Keene Melissa, Roston Alicia, Keith Louis, Patel Ashlesha
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
Division of Family Planning, Department of Obstetrics and Gynecology, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
Contraception. 2015 May;91(5):398-402. doi: 10.1016/j.contraception.2014.10.011. Epub 2015 Jan 29.
The objective was to compare contraceptive method selection in women undergoing their first pregnancy termination versus women undergoing repeat pregnancy termination in an urban abortion clinic. We hypothesized that women undergoing repeat abortions will select highly effective contraceptives (intrauterine device, subdermal implant, tubal ligation) more often than patients undergoing their first abortion.
We conducted a retrospective analysis of all women undergoing first-trimester surgical abortion at John H. Stroger, Jr., Hospital of Cook County from October 1, 2009, to October 31, 2011. We compared contraceptive method selection in the postabortion period after receipt of contraceptive counseling for 7466 women, stratifying women by history of no prior abortion versus one or more abortions.
Of the 7466 women, 48.6% (3625) had no history of previous abortion. After controlling for age, race and number of living children, women with a history of abortion were more likely to select a highly effective method [odds ratio (OR) 1.19, 95% confidence interval (CI) 1.06-1.33]. Most significantly, having living children was the strongest predictor of a highly effective method with an OR of 3.17 (95% CI 2.69-3.75).
In women having a first-trimester abortion, the factors most predictive of selecting a highly effective method for postabortion contraception include history of previous abortion and having living children. The latter holds true independent of abortion history.
This paper is unique in its ability to demonstrate the high interest in highly effective contraceptive selection in high-risk, low-income women with prior abortion history. Efforts to integrate provision of highly effective methods of contraception for postabortion care are essential for the reduction of future unintended pregnancies.
本研究旨在比较城市堕胎诊所中首次终止妊娠的女性与重复终止妊娠的女性在避孕方法选择上的差异。我们假设，与首次堕胎的患者相比，重复堕胎的女性会更频繁地选择高效避孕措施（宫内节育器、皮下植入剂、输卵管结扎）。
我们对2009年10月1日至2011年10月31日在库克县约翰·H·斯特罗格医院接受孕早期人工流产的所有女性进行了回顾性分析。我们比较了7466名女性在接受避孕咨询后的堕胎后时期的避孕方法选择情况，根据有无堕胎史将女性分为两组。
在这7466名女性中，48.6%（3625名）没有堕胎史。在控制了年龄、种族和存活子女数量后，有堕胎史的女性更有可能选择高效避孕方法[优势比（OR）为1.19，95%置信区间（CI）为1.06 - 1.33]。最显著的是，有存活子女是选择高效避孕方法的最强预测因素，优势比为3.17（95%CI为2.69 - 3.75）。
在进行孕早期堕胎的女性中，预测其选择高效堕胎后避孕方法的最主要因素包括既往堕胎史和有存活子女。后者与堕胎史无关。
本文的独特之处在于能够证明有堕胎史的高危低收入女性对高效避孕选择的高度关注。将高效避孕方法纳入堕胎后护理对于减少未来意外怀孕至关重要。
