Termination of pregnancy for maternal medical indications: Failings in delivery of contraceptive advice?

Abstract

The majority of therapeutic terminations of pregnancy occur for maternal psychological, social or fetal reasons. Available data on maternal medical indications, rather than social, are sparse. To examine the maternal medical indications for the termination of pregnancy and use of contraception over a ten-year period. A retrospective review of cases of termination of pregnancy performed for maternal indications in an Australian tertiary obstetric referral hospital. Cases from January 2000 to July 2010 inclusive were selected by examination of a termination of pregnancy database at our hospital. From 893 terminations, 104 were performed for maternal indications and had notes available for review: mean maternal age, 28.2 years (SD, 6.6; range, 14-44); median gravidity, 2; and parity, 1; and mean gestational age, 11.5 weeks (SD, 4.6; range, 5-23). Terminations were primarily surgical (n=81 (78.6%)) rather than by induction of labour (n=22 (21.4%)). Frequent maternal indications included psychiatric (n=24 (23.1%)), malignancy (n=17 (16.3%)) and cardiac (n=13 (12.5%)). Information on contraceptive use prior to termination was available in 40 (53%) women known to have disease prior to conception. Contraception was recorded as being in use prior to conception in 19 (47.5%) of these. Following termination, 75 (75.7%) were recorded as using contraception. Contraceptive rates in this at risk group appear to be poor and require attention.