Termination of pregnancy

Since 1981 I have worked as a certifying consultant appointed by the Abortion Supervisory Committee under the Contraception, Sterilisation and Abortion Act 1977 to consider, in accordance with section 33 of the Act, whether an abortion should be authorised in women whom I see who are seeking termination of their pregnancy. I have never worked as an operating doctor performing abortions. I have a small body of work pertaining to research on aspects of termination of pregnancy

Choosing medical or surgical terminations of pregnancy in the first trimester: what is the difference?

Goodyear-Smith F, Knowles A. Australian and New Zealand Journal of Obstetrics and Gynaecology, 49:211-215, 2009. doi:10.1111/j.1479-828X.2009.00967
BACKGROUND: Women seeking termination of pregnancy in Auckland, New Zealand can chose between medical and surgical options up to eight weeks gestation.
AIMS: To assess demographic differences or changes over time between proportions of women choosing medical or surgical abortions at a single centre and determine whether changing the mifepristone-misoprostol interval from two to one day impacted on outcomes.
METHODS: Retrospective audit of two consecutive years (December 2005-November 2006 and December 2006-November 2007) of first-trimester surgical and medical terminations where the mifepristone-misoprostol interval was reduced from two to one day between years. Analysis using descriptive statistics and assessment of probability of observed differences between groups.
RESULTS: A total of 1495 terminations were performed in 2005-2006 and 1588 in 2006-2007. No significant difference (P = 0.4) of eligible women choosing medical (21% and 23%) or surgical abortion between years. Ethnicity, age and residency status did not influence choice. Medical termination of pregnancy was more likely in women who were without previous children (P = 0.009), pregnancies (P = 0.02) or terminations (P = 0.04). Medical termination was similarly effective within six hours with either two- or one-day intervals.
CONCLUSIONS: Both medical and surgical first-trimester abortions are safe and effective. It is optimal to be able to offer women choice. Reducing the medical interval to one day does not increase adverse outcomes.

First trimester medical termination of pregnancy: an alternative for New Zealand women

Goodyear-Smith F, Knowles A, Masters J. Australian and New Zealand Journal of Obstetrics and Gynaecology, 46: 193-198, 2006
BACKGROUND: First trimester medical terminations of pregnancy (TOP) have been carried out in a private abortion clinic in Auckland from 1 July 2003 to 30 June 2005.
AIMS: To audit first trimester medical TOP outcomes over the first 2 years and to compare the demographics and complication rates of women opting for medical TOP with those choosing surgical TOP during this period.
METHODS: Retrospective, consecutive case audit of women presenting for a first trimester TOP. Anonymous audit included ethnicity, gestation at first appointment, pain relief requirements, blood loss, timing from the taking of misoprostol to expulsion of products of conception, complications and comparison of outcomes and characteristics between medical termination of pregnancy (MTOP) and surgical termination of pregnancy (STOP).
RESULTS: A total of 3311 TOPs were performed over the 2-year study period, including 390 MTOPs (12%). No significant differences were found in age, ethnicity or history of previous TOP between women choosing MTOP or STOP. Gravida 1 and nulliparous women were significantly more likely to choose MTOP. Five per cent (21/390) of women taking mifepristone progressed to STOP. Complications involving hospitalisation occurred in six MTOPs (1.5%) and 18 STOPs (0.6%).
CONCLUSIONS: First trimester MTOP is safe and effective and is a realistic alternative for women wanting choice of method in New Zealand.

