title: [Post-partum: Guidelines for clinical practice--Short text].
abstract: OBJECTIVE
  To determine the post-partum management of women and their newborn whatever the mode of delivery.
  
  
  METHODS
  The PubMed database, the Cochrane Library and the recommendations from the French and foreign obstetrical societies or colleges have been consulted.
  
  
  RESULTS
  Because breastfeeding is associated with a decrease in neonatal morbidity (lower frequency of cardiovascular diseases, infectious, atopic or infantile obesity) (EL2) and an improvement in the cognitive development of children (EL2), exclusive and extended breastfeeding is recommended (grade B) between 4 to 6 months (Professional consensus). In order to increase the rate of breastfeeding initiation and its duration, it is recommended that health professionals work closely with mothers in their project (grade A) and to promote breastfeeding on demand (grade B). There is no scientific evidence to recommend non-pharmacological measures of inhibition of lactation (Professional consensus). Pharmacological treatments for inhibition of lactation should not be given routinely to women who do not wish to breastfeed (Professional consensus). Because of potentially serious adverse effects, bromocriptin is contraindicated in inhibiting lactation (Professional consensus). For women aware of the risks of pharmacological treatment of inhibition of lactation, lisuride and cabergolin are the preferred drugs (Professional consensus). Whatever the mode of delivery, numeration blood count is not systematically recommended in a general population (Professional consensus). Anemia must be sought only in women with bleeding or symptoms of anemia (Professional consensus). The only treatment of post-dural puncture headache is the blood patch (EL2), it must not be carried out before 48 h (Professional consensus). Women vaccination status and their family is to be assessed in the early post-partum (Professional consensus). Immediate postoperative monitoring after caesarean delivery should be performed in the recovery room, but in exceptional circumstances, it may be performed in the delivery unit provided safety rules are maintained and regulatory authorities are informed (Professional consensus). An analgesic multimodal protocol developed by the medical team should be available and oral way should be favored (Professional consensus) (grade B). For every cesarean delivery, thromboprophylaxis with elastic stockings applied on the morning of the surgery and kept for at least 7 postoperative days is recommended (Professional consensus) with or without the addition of LMWH according to the presence or not of additional risk factors, and depending on the risk factor (major, minor). Early postoperative rehabilitation is encouraged (Professional consensus). Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, after normal pregnancy and delivery (Professional consensus). Starting effective contraception later 21 days after delivery in women who do not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). According to the postpartum risk of venous thromboembolism, the combined hormonal contraceptive use before six postpartum weeks is not recommended (grade B). Rehabilitation in asymptomatic women in order to prevent urinary or anal incontinence in medium or long-term is not recommended (Expert consensus). Pelvic-floor rehabilitation using pelvic-floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months postpartum (grade A), regardless of the type of incontinence. Postpartum pelvic-floor rehabilitation is recommended to treat anal incontinence (grade C). Postpartum pelvic-floor rehabilitation is not recommended to treat or prevent prolapse (grade C) or dyspareunia (grade C). The optimal time for maternity discharge for low risk newborn depends more on the organisation of the post-discharge follow up (Professional consensus). The months following the birth are a transitional period, and psychological alterations concern all parents (EL2). It is more difficult in case of psychosocial risk factors (EL2). In situations of proven psychological difficulties, the impact on the psycho-emotional development of children can be important (EL3). Among these difficulties, postpartum depression is the most common situation. However, the risk is generally higher in the perinatal period for all mental disorders (EL3).
  
