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healthier counterparts and are even mostly hospitalised for long
periods; they do not have better counselling for future family
planning methods.4
When pregnancies are ‘‘too early, too late, too many, and too
close’’, maternal and neonatal outcomes are negatively affected.5
The risks of childbirth are known to vary with the mother’s age and
may also be linked to her parity and to the interval since the
previous birth.6 Despite the improvement in postpartum family
planning programmes and contraceptive technology, still unintended
and high-risk pregnancies occur frequently. The connections
between contraceptive use, unintended pregnancies and
women with a recent preterm delivery have been reported.7–9
Women having unintended pregnancies unfortunately report not
using contraceptives, or inconsistent and ineffective method use.10
Though clinicians are assisted by the American College of
Obstetricians and Gynecologists (ACOG) and the US Centers for
Disease Control and Prevention (CDC) guidelines about contraceptive
preferences for women with medical comorbidities, there is
still lack of knowledge and usage of contraceptive methods.4 It
should be kept in mind that family planning and consistent
contraceptive use is an important key to achieve maternal and
infant health.11
Our hypothesis in this study was that pregnant women
followed as having ‘‘high-risk pregnancy’’ would be more inclined
to use contraceptive methods after delivery and their current
situation may create awareness about planning the future
pregnancies. We evaluated and compared the knowledge and
preferences of preconceptional contraceptive methods and future
plans for postpartum contraceptive usage and analysed the
requests for any contraceptive counselling inthe postpartumperiod.
2. Subjects and methods
The study was conducted at the High-Risk Pregnancy Clinic of a
tertiary research and training hospital. The Institutional Local
Ethics Committee and Institutional Education and Planning
Committee approvals were obtained and each patient gave a
signed informed consent for recruitment to the study. From
January 2009 to May 2011, face-to-face interviews were
carried out with 655 pregnant women with pregnancies greater
than 20 weeks of gestation who were admitted for at least one
high-risk obstetric indication and who were between the ages of 16
and 48. A high-risk pregnancy was defined as a pregnancy affected
by a pre-existing or a pregnancy-related condition that leads to
increased risk of morbidity or mortality before or after delivery for
the mother, foetus, or neonate. Patients who were not in a stable
medical condition and who could not fill in the questionnaire
without help were not included in the study.
Each patient was asked to complete a questionnaire that
included 25 questions related to demographic characteristics,
presence of unintended pregnancy, educational and economic
status, prior contraceptive use and postpartum plans for contraceptive
use following delivery. Prior contraceptive use and
future plans for contraceptive use following delivery were
assessed with multiple-choice questions. The questionnaire also
contained questions about the source of contraceptive knowledge
and whether the individual wanted to get counselling on
contraception before discharge. All responses to the questions
are the basis for the findings.
2.1. Patient classification
High-risk conditions were classified as maternal, foetal
and uterine factors. Maternal factors included diabetes
mellitus (gestational or pregestational), hypertensive disorders
(preeclampsia, eclampsia, chronic hypertension and gestational
hypertension), obesity, grandmultiparity, pregnancy and other
factors (anaemia, infections, other systemic diseases). Foetal
factors consisted of foetal growth disorders, disorders of
amniotic fluid volume (AFV), postterm pregnancies, preterm
delivery, multifoetal gestation, foetal anomalies. Uterine factors
included previous uterine surgery (repeated caesarean section
or myomectomy), abnormalities of the placenta, umblical cord
and membranes (placenta previa, placenta accreata, – increata
or – percreata), and cervical incompetence.
2.2. Questionnaire variables
Sociodemographic characteristics. Age, gravidity, parity,
induced abortion, marital status, education levels, working status,
family income, and the presence of health insurance were noted.
Induced abortion was defined as surgically or medically terminated
pregnancies by the request of parents without any medical
necessity. Education levels were considered as primary school for
5 years education, secondary school for 8 years education, high
school for 12 years education. Women who had never been to
school or had learned how to read and write but not able to finish
the school, were accepted as no education. Family income equal or
lower than minimum wage was considered as low, up to twice of
the minimum wage as moderate and higher than twice of the
minimum wage was evaluated as high-income level.
Pregnancy intention. Participants were asked if they had any
demand for another pregnancy and when they would prefer to
become pregnant again. They were also asked for the ideal
number of children.
Contraceptive use. Participants were asked ‘‘What kind of
birth control were you or your husband or partner using before
getting pregnant?’’ for their prior contraceptive use. To assess
future plans for contraceptive use following delivery, they were
asked ‘‘Are you or your husband or partner going to use a method
to prevent pregnancy?’’ The ones who responded ‘‘yes’’ to the
question were asked ‘‘What kind of birth control are you or your
husband or partner planning to use?’’ Participants were also
approached if they knew or had heard about all contraceptive
methods available in Turkey (barrier methods, copper intrauterine
device (Cu-IUD), the levonorgestrel-releasing intrauterine system
(LNG-IUS), combined oral contraceptives (COCs), combined
monthly injection, combined vaginal ring, depot-injection, minipill,
progesterone implant) by choosing ‘‘Yes, I have heard.’’, ‘‘No, I
have not heard before.’’. Traditional methods of contraception
included withdrawal (coitus interruptus) and periodic abstinence.
SPSS (Statistical Package for the Social Sciences) version 17.0
was used to record and statistically analyse the data. Normally
distributed data were expressed as means standard deviation
and data that were non-normally distributed was expressed as the
median for descriptive statistics. Chi-square test was used and
statistical significance was defined as p < 0.05.
3. Results
3.1. Participants’ demographics
Of the 692 questionnaires distributed, 655 were returned. The
response rate was 94.6%. The mean age, gravidity and parity of the
patient group were 27.48 6.25 years (range 16–48 years),
2.81 2.15 (range 1–12) and 1.40 1.77 (range 0–11) respectively.
Of 655 pregnant women, 29.2% were nulliparous. Approximately two
thirds of the participants lived in Ankara, the capital city of Turkey,
and the vast majority of them (96.2%) had health insurance.
In the study population, while 80.2% of the women reported
that the current pregnancy was desired, one-fifth (19.8%) of them
reported the current pregnancy as unintended with a concomitant
S.
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