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CONTRACEPTION POST ABORTION

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

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CONTRACEPTION POST ABORTION

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  1. CONTRACEPTION POST ABORTION

  2. 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

  3. 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?

  4. 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

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

  6. ICGP Interim Guideline P26. Table 4: Contraception Methods and post-termination initiation timeframes

  7. 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

  8. 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

  9. 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

  10. 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

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