Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data

Stephen J. McCall, Gillian Flett, Emmanuel Okpo, Sohinee Bhattacharya

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Abstract

Background
Repeat termination of pregnancy highlights the issues of unplanned pregnancies and effective post-termination contraceptive practices.

Objective
To examine the risk factors at the time of a first termination that are associated with subsequent repeat termination.

Design
Registry-based study.

Setting
Grampian region of Scotland, UK.

Methods
A retrospective study using data from the Termination of Pregnancy Database, NHS Grampian for the period 1997–2013. Associations between repeat termination and women’s sociodemographic characteristics and contraceptive use were assessed using multivariable logistic regression models.

Results
This study showed that 23.4% of women who had an initial termination (n=13 621) underwent a repeat termination. Women who had repeat terminations were more likely to be aged under 20 years at their initial termination with an adjusted odds ratio (AOR) of 5.59 [95% confidence interval (CI) 4.17–7.49], to belong to the most deprived social quintile [AOR 1.23 (95% CI 1.05–1.43)], and to be more likely to have had two or more previous livebirths [AOR 1.51 (95% CI 1.12–2.02)] or miscarriages [AOR 1.40 (95% CI 1.02–1.92)]. The likelihood of having a repeat termination was increased in women who had a contraceptive implant as post-termination contraception [AOR 1.78 (95% CI 1.50–2.11)] compared to women who left with none or unknown methods following the first termination. In those who had repeat terminations, women who had an implant or Depo-Provera® were at increased odds of repeat termination in the 2–5 years interval compared to the 0–2 years after their initial termination.

Conclusions
Teenage pregnancy, social deprivation, two or more previous livebirths or miscarriages at the time of the initial termination were identified as risk factors for repeat terminations. Post-termination contraception with implants and Depo-Provera® were associated with repeat termination 2–5 years after the first termination.
Original languageEnglish
Pages (from-to)133-142
Number of pages10
JournalJournal of Family Planning and Reproductive Health Care
Volume42
Issue number2
Early online date7 Dec 2015
DOIs
Publication statusPublished - Apr 2016

Fingerprint

Delivery of Health Care
Pregnancy
Odds Ratio
Confidence Intervals
Contraceptive Agents
Medroxyprogesterone Acetate
Spontaneous Abortion
Contraception
Logistic Models
Unplanned Pregnancy
Pregnancy in Adolescence
Scotland
Registries
Retrospective Studies
Databases

Keywords

  • abortion
  • epidemiology
  • long-acting reversible contraception

Cite this

@article{813e3dd790854e2881b8f21363bb539f,
title = "Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data",
abstract = "Background Repeat termination of pregnancy highlights the issues of unplanned pregnancies and effective post-termination contraceptive practices.Objective To examine the risk factors at the time of a first termination that are associated with subsequent repeat termination.Design Registry-based study.Setting Grampian region of Scotland, UK.Methods A retrospective study using data from the Termination of Pregnancy Database, NHS Grampian for the period 1997–2013. Associations between repeat termination and women’s sociodemographic characteristics and contraceptive use were assessed using multivariable logistic regression models.Results This study showed that 23.4{\%} of women who had an initial termination (n=13 621) underwent a repeat termination. Women who had repeat terminations were more likely to be aged under 20 years at their initial termination with an adjusted odds ratio (AOR) of 5.59 [95{\%} confidence interval (CI) 4.17–7.49], to belong to the most deprived social quintile [AOR 1.23 (95{\%} CI 1.05–1.43)], and to be more likely to have had two or more previous livebirths [AOR 1.51 (95{\%} CI 1.12–2.02)] or miscarriages [AOR 1.40 (95{\%} CI 1.02–1.92)]. The likelihood of having a repeat termination was increased in women who had a contraceptive implant as post-termination contraception [AOR 1.78 (95{\%} CI 1.50–2.11)] compared to women who left with none or unknown methods following the first termination. In those who had repeat terminations, women who had an implant or Depo-Provera{\circledR} were at increased odds of repeat termination in the 2–5 years interval compared to the 0–2 years after their initial termination.Conclusions Teenage pregnancy, social deprivation, two or more previous livebirths or miscarriages at the time of the initial termination were identified as risk factors for repeat terminations. Post-termination contraception with implants and Depo-Provera{\circledR} were associated with repeat termination 2–5 years after the first termination.",
keywords = "abortion, epidemiology, long-acting reversible contraception",
author = "McCall, {Stephen J.} and Gillian Flett and Emmanuel Okpo and Sohinee Bhattacharya",
note = "Authors’ thanks goes to Mr Peter Szchechina and Mr Alastair Soutar for extracting the data for this study and to Prof Allan Templeton for initiating the TOPS database in Grampian and for critically evaluating the manuscript.",
year = "2016",
month = "4",
doi = "10.1136/jfprhc-2014-101059",
language = "English",
volume = "42",
pages = "133--142",
journal = "Journal of Family Planning and Reproductive Health Care",
issn = "1471-1893",
publisher = "Royal College of Obstetricians and Gynaecologists",
number = "2",

}

TY - JOUR

T1 - Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy

T2 - analysis of routinely collected health care data

AU - McCall, Stephen J.

