title: Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data.
abstract: BACKGROUND
  Repeat termination of pregnancy highlights the issues of unplanned pregnancies and effective post-termination contraceptive practices.
  
  
  OBJECTIVE
  To examine the risk factors at the time of a first termination that are associated with subsequent repeat termination.
  
  
  METHODS
  Registry-based study.
  
  
  METHODS
  Grampian region of Scotland, UK.
  
  
  METHODS
  A retrospective study using data from the Termination of Pregnancy Database, NHS Grampian for the period 1997-2013. Associations between repeat termination and women's sociodemographic characteristics and contraceptive use were assessed using multivariable logistic regression models.
  
  
  RESULTS
  This study showed that 23.4% of women who had an initial termination (n=13 621) underwent a repeat termination. Women who had repeat terminations were more likely to be aged under 20 years at their initial termination with an adjusted odds ratio (AOR) of 5.59 [95% confidence interval (CI) 4.17-7.49], to belong to the most deprived social quintile [AOR 1.23 (95% CI 1.05-1.43)], and to be more likely to have had two or more previous livebirths [AOR 1.51 (95% CI 1.12-2.02)] or miscarriages [AOR 1.40 (95% CI 1.02-1.92)]. The likelihood of having a repeat termination was increased in women who had a contraceptive implant as post-termination contraception [AOR 1.78 (95% CI 1.50-2.11)] compared to women who left with none or unknown methods following the first termination. In those who had repeat terminations, women who had an implant or Depo-Provera(®) were at increased odds of repeat termination in the 2-5 years interval compared to the 0-2 years after their initial termination.
  
  
  CONCLUSIONS
  Teenage pregnancy, social deprivation, two or more previous livebirths or miscarriages at the time of the initial termination were identified as risk factors for repeat terminations. Post-termination contraception with implants and Depo-Provera® were associated with repeat termination 2-5 years after the first termination.
authors.affiliation: Research Assistant, Epidemiology Group, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK DPhil Student, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: McCall
authors.affiliation: Consultant in Sexual and Reproductive Health, Department of Sexual Health, NHS Grampian, Aberdeen, UK.
authors.forename: Gillian
authors.initials: G
authors.lastname: Flett
authors.affiliation: Consultant in Public Health Medicine, Department of Public Health, NHS Grampian, Aberdeen, UK.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Okpo
authors.affiliation: Senior Lecturer, in Obstetric Epidemiology Epidemiology Group, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK.
authors.forename: Sohinee
authors.initials: S
authors.lastname: Bhattacharya
mesh_terms: D000028:Abortion, Induced / Q000379:methods* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland; D012923:Social Class; D012959:Socioeconomic Factors; D013997:Time Factors; D016387:Women's Health; D055815:Young Adult
keywords: abortion; epidemiology; long-acting reversible contraception