Risk factors and the choice of long-acting reversible contraception following medical abortion : effect on subsequent induced abortion and unwanted pregnancy

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Korjamo , R , Heikinheimo , O & Mentula , M 2018 , ' Risk factors and the choice of long-acting reversible contraception following medical abortion : effect on subsequent induced abortion and unwanted pregnancy ' , European Journal of Contraception and Reproductive Health Care , vol. 23 , no. 2 , pp. 89-96 . https://doi.org/10.1080/13625187.2018.1440385

Title: Risk factors and the choice of long-acting reversible contraception following medical abortion : effect on subsequent induced abortion and unwanted pregnancy
Author: Korjamo, Riina; Heikinheimo, Oskari; Mentula, Maarit
Contributor: University of Helsinki, Clinicum
University of Helsinki, Clinicum
University of Helsinki, Department of Obstetrics and Gynecology
Date: 2018
Language: eng
Number of pages: 8
Belongs to series: European Journal of Contraception and Reproductive Health Care
ISSN: 1362-5187
URI: http://hdl.handle.net/10138/322885
Abstract: Objective: To analyse the post-abortion effect of long-acting reversible contraception (LARC) plans and initiation on the risk of subsequent unwanted pregnancy and abortion. Materials and methods: retrospective cohort study of 666 women who underwent medical abortion between January-May 2013 at Helsinki University Hospital, Finland. Altogether 159 (23.8%) women planning post-abortion use of levonorgestrel-releasing intrauterine system (LNG-IUS) participated in a randomized study and had an opportunity to receive the LNG-IUS free-of-charge from the hospital. The other 507 (76.2%) women planned and obtained their contraception according to clinical routine. Demographics, planned contraception, and LARC initiation at the time of the index abortion were collected. Data on subsequent abortions were retrieved from the Finnish Abortion Register and electronic patient files until the end of 2014. Results: During the 21 months ([median], IQR 20-22) follow-up, 54(8.1%) women requested subsequent abortions. When adjusted for age, previous pregnancies, deliveries, induced abortions and gestational-age, planning LARC for post-abortion contraception failed to prevent subsequent abortion (33 abortions/360 women, 9.2%) compared to other contraceptive plans (21/306, 6.9%) (HR 1.22, 95% CI 0.68-2.17). However, verified LARC initiation decreased the abortion rate (4 abortions/177 women, 2.3%) compared to women with uncertain LARC initiation status (50/489, 10.2%) (HR 0.17, 95% CI 0.06-0.48). When adjusted for LARC initiation status, age= 25 years (27/383, 7.0%, HR1.95, 95% CI 1.04-3.67). Conclusions: Initiation of LARC as part of abortion service at the time of medical abortion is an important means to prevent subsequent abortion, especially among young women.
Subject: Abortion
termination of pregnancy
repeat abortion
long-acting reversible contraception
RANDOMIZED CONTROLLED-TRIAL
DELAYED INSERTION
REPEAT PREGNANCY
INTRAUTERINE CONTRACEPTION
UNINTENDED PREGNANCY
NO-COST
IMMEDIATE
TERMINATION
IMPLANTS
1ST
3123 Gynaecology and paediatrics
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