C. Dufey-Liengme
Speeches:
-
Termination of pregnancy among teenagers – why
more surgical terminations?
Dufey-Liengme, C; Coquillat, F; Demierre, M;
Renteria, S-C
Centre for Sexual Health and Planned Parenthood, Unit for Psycho-
social gynaecology and obstetrics, ObGyn Department, Centre
Hospitalier Universitaire Vaudois, Lausanne, Switzerland
Introduction: In 2012, a study by K. Chatziioannidou and S-C.
Renteria showed that teenagers chose to undergo a surgical
termination of pregnancy (TOP) more often than a medical TOP
(mifepristone followed by misoprostol) when they decided to
terminate a pregnancy. It also showed that the teenagers’ choice
for a medical versus surgical method is inversely proportional to
the adults’ choice although the efficiency of the medical method
showed even better results for teenagers than for adults.Accordingtothehypothesismade,thereasonsforthischoice
mightbeinfluencedbythefollowingfacts:(i)thebelatedcalltomake
anappointment,themedicalprocedurenotbeingavailableafter
9 weeksofgestation;(ii)theimperativerequestforconfidentiality;
(iii)thebeliefsandsubjectiveappreciationofthemedicalstaff.
Objectives: The aim of this retrospective and qualitative study is
to analyse the reasons why, in case of a TOP, teenagers chose the
surgical method more often than their adult counterparts.
Material: (i) All teenagers who were admitted for an abortive
procedure during 2011 in the in- or outpatient ward.
(ii) The professional team (midwives and sexual and
reproductive counsellors) in charge in the case of a TOP request.
Methods: The information about the patient’s history and the bio-
psycho-social data was retrieved from thepatient files filled out by
midwives and sexual and reproductive healthcounsellors during the
first appointment for a TOP request orduring its process.
The professionals’ appreciation was evaluated by means of a
semi-structured questionnaire.
Results: Concerning the choice of the method for a pregnancy
termination, the results of our research show that:
(i) Out of 47 teenagers, 27 chose the surgical method and 17
the medical method.
(ii) Three had a second trimester abortion (which includes use
of the medical method).
(iii) Fifteen teenagers out of the 27 who chose a surgical
method consulted between the 9th and 14th weeks of
amenorrhoea and therefore did not have any other choice.
The reasons for their ‘late arrival’ will be explained in detail.
The 12 teenagers who arrived before the 8th week of
amenorrhoea and chose to undertake abortion by suction &
curettage under general anaesthesia did it for the following
reasons:
(i) Four were afraid of bleeding and pain.
(ii) Five thought that the organisation of the surgical procedure
was easier.
(iii) Two did not trust the abortion pill.
(iv) One was taken to her mother’s gynaecologist where she
had a D&C.
Confidentiality was requested nine times out of 27 whenchoosing the surgical method, and six times out of 17 when
choosing the medical method.
Therefore, although confidentiality concerns a third of the
teenagers’ pregnancy termination requests, it does not seem to be
a significant element for the choice of the method.
As for the subjective appreciation of the professionals, the first
results of the discussions seem to show that teenagers were
reluctant or resistant towards the medical method.
Conclusion: This study shows that the reasons why teenagers still
prefer the use of the surgical over the medical method compared
to adults, seem to include the late request for an appointment,
fear of pain and bleeding and organisational issues.
Confidentiality does not seem to greatly influence the teenagers’
choice. Nonetheless, medical professionals seem to favour the
suction curettage procedure performed under anesthesia because
they associate young age with vulnerability and psychological
frailty and consequently diminished ability to cope with pain and
emotional distress during the medical procedures.