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  • Title: Lessons from an audit of unplanned pregnancies.
    Author: Metson D.
    Journal: BMJ; 1988 Oct 08; 297(6653):904-6. PubMed ID: 3140975.
    Abstract:
    To determine the effectiveness of contraceptive use a two year audit of pregnant women registered in one group practice was carried out. The methods of contraception used by women with unplanned pregnancies were studied and the rates of failure assessed. Of the 518 pregnancies during the study, 187 (36%) were unplanned. Unplanned pregnancies were most common in the 15-19 age group (54 out of 187), and women aged under 25 used contraceptives less reliably than women aged 25 and over. The combined pill was the most effective method of contraception in all age groups. The methods that resulted in most unplanned pregnancies were the sheath in women aged 25 and over and incorrect use of oral contraceptive or no contraception in those aged under 25. The fear of side effects was an important reason why women did not use the combined pill, being cited by 22 out of 134 women, and inappropriate medical advice was cited by a further 20 women. More discussion between doctors and patients and readily available information on the use of oral contraceptives might help to reduce the number of unplanned pregnancies. To evaluate the effectiveness of contraceptive usage, a 2-year (1985-87) review of pregnant women registered in a large group medical practice west of London was carried out. Altogether, 518 pregnancies were reported during the study period, 187 (36%) of which were unplanned. Broken down by age category, the unplanned pregnancy rate was: 15-19 years, 7.5; 20-24 years, 6.5; 25-29 years, 5.4; 30-34 years, 3.5; and 35-44 years, 2.0. The methods of contraception used at the time of the unplanned pregnancies were: no contraception, 61 women; condom, 49 women; combined oral contraceptive, 27 women; progesterone-only oral contraceptive, 14 women; IUD, 12 women; cap, 12 women; rhythm, 6 women; and withdrawal, 6 women. Of the 49 couples who were relying on the condom for fertility control, 16 had not been using this method at the probable time of conception. In the 27 pregnancies due to failure of the combined pill, 16 indicated they had missed some pills and 3 had gastroenteritis at the probable time of conception; similarly, of the 14 pregnancies involving failure of the progesterone pill, 6 women had forgotten pills and 1 had gastroenteritis. The most commonly cited reasons for nonuse of contraception were fear of or actual side effects (obesity, cancer, heart disease). Unplanned pregnancies in women under 25 years of age tended to be the result of not using any form of contraception or of using combined oral contraceptives incorrectly; in women over this age, unplanned pregnancies were most often associated with condom use. These results suggest several steps: 1) physicians should discuss contraception with all teenagers thought to be sexually active; 2) more time should be spent exploring patients' fears of side effects; 3) patients should be counseled about procedures to follow if a pill is missed; and 4) use of both the condom and combined oral contraceptives should be encouraged in younger women.
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