Does abortion procedure influence contraceptive choices and behaviour?

Does abortion procedure influence contraceptive choices and


A. Gairing, S. Tschudin, D. Zanotelli, W. Holzgreve, J.


University Women’s Hospital, Basel, Switzerland

Objectives: To prevent repeated unwanted pregnancies and

abortion, it is crucial to discuss sub-sequent contraception with the patient

and to start it as soon as possible after the abortion. Medical and surgical

abortion explicitly differ in the course of the procedure. With regard to

optimise our pre-abortion contraceptive counselling we wanted to investigate

whether the choice of the contraceptive method and its initiation depend on the

chosen abortion procedure.

Design and methods: We retrospectively collected data of

all patients who underwent either medical or surgical abortion at our clinic

between 1.3. 2002 and 28. 3. 2003. Medical abortion was offered until a

gestational age of 49 days using Mifepriston and Misoprostol, surgical abortion

was performed by suction curettage up to 12 weeks of gestation. The data were

analysed by descriptive statistics.

Results: Of a total of 422 abortions, 184 (43,6%) were

performed surgically, 238 (56,4%) medically. The patients mean age was 32.7

years with a minimum of 16 to a maximum of 50 year. 4,8% of the patients were

younger than 20 years of age, 41,4% between 20 and 30 years, 41,1% between 30

and 40 years and 12,6% over 40 years. The contraceptive method to be used after

abortion was known in 248 (58,8%) cases, in the remaining 174 (41,2%) cases

subsequent contraception was not documented. We know of twice as many patients

with surgical abortion, which method of contraception they used (82%) compared

to the group who underwent medical abortion (40%). This might be due to lost

follow up for patients who went back to their practising gynaecologists and/or

the less clear end point of the medical procedure. In case of suction curettage,

IUD (half copper and half levonorgestrel-containing) was used twice as much

(40,4%) as after medical abortion (20%). The most frequently chosen

contraceptive method after medical abortion was a combined oral contraceptive

(56,7%). A progestogen only preparation (progestogen-only pill, implant or

depot-injection) was chosen by 21,6% after medical and 11,9% after surgical


Conclusions: According to our retrospective evaluation

the initiation of post-abortion contraception is better established after

surgical than after medical abortion and IUDs seem to be more frequently chosen

by the ‘surgical group’. This may have an impact on the risk of repeated

unwanted pregnancy and does demand special counselling efforts in the medical

abortion group.

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