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