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J Pediatr Adolesc Gynecol. 2019 Apr 10. pii: S1083-3188(19)30179-2. doi: 10.1016/j.jpag.2019.04.006. [Epub ahead of print]

Follow-Up Rates And Contraceptive Choices After Medical Abortion In Adolescents At Cook County Hospital.

Author information

1
John H. Stroger, Jr. Hospital of Cook County, Department of Obstetrics and Gynecology, 1969 W Ogden Ave, Chicago, IL 60612; Northwestern University, Department of Obstetrics and Gynecology, 250 E Superior St, Chicago, IL 60611. Electronic address: Jacqueline.lee1@northwestern.edu.
2
John H. Stroger, Jr. Hospital of Cook County, Department of Obstetrics and Gynecology, 1969 W Ogden Ave, Chicago, IL 60612. Electronic address: jessica.madrigal@cookcountyhhs.org.
3
John H. Stroger, Jr. Hospital of Cook County, Department of Obstetrics and Gynecology, 1969 W Ogden Ave, Chicago, IL 60612; Northwestern University, Department of Obstetrics and Gynecology, 250 E Superior St, Chicago, IL 60611. Electronic address: apatel2@cookcountyhhs.org.

Abstract

STUDY OBJECTIVE:

To determine follow-up rates for adolescent patients undergoing medical abortion in comparison to adult patients, identify patient factors associated with follow-up, and evaluate contraceptive choices at the time of follow-up.

DESIGN:

Setting and Participants: A retrospective cohort study of adolescent patients (ages 15-19) undergoing first-trimester medical abortions at John H. Stroger, Jr. Hospital of Cook County from 2014 through 2017.

INTERVENTIONS:

None MAIN OUTCOME MEASURES: Rate of follow-up after medical abortion, demographic factors associated with higher follow-up rates, and contraceptive choices by adolescents at follow-up encounters.

RESULTS:

During the study period, 8,111 medication abortions were performed in our clinic. Adolescents accounted for 5.5% of these patients (446/8111=5.5%). Among adolescents, the follow-up rate was 51.8% (231/446). We determined the follow-up rates among a random sample of patients ages 20 to 24 (n=494) and 25 to 39 (n=397) to be 43.1% (213/494), and 40.5% (161/397), respectively. African American adolescents were significantly less likely to follow-up when compared to their Hispanic and white counterparts (RR 0.76, 95% CI 0.66-0.89). Those enrolled in college were significantly more likely to follow-up when compared to those who reported lower levels of education (RR 1.4, 95% CI 1.0-1.9). Only 2.5% of adolescents reported ever using a tier 1 contraception option before presenting for an abortion and among those that did follow-up, only 18% chose a tier 1 option for ongoing pregnancy prevention.

CONCLUSIONS:

Approximately half of our adolescent study population is at risk for undetected failed medical abortion and subsequent unplanned pregnancy.

KEYWORDS:

adolescent; contraception; early medical abortion; sexually transmitted diseases

PMID:
30980940
DOI:
10.1016/j.jpag.2019.04.006

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