PRA CONCEPTION POST ABORTION

AND POST CONTRACEPTION

Sri Ratna D
FK Unair-RSUD Dr. Soetomo
2019
 DEFINITION
Prenatal prevention care:
A set intervention that aim to identify and
modify biomedical, behavior, and social risk
to women`s health or pregnancy outcome
through prevention and management.
 GOAL OF PRECONCEPTION CARE
• Improve knowledge, attitudes, and behavior of mens
and women related to preconceptional health
• Assure that all women of childbearing age receive
preconceptional care service – including evidence
based risk screening, health promotion and
intervention- that will enable them to enter pregnancy
in optimal health
• Reduced risk indicated by a previous adverse
pregnancy outcome through interconceptional
interventions to prevent or minimize recurrent adverse
outcome
• Reduce the disparities in adverse pregnancy outcome
 Birth spacing and mortality
• The relationship between birth spacing and maternal
mortality has not been so extensively studied (possibly
due to the low frequency of maternal deaths).
• A short time interval between the end of a pregnancy
and the beginning of the next  cause nutritional
depletion ( mostly Anaemia) , with or without previous
excessive blood loss.
• Anaemic women may be at an increased risk of
puerperal sepsis, and their tolerance to blood loss may
be reduced, which increases the risk of maternal
mortality.
 Birth spacing and mortality

A nested case control study conducted on a

cohort of women under demographic
surveillance in Matlab, Bangladesh, found that
the length of the preceding birth-to-conception
interval did not affect the risk of maternal
mortality

Ronsmans C, Campbell O. Short birth intervals don't kill women: evidence from
Matlab, Bangladesh. Studies in Family Planning 1998 Sep;29(3):282e90.
 Birth spacing and mortality
a cross-sectional study based on the Perinatal Information
System database of the Latin American Centre for Perinatology,
which included 456,889 parous women with singleton infants.

This study found that women with inter-pregnancy

intervals of ≤ 5 months had higher risks of maternal
death (odds ratio 2.54; 95% CI 1.22-5.38) compared
with those conceiving at 18 to 23 months after the
previous childbirth
 Birth spacing and mortality
• These conflicting results do not confirm the
common assumption that very short inter-
pregnancy intervals carry a higher risk of
maternal mortality and that by increasing such
interval, it is possible to reduce MMR .
• However, even if birth interval does not have a
signifcant impact on mortality, there are several
other health reasons that promote longer birth
intervals, although not as long as ≥ 5 years
 Birth spacing and mortality
• Studies have long shown that inter-pregnancy
intervals <12 months or >60 months have an
adverse effect on maternal and perinatal
outcomes
• The effect of short intervals on puerperal
endometritis (23% increase), and long
intervals on eclampsia (74% increase), third-
trimester bleeding (11% increase), and fetal
death (18% increase)
Birth spacing and mortality
 Birth Spacing
A WHO technical consultation, 2005 ,to decide (based on
the research evidence) what constitutes the ideal inter-
pregnancy interval.
• Nothing the effects of short intervals (<12 months) and
long intervals (>60 months) on maternal and perinatal
outcomes, especially mortality
• Experts recommended a space of 18-24 months after a
live birth.
• A recommendation for pregnancy spacing of 24
months would coincide with the optimal duration of
breastfeeding, conferring added nutritional benefit in
early childhood
 Reproductive planning after abortion

• Complications of unsafe abortion include:

incomplete abortion, hemorrhage, sepsis,
uterine perforation, intra-abdominal injury,
psychological trauma, infertility, reproductive
tract infections, and maternal death
• Care after an abortion includes emergency
treatment of abortion complications, and
provision of (or referral to) other reproductive
health and counseling services
 POST ABORTION FAMILY PLANNING:
A KEY COMPONENT OF POST ABORTION CARE

• Globally, one in three pregnancies (75 million)

end by either induced abortion (44 million), or
spontaneous abortion or stillbirth (31 million).
• Unmet need for family planning one of the
primary causes of induced abortion
• Post abortion women are at risk of pregnancy
almost immediately
 POST ABORTION FAMILY PLANNING:
A KEY COMPONENT OF POST ABORTION CARE

• All post abortion women should receive voluntary

post abortion family planning counseling and
should be offered FP services at the site of care,
including a wide range of methods
• Post abortion family planning uptake is high (50–
80%) when quality services are offered before
discharge
• Provision of universal access to voluntary post
abortion contraception should be a standard of
practice for doctors, nurses, and midwives
 Reproductive planning after abortion

• women receiving care were 3.38 times less likely to

have an unplanned pregnancy, and 8% fewer repeat
abortions
• repeat abortions among women receiving the
intervention decreased to half the rate in the general
population.
• Counseling also creates opportunities to involve
women’s partners by increasing the likeli hood (OR 1.6)
that they will support contraceptive uptake
• women who receive partners’ support are almost 6
times more likely to use contraception.