Contraceptive choices of women undergoing midterm trimester pregnancy termination (MTPT) in a single obstetric unit in Singapore
ESC Congress Library. Zhong Wei H. May 10, 2018; 208099; ESC95
Dr. Huang Zhong Wei
Dr. Huang Zhong Wei
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Objective: To evaluate uptake and contraceptive choices in women undergoing MTPT for social reasons or foetal anomalies (FA) below 24 weeks gestation age (GA).   Background: Pregnant women are legally allowed to terminate a pregnancy below 24 weeks GA in Singapore. Women are routinely counselled on contraceptive use to prevent further unplanned pregnancies as repeated TOPs may result in complications such as pelvic infections leading to secondary subfertility.    Methods: 87 Women who underwent MTPT after 12 weeks GA at this unit from December 2015 -October 2017 were included in this retrospective cohort study. Data were obtained from electronic medical records and include indication for MTPT, marital status, history of previous abortions, contraceptive usage before and after MTPT.  Results: 87 women underwent MTPT - 52.9% for social reasons, 36.8% for FA and 1.1% for maternal health reasons. GA of MTPT ranged from 12 weeks 5 days to 23 weeks 5 days. Women undergoing MTPT for social reasons were younger than women undergoing MTPT for FA (28.2 +/- 8 and 33.8 +/- 5 p=0.0002) with higher proportions of single women undergoing MTPT for social reasons (41%), and all but one undergoing MTPT for FA being married. A higher proportion of women with previous abortions underwent MTPT for social reasons compared to those for FA (17/46 36.9% versus 1/40 2.5% p=0.0001). The proportion of women undergoing MTPT for social reasons requiring surgical evacuation (43%) was higher than women who underwent MTPT for FA (35%), although not reaching statistical significance. Only one woman who underwent an MTPT for social reasons used pre-conception contraception. 65.2% (30/46) of these women opted for contraception post procedure. Of these, 10% opted for condoms, 10% for combined contraceptive pills, 3.3% for intramuscular progesterones, 66.6% for subdermal progesterone implants and 16.7% for intrauterine devices. Women who underwent MTPT for FA did not utilize contraception before conception and only 2.5% (1/40) opted for contraception using intramuscular progesterone post MTPT.  Conclusion:Women undergoing MTPT for social reasons were younger than women undergoing MTPT for FA. Contraception uptake was minimal in women having MTPT for FA as they were married and planning for subsequent conceptions. This study suggests that younger women undergoing MTPT for social reasons are likely to have repeated abortions, thus contraception counselling is pertinent. Improvement of contraceptive uptake post MTPT will reduce the number of unplanned pregnancies and the sequelae of MTPT. 
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