, 在24个月的随访期内评估重复人工流产的发生率。

结果：988名妇女中有49名（5.0%）重复次流产, 长效可逆避孕（LARC）的使用者与非LARC方法的使用者相比, 重复流产较少；皮下避孕植入者总体重复流产率为0.8%, 宫内节育器（IUCD）使用者为1.5%, 阴道环使用者为2.8%, 口服避孕药使用者为5.8%（p<0.05）。Cox危险比（HR）分析显示流产后的方法选择与重复流产的概率显着相关（p<0.05）。以使用选择口服避孕药的妇女作为参照组, 重复流产的HR（95%CI）如下：IUCD 0.282（0.084,0.942）, 避孕植入物0.142（0.019,1.050）, 阴道环0.508（0.175,1.477）。

结论：尽管葡萄牙可以免费获得高效的避孕方法, 但必须应对其他挑战以改善再次流产的结果, 例如及时以患者为中心的咨询途径。

Keywords:

• Contraceptive implant
• delayed post-abortion contraception
• intrauterine device
• long-acting reversible contraception (LARC)
• repeat abortion

Acknowledgements

We would like to thank the unit’s nursing team for their remarkable work and give special acknowledgement to professors Henriqueta Nóvoa and Miguel Gomes from the Faculty of Engineering at Oporto’s university for their assistance with the methods section.

Disclosure statement

No potential conflict of interest was reported by the author(s).