title: Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF).
abstract: OBJECTIVE
  To make evidence-based recommendations for the postpartum management of women and their newborns, regardless of the mode of delivery.
  
  
  METHODS
  Systematic review of articles from the PubMed database and the Cochrane Library and of recommendations from the French and foreign societies or colleges of obstetricians.
  
  
  RESULTS
  Because breast-feeding is associated with reductions in neonatal, infantile, and childhood morbidity (lower frequency of cardiovascular, infectious, and atopic diseases and infantile obesity) (LE2) and improved cognitive development in children (LE2), exclusive and extended breastfeeding is recommended (grade B) for at least 4-6 months (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, bromocriptine is contraindicated in inhibiting lactation (professional consensus). For women aware of the risks of pharmacological treatments to inhibit lactation but choose to take them, lisuride and cabergoline are the preferred drugs (professional consensus). Regardless of the mode of delivery, only women with bleeding or symptoms of anemia should be tested for it (professional consensus). Immediate postoperative monitoring after cesarean delivery should be performed in the postanesthesia care unit (PACU). An analgesic multimodal protocol for analgesia, preferring oral administration, should be developed by the medical team and be available for all staff (professional consensus) (grade B). Thromboprophylaxis with compression stockings should begin the morning of all cesarean deliveries and maintained for at least 7 postoperative days (professional consensus) with or without the addition of LMWH, depending on the presence and severity (major or minor) of additional risk factors. It is recommended that women be informed of the dangers of closely spaced pregnancies (LE3), that effective contraception begin no later than 21 days post partum for women who do not want such a pregnancy (grade B), and that it be prescribed at the maternity ward (professional consensus). In view of the postpartum risk of venous thromboembolism, use of combination hormonal contraception is not recommended before six weeks post partum (grade B). Pelvic floor rehabilitation in asymptomatic women to prevent urinary or anal incontinence in the medium or long term is not recommended (professional consensus). Rehabilitation using pelvic floor muscle contraction exercises is recommended to treat persistent urinary incontinence at 3 months post partum (grade A), regardless of the type of incontinence. Postpartum pelvic floor rehabilitation is recommended to treat anal incontinence (grade C), but not to treat or prevent prolapse (grade C) or dyspareunia (grade C). The months following the birth are a period of transition and of psychological changes for all parents (LE2) and are still more difficult for those with psychosocial risk factors (LE2). Situations of evident psychological difficulties can have a significant effect on the child's psychological and emotional development (LE3). Among these difficulties, postpartum depression is most common, but the risk of all mental disorders is generally higher in the perinatal period (LE3).
  
  
  CONCLUSIONS
  The postpartum period presents clinicians with a unique and privileged opportunity to address the physical, psychological, social, and somatic health of women and babies.
authors.affiliation: Service de Gynécologie Obstétrique Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Université Paris-Sud, France. Electronic address: marie-victoire.senat@aphp.fr.
authors.forename: Marie-Victoire
authors.initials: MV
authors.lastname: Sénat
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Bordeaux, Université de Bordeaux, Bordeaux, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Sentilhes
authors.affiliation: Collège National des Sages-Femmes de France (CNSF), France.
authors.forename: Anne
authors.initials: A
authors.lastname: Battut
authors.affiliation: Service d'Anesthésie Réanimation Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Université Paris-Sud, France.
authors.forename: Dan
authors.initials: D
authors.lastname: Benhamou
authors.affiliation: Département de psychiatrie de l'enfant et de l'adolescent - Association de Santé Mentale du XIIIème arrondissement, Paris, France.
authors.forename: Sarah
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; Ecole de sages-femmes Baudelocque, Assistance publique-Hôpitaux de Paris, Université Paris Descartes, 75014 Paris, France.
authors.forename: Anne
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 (APHP), Clamart, Université Paris-Sud, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Deffieux
authors.affiliation: Collectif Inter-Associatif autour de la NaissancE (CIANE), Pairs, France.
authors.forename: Flore
authors.initials: F
authors.lastname: Diers
authors.affiliation: Hospices Civils de Lyon, Hôpital Femme-Mère-Enfant, Service de Gynécologie-Obstétrique, Bron, France; Université Lyon 1, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Doret
authors.affiliation: Collectif Inter-Associatif autour de la NaissancE (CIANE), Pairs, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Ducroux-Schouwey
authors.affiliation: Service de Gynécologie Obstétrique Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, Université Paris-Sud, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Fuchs
authors.affiliation: Service de réanimation et médecine néonatale, CHU Angers, Angers, Université d'Angers, France.
authors.forename: Geraldine
authors.initials: G
authors.lastname: Gascoin
authors.affiliation: Direction des ressources humaines et des écoles, CHU Tours, Tours, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Lebot
authors.affiliation: Service de Gynécologie-Obstétrique II et Médecine de la Reproduction, Port-Royal Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France.
authors.forename: Louis
authors.initials: L
authors.lastname: Marcellin
authors.affiliation: Service de Gynécologie-Obstétrique II, Unité de Gynécologie Endocrinienne, Port-Royal Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Descartes, Paris, France.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Plu-Bureau
authors.affiliation: Service de Gynécologie-Obstétrique, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
authors.forename: Brigitte
authors.initials: B
authors.lastname: Raccah-Tebeka
authors.affiliation: Service de Gynécologie Obstétrique, Médecine Fœtale. CHRU de Tours, Université François-Rabelais de Tours, Tours, France.
authors.forename: Emmanuel
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, Paris, France.
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
authors.affiliation: Service de Gynécologie-Obstétrique, CHU Charles Nicolle, Rouen, Université de Rouen, France.
authors.forename: Loïc
authors.initials: L
authors.lastname: Marpeau
mesh_terms: D001942:Breast Feeding; D032921:Consensus; D003267:Contraception / Q000379:methods; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006176:Gynecology; D006801:Humans; D009774:Obstetrics; D017773:Pelvic Floor / Q000502:physiology; D011181:Postnatal Care / Q000379:methods*; D049590:Postpartum Period / Q000502:physiology; D011247:Pregnancy
keywords: Breast-feeding; Cesarean and vaginal delivery; Contraception; Pelvic floor muscle training; Postpartum; Psychological disorders