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Contraception post-surgery

Post-surgical contraception advice not adhered to

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Some 24.8% of responders stated that they did not receive any advice on avoiding pregnancy postoperatively

A majority of post-bariatric patients are not adhering to contraceptive recommendations that they should avoid pregnancy for at least 12 months post-surgery, according to a paper published in Obesity Surgery. The paper, ‘Contraceptive Use Before and After Gastric Bypass: a Questionnaire Study’, by researchers from the University Hospital, Linköping University, Linköping and Örebro University, Örebro, Sweden, states that significant improvements in contraceptive counselling are required in this growing group of women.

The study authors used data from the Scandinavian Obesity Surgery Register (SOReg) to assess how women having bariatric surgery perceived the contraceptive counselling they were given before the procedure and to determine patterns of contraceptive use before and after the surgery.

A postal questionnaire was sent to 987 women that comprised questions regarding educational level, smoking habits, pre- and postoperative weight, and history of childbirth and pregnancies both before and after the operation. Additional questions concerned previous and present contraceptive use, contraceptive counselling, and recommendations concerning avoidance of pregnancy after bariatric surgery. In addition, the researchers asked questions regarding type and frequency of stool as frequent, loose stool might affect uptake of pharmacological agents. Comorbidity data were also retrieved from SOReg.

Outcomes

A total of 563 women answered the questionnaire (57% response rates), with 64% of responders having the operation more than two but less than three years earlier and 36% between one and two years earlier.

They report that there were no differences in weight loss during the first postoperative year in relation to the contraceptive method the women used during this time with 67% of the women used some kind of contraceptive method preoperatively and 80% of these women were satisfied with their preoperative contraceptive method.

Some 24.8% of responders stated that they did not receive any advice on avoiding pregnancy postoperatively and 14.8 % did not remember whether or not they had received such advice or not. Interestingly, the main sources of this information were midwives or gynaecologists. However, 18% stated they could have benefited from more contraceptive counselling at the time of surgery.

Additional findings were:

  • Almost one third of the women had not used any contraception at all during the first year following surgery
  • Among the women who presently used contraception, a majority (82%) were satisfied with their contraceptive method
  • Twenty-five percent had become pregnant after surgery
  • 12% were actively trying to become pregnant when they answered the questionnaire.
  • 3% reported becoming pregnant postoperatively in spite of using contraception properly (although it was not possible to determine what methods these women had used at the time of conception or how far after the surgery it had happened)

“A substantial number of these women stated that they had received insufficient advice about avoiding pregnancy,” the authors write. “A majority also stated that they received no or insufficient contraceptive counselling. The Swedish guidelines recommend avoiding the combination of obesity and use of combined hormonal contraceptives, as this has been shown to increase the risk of venous thromboembolism…It is therefore noteworthy and alarming that almost every tenth woman had used combined hormonal contraceptives at sometime within one year prior to surgery.”

“We identified a great need to provide improved contraceptive counselling for this growing group of women undergoing gastric bypass surgery,” the authors conclude. “Health-care professionals involved in bariatric surgery need to emphasise the recommendations concerning contraception and, if needed, refer the patients to a gynaecologist preoperatively for contraceptive counselling. We suggest that standard written information on advice concerning postoperative pregnancies/contraception should be handed out by the operating centre to every individual considering undergoing bariatric surgery.”

To access this paper, please click here

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