High rates of chlamydia in patients referred for termination of pregnancy: treatment, contact tracing, and implications for screening

Rose S, Lawton B. Brown S, Goodyear-Smith F, Arroll B. New Zealand Medical Journal,118 (1221):1-8, 2005
AIMS: To determine the rate of chlamydia and other sexually transmitted infections (STIs), and to describe treatment and factors associated with chlamydia in patients presenting for a termination of pregnancy (TOP).
METHODS: A retrospective audit of patients attending one of two TOP clinics from 1 February 2003. (Clinic A, n=500; Clinic B, n=501). Age, ethnicity, marital status, previous pregnancies, contraception, STIs, and treatment were recorded.
RESULTS: Ten percent of patients tested positive for an STI. Chlamydia was most commonly detected, in 7.7% of all patients. Higher rates of chlamydia were observed at clinic B (10.2% vs 5.2%, p=0.005) and in under 25 year olds (11.2% vs 3.6%, p<0.001). Rates of chlamydia in Pacific women were 18.6%, in Maori 12.9%, in Asian 7.3% and 4.4% in New Zealand European women. All patients testing positive for chlamydia were treated prior to TOP but only 41% of partners were treated. Other infections detected included 18 cases of human papillomavirus (HPV), three cases of trichomoniasis, one case of gonorrhoea, and one case of syphilis. CONCLUSIONS: There is a high rate of chlamydia in women presenting for TOP, particularly in under 25 year olds, Pacific, and Maori women. There is an immediate need for policymakers to respond to this increasing burden of chlamydia by instigating targeted education, guidelines, and mandatory chlamydia screening and contact tracing for pregnant women.

Contraceptive use before and after termination of pregnancy

Goodyear-Smith F, Arroll B invited expert columnist, Sociedad Iberoamericana de Información Científica (SIIC),5 May, 1-11, 2005

Contraception before and after termination of pregnancy: can we do it better?

Goodyear-Smith F, Arroll B New Zealand Medical Journal, 116 (1186): 1-9, 2003
AIM: To compare contraceptive use pre- and post-therapeutic abortion in 1995, 1999 and 2002 in a New Zealand clinic.
METHODS: Retrospective, consecutive case review of women presenting for therapeutic abortion. Anonymous data included demographic details, contraception used at conception, and post-termination contraception.
RESULTS: Pre-conception contraceptive use is significantly declining, with post-termination condom choice increasing. This is predominantly due to increasing numbers of Asian women presenting for abortion. In 2002, 97% of Asian women used no contraception or only condoms pre-conception, and 62% chose condoms or abstinence post-termination. Oral contraceptives are used significantly less by Asian than European women both pre-termination (p = 0.0002) and post-termination (p = 0.00001). Other ethnic groups showed little change in contraceptive use over the study periods.
CONCLUSIONS: It is speculated that ethnic Chinese women lack adequate contraceptive education, demonstrate distrust of non-barrier methods, believe men should provide the prophylactic, and mistakenly believe contraception unnecessary for the first week following menstruation. Abortion may be used for family planning rather than as back up for contraceptive failure. Young Chinese arriving in New Zealand require immediate sexual health education including accurate contraceptive information. Liaison between primary healthcare sectors and policy makers of immigration and other services assisting overseas students is recommended to provide culturally appropriate education.

Termination of pregnancy following panic-stopping of oral contraceptives

Goodyear-Smith F, Arroll B Contraception, 66: 3, 163-167, 2002
This study assessed characteristics of women presenting for termination of pregnancy subsequent to stopping combined oral contraceptive use in response to publicity-mediated fears regarding venous thromboembolism. Records of 400 women attending for pregnancy termination assessment were reviewed retrospectively. Panic-stopping of oral contraceptives was implicated in 9.5%. Nearly 50% of combined pill users claimed their pregnancy resulted from panic-stopping because of media-promoted fear of health risks, especially ‘clots.’ Panic-stoppers had significantly lower identified risk factors for venous thromboembolism than pill users who had not panic-stopped. The relative safety of third-generation pills is under debate. The risk-benefit ratio of contraceptive pills is overwhelmingly positive but practitioners must be vigilant in screening for risk factors and contraindications. Panic-stopping results in unwanted pregnancies with concomitant psychological distress and potential physical morbidity. In future situations where research findings may precipitate drug scares, we recommend recall of patients by their health provider, funded by the relevant health authority or pharmaceutical companies, to allow discussion of risks before the media is enabled to have access to the information.