[Postpartum birth control: state-of-the-art].
It takes some six weeks for menstrual flow to come back after delivery, but an ovulation may occur from the twenty-fifth day, especially in the absence of bottle feeding. That is the reason why postpartum birth control must be gets onto in maternity wards. Obstetricians and midwives are supposed to deliver update information about variant contraceptive means. They have to be able to diagnose any risk factor and to prescribe an efficient contraceptive option to every woman who wishes for it, before she leaves the maternity ward. Recent studies incite us to amend our medical behaviour regarding postpartum contraception, even if there is no consensus at present. In a normal context, without any add on risk factor, it is possible to prescribe a birth control pill containing low dosage of combined oral contraceptives. Doing that, you will not expose the patient to an increased risk of deep venous thrombosis nor to significant breastfeeding disruption. Low-dose progestin-only pills are also a good choice because there are no risks during the lactation. When the patient suffers from some disease which stops you from giving combined oral contraceptives, it is still possible to resort to progestin-only. It is now admitted to insert an intra-uterine device from the fourth or sixth week following the delivery. In certain conditions, it can be inserted over the 48 hours following a delivery, some obstetrician would even insert it during the caesarean section. The main purpose of these recent references is to simplify the contraceptive outline in order to ease its prescription and to avoid unwanted pregnancies.
Service de gynécologie-obstétrique, centre hospitalier d'Armentières, rue Sadi-Carnot, 59280 Armentières, France. geoffroy.robin@laposte.net
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D000328:Adult; D003267:Contraception / Q000009:adverse effects / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000008:administration & dosage* / Q000009:adverse effects*; D003277:Contraceptives, Oral, Combined / Q000008:administration & dosage / Q000009:adverse effects; D003692:Delayed-Action Preparations; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007434:Intrauterine Devices; D007774:Lactation / Q000187:drug effects / Q000502:physiology; D049590:Postpartum Period; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D003692:Delayed-Action Preparations