AU - Flett, Gillian

AU - Okpo, Emmanuel

AU - Bhattacharya, Sohinee

N1 - Authors’ thanks goes to Mr Peter Szchechina and Mr Alastair Soutar for extracting the data for this study and to Prof Allan Templeton for initiating the TOPS database in Grampian and for critically evaluating the manuscript.

PY - 2016/4

Y1 - 2016/4

N2 - Background Repeat termination of pregnancy highlights the issues of unplanned pregnancies and effective post-termination contraceptive practices.Objective To examine the risk factors at the time of a first termination that are associated with subsequent repeat termination.Design Registry-based study.Setting Grampian region of Scotland, UK.Methods A retrospective study using data from the Termination of Pregnancy Database, NHS Grampian for the period 1997–2013. Associations between repeat termination and women’s sociodemographic characteristics and contraceptive use were assessed using multivariable logistic regression models.Results This study showed that 23.4% of women who had an initial termination (n=13 621) underwent a repeat termination. Women who had repeat terminations were more likely to be aged under 20 years at their initial termination with an adjusted odds ratio (AOR) of 5.59 [95% confidence interval (CI) 4.17–7.49], to belong to the most deprived social quintile [AOR 1.23 (95% CI 1.05–1.43)], and to be more likely to have had two or more previous livebirths [AOR 1.51 (95% CI 1.12–2.02)] or miscarriages [AOR 1.40 (95% CI 1.02–1.92)]. The likelihood of having a repeat termination was increased in women who had a contraceptive implant as post-termination contraception [AOR 1.78 (95% CI 1.50–2.11)] compared to women who left with none or unknown methods following the first termination. In those who had repeat terminations, women who had an implant or Depo-Provera® were at increased odds of repeat termination in the 2–5 years interval compared to the 0–2 years after their initial termination.Conclusions Teenage pregnancy, social deprivation, two or more previous livebirths or miscarriages at the time of the initial termination were identified as risk factors for repeat terminations. Post-termination contraception with implants and Depo-Provera® were associated with repeat termination 2–5 years after the first termination.

AB - Background Repeat termination of pregnancy highlights the issues of unplanned pregnancies and effective post-termination contraceptive practices.Objective To examine the risk factors at the time of a first termination that are associated with subsequent repeat termination.Design Registry-based study.Setting Grampian region of Scotland, UK.Methods A retrospective study using data from the Termination of Pregnancy Database, NHS Grampian for the period 1997–2013. Associations between repeat termination and women’s sociodemographic characteristics and contraceptive use were assessed using multivariable logistic regression models.Results This study showed that 23.4% of women who had an initial termination (n=13 621) underwent a repeat termination. Women who had repeat terminations were more likely to be aged under 20 years at their initial termination with an adjusted odds ratio (AOR) of 5.59 [95% confidence interval (CI) 4.17–7.49], to belong to the most deprived social quintile [AOR 1.23 (95% CI 1.05–1.43)], and to be more likely to have had two or more previous livebirths [AOR 1.51 (95% CI 1.12–2.02)] or miscarriages [AOR 1.40 (95% CI 1.02–1.92)]. The likelihood of having a repeat termination was increased in women who had a contraceptive implant as post-termination contraception [AOR 1.78 (95% CI 1.50–2.11)] compared to women who left with none or unknown methods following the first termination. In those who had repeat terminations, women who had an implant or Depo-Provera® were at increased odds of repeat termination in the 2–5 years interval compared to the 0–2 years after their initial termination.Conclusions Teenage pregnancy, social deprivation, two or more previous livebirths or miscarriages at the time of the initial termination were identified as risk factors for repeat terminations. Post-termination contraception with implants and Depo-Provera® were associated with repeat termination 2–5 years after the first termination.

KW - abortion

KW - epidemiology

KW - long-acting reversible contraception

U2 - 10.1136/jfprhc-2014-101059

DO - 10.1136/jfprhc-2014-101059

M3 - Article

VL - 42

SP - 133

EP - 142

JO - Journal of Family Planning and Reproductive Health Care

JF - Journal of Family Planning and Reproductive Health Care

SN - 1471-1893

IS - 2

ER -