The incidence of repeat termination of pregnancies (TOP) has been increasing in the past decade in-spite-of widespread availability of free and effective contraceptive methods. A retrospective analysis of case notes of women referred for TOP in the Family Planning clinic at Luton, between January and October 2005 was carried out. A total of 159 women were referred for TOP. Of these, 42 (26.4%) were repeat procedures. In this subgroup, 78.5% had used one or more contraceptive methods after the first termination. However, only 61.9% of them continued to use contraception at the time of presentation for a repeat TOP, the most common method being the male condom. Half of the total women seen for a repeat TOP were under 6-weeks' gestation and 14.2% had been treated for sexually transmitted infections in the past. The incidence of repeat TOPs is increasing in the UK. Many studies have shown that the periabortion contraceptive practices are generally poor. In our study, women undergoing repeat termination of pregnancies were either not using contraception or using a method with a high failure rate. We also found the highest number of repeat TOPs occurring in the 20 - 25 age group. Effective contraceptive counselling is vital to combat this worrying trend. Routine 2-week follow-up appointments after TOP and regular auditing of the periabortion contraceptive practices are needed.

We describe two unusual cases; both patients wish to continue using the Gynefix despite experiencing difficulty with the device. In case A, the marker string of the Gynefix(R) perforated the full thickness of the cervix and was visualized on the left lateral aspect of the cervix. Three months later the string had moved again and could no longer be visualized, but an ultrasound scan confirmed fundal implantation of the device. Case B demonstrates repeated late expulsion and failure of implantation of Gynefix. Appropriateness of ultrasound with reference to measurement of the distance SS (between the peritoneal surface of the uterine fundus and the first copper sleeve of the Gynefix), failure of implantation and problems with the new Gynefix introducer are discussed.

No abstract