C. Dufey-Liengme

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    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 when

    choosing 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.