  
  CONCLUSIONS
  Postpartum is, for clinicians, a unique and privileged opportunity to address the physical, psychological, social and somatic health of their patients.
authors.affiliation: Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France. Electronic address: marie-victoire.senat@bct.aphp.fr.
authors.forename: M-V
authors.initials: MV
authors.lastname: Sénat
authors.affiliation: Service de gynécologie-obstétrique, université d'Angers, CHU d'Angers, 49000 Angers, France.
authors.forename: L
authors.initials: L
authors.lastname: Sentilhes
authors.affiliation: Collège national des sages-femmes de France (CNSF), France.
authors.forename: A
authors.initials: A
authors.lastname: Battut
authors.affiliation: Service d'anesthésie réanimation, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Sud, 94270 Le Kremlin-Bicêtre, France.
authors.forename: D
authors.initials: D
authors.lastname: Benhamou
authors.affiliation: Département de psychiatrie de l'enfant et de l'adolescent, association de santé mentale du xiii(e) arrondissement, 75013 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Bydlowski
authors.affiliation: Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris-Cité, DHU risques et grossesse, université Paris-Descartes, 75014 Paris, France; École de sages-femmes Baudelocque, université Paris-Descartes, Assistance publique-Hôpitaux de Paris, 75014 Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Chantry
authors.affiliation: Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Sud, 92140 Clamart, France.
authors.forename: X
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Collectif inter-associatif autour de la naissance (CIANE), Paris, France.
authors.forename: F
authors.initials: F
authors.lastname: Diers
authors.affiliation: Service de gynécologie-obstétrique, hôpital Femme-Mère-Enfant, université Lyon 1, hospices civils de Lyon, 69500 Bron, France.
authors.forename: M
authors.initials: M
authors.lastname: Doret
authors.affiliation: Collectif inter-associatif autour de la naissance (CIANE), Paris, France.
authors.forename: C
authors.initials: C
authors.lastname: Ducroux-Schouwey
authors.affiliation: Service de gynécologie-obstétrique, hôpital Bicêtre, Assistance publique-Hôpitaux de Paris (AP-HP), université Paris-Sud, 78, avenue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
authors.forename: F
authors.initials: F
authors.lastname: Fuchs
authors.affiliation: Service de réanimation et médecine néonatales, université d'Angers, CHU d'Angers, 49000 Angers, France.
authors.forename: G
authors.initials: G
authors.lastname: Gascoin
authors.affiliation: Direction des ressources humaines et des écoles, CHU de Tours, 37000 Tours, France.
authors.forename: C
authors.initials: C
authors.lastname: Lebot
authors.affiliation: Service de gynécologie-obstétrique II et médecine de la reproduction, Port-Royal hôpital Cochin, université Paris-Descartes, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France.
authors.forename: L
authors.initials: L
authors.lastname: Marcellin
authors.affiliation: Service de gynécologie-obstétrique II, unité de gynécologie endocrinienne, Port-Royal hôpital Cochin, université Paris-Descartes, Assistance publique-Hôpitaux de Paris (AP-HP), 75014 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Plu-Bureau
authors.affiliation: Service de gynécologie-obstétrique, hôpital Robert-Debré, Assistance publique-Hôpitaux de Paris (AP-HP), 75019 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Raccah-Tebeka
authors.affiliation: Service de gynécologie obstétrique, médecine fœtale, université François-Rabelais de Tours, CHRU de Tours, 37000 Tours, France.
authors.forename: E
authors.initials: E
authors.lastname: Simon
authors.affiliation: Inserm UMR 1153, équipe de recherche en épidémiologie obstétricale, périnatale et pédiatrique (EPOPé), centre de recherche épidémiologie et statistique Sorbonne Paris-Cité, DHU risques et grossesse, université Pierre-et-Marie-Curie, 75014 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Bréart
authors.affiliation: Service de gynécologie-obstétrique, université de Rouen, CHU Charles-Nicolle, 76000 Rouen, France.
authors.forename: L
authors.initials: L
authors.lastname: Marpeau
mesh_terms: D001942:Breast Feeding / Q000523:psychology / Q000706:statistics & numerical data; D032921:Consensus; D003267:Contraception / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data; D000075202:Contraindications; D036861:Delivery, Obstetric / Q000379:methods / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D011181:Postnatal Care / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D049590:Postpartum Period / Q000502:physiology / Q000523:psychology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D011247:Pregnancy
keywords: Allaitement; Breastfeeding; Cesarean delivery; Contraception; Césarienne; Dépression postnatale; Newborn; Nouveau-né; Post-partum; Postpartum; Postpartum depression; Rehabilitation; Rééducation périnéale