Rates of Follow-up and Repeat Pregnancy in the 12 Months After First-Trimester Induced Abortion

Abstract

OBJECTIVE: To estimate the proportion of women who returned for a routine follow-up visit after elective abortion and to identify factors associated with repeat pregnancy in the subsequent year. METHODS: We performed a historical cohort study of 865 women who underwent first-trimester surgical abortion at a hospital-based family planning clinic between March 2003 and February 2004. We collected demographic and clinical data from procedure notes and a computerized hospital patient database. We used univariable and multivariable logistic regression to analyze associations between patient characteristics and repeat pregnancy within 1 year. RESULTS: There were a total of 865 women in our cohort. Of these, 753 (87%) returned to the medical center for care; 485 women returned on time, 268 women returned late, and 112 had no further visit. There were 161 repeat pregnancies; 87 (17.9%) in the on-time group and 74 (27.6%) in the late group (P<.001). There were 85 repeat abortions; 42 (8.7%) in the on-time group and 43 (16.0%) in the late group (P<.001). Multivariable analysis demonstrated that on-time follow-up was associated with a reduction in repeat pregnancy (odds ratio [OR] 0.54, 95% confidence interval [CI] 0.37–0.77) and repeat abortion (OR 0.53, 95% CI 0.33–0.86). A total of 130 women received injectable depot medroxyprogesterone acetate (DMPA) at the time of abortion. The rates of repeat pregnancy and abortion in these women were 13.7% and 6.2%, respectively. Women who received DMPA had a decrease in rates of repeat pregnancy (OR 0.41, 95% CI 0.23–0.73) and repeat abortion (OR 0.45, 95% CI 0.20–0.99). CONCLUSION: Timely follow-up and immediate administration of DMPA are associated with a decrease in repeat pregnancy in the 12 months after first-trimester elective abortion. LEVEL OF EVIDENCE: II