CONTRACEPTION POST ABORTION

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Post Abortion Contraception

Presentation transcript:

CONTRACEPTION POST ABORTION

Some Statistics 39% of women who had an abortion in England and Wales in 2017 had one or more previous abortion 40% of pregnancies worldwide are unplanned (WHO) A woman can ovulate as early as 8 days post abortion 90% of women ovulate within one month Therefore post abortion contraception is a vital part of abortion provision and aftercare

Why so important? Highly motivated at this time Known not to be pregnant Currently accessing healthcare “captive audience” Reduces chances of another unintended pregnancy Chance to review contraceptive history, were they using any contraception at all? If so did it fail? If it failed why did it fail?

Methods of Contraception Pills-OCP, POP Patch-Evra Ring-Nuvaring Injection-Depo-provera Implant-Implanon IUD/IUS-Copper IUDs, Mirena, Kyleena, Jaydess Barrier-Condoms, diaphragm Sterilisation

Long Acting Reversible Contraception Implant, IUD, IUS and injection Abortion consultations are an ideal opportunity to promote LARC

Contraceptive method Earliest time post medical ICGP Interim Guideline P26. Table 4: Contraception Methods and post-termination initiation timeframes Contraceptive method Earliest time post medical of initiation Earliest time of initiation termination post surgical termination Combined hormonal contraception (pills, patch or ring) Progesterone only pill Subdermal implant DPMA ( Depo-provera) Condoms & spermicide IUD/IUS Day of mifepristone As soon as intercourse resumes Once expulsion has occurred Immediately

Surgical Abortion All methods can be commenced on the same day IUD/IUS-There is an increased risk of expulsion if fitted on the day of the surgical abortion 27.5% vs 4% if insertion delayed

Medical Abortion All methods, exception IUD and IUS, can be started at the time of medical abortion ie same day as MIFE Depoprovera MAY increase the incomplete abortion rate by 2.7%. However this was one small study, needs further research and should not prevent the use of depoprovera Implanon can be fitted on the same day as Mifepristone

IUD/IUS Cannot be fitted until confirmation that the abortion is complete The 2 week check up is an ideal time to fit once low sensitivity pregnancy test is negative Consider bridging

Conclusion There are 2 if not 3 consultations in the process of an abortion Each consultation should be an opportunity to promote contraception in particular LARC (Long acting reversible contraception) Think CONTRACEPTION and think LARC