Postpartum Contraception TOG 2018 Flashcards
If not breast-feeding how soon after childbirth can ovulation occur?
3-4 weeks
50% women resume SI within 6 weeks
Table with contraceptives effectiveness typical use and perfect use
When does NICE advise 1st discussion about contraception should be held?
Within the 1st week
Postpartum breastfeeding UKMEC criteria for IMP, DMPA, POP and CHC at
0-6 weeks
>6 weeks - <6 months
> 6month
Postpartum non-
breastfeeding UKMEC criteria for IMP, DMPA, POP and CHC at
0-3 weeks
>3 weeks - <6 weeks
> 6 weeks
If not other RF for VTE COCP becomes UKMEC 2 after 3 weeks for non-breast feeding mothers
UKMEC for CU-IUD/LNG-IUS
1) 0 - <48 hours
2) 48 hours - 4 weeks
3) > 4weeks
4) PP sepsis
1) 0 - <48 hours 1
2) 48 hours - 4 weeks 3
3) > 4weeks 1
4) PP sepsis 4
If Hx high BP in pregnancy (non controlled) or Hx OC what is the UKMEC for CHC?
2
What criteria should be met for lactational amenorrhoea to be effective?
- < 6 month
- Exclusively breast feeding
- Fully amenorrhoeic
How effective is factional amenorrhoea?
98%
What % of women are exclusively breastfeeding at
1) 6-8 weeks?
28.5%
When should postpartum intrauterine device insertion occur?
Within 48 hours of childbirth
<10 mins after placenta delivered
Expulsion rate immédiate PP IUD insertion
10-32%
LNG-IUS > Cu-IUD
VD>C/S
RCOG recommendation of child insertion after vaginal delivery
Excision criteria for PP insertion of IUD
Is there increased risk of uterine perforation or infection with immediate PP insertion?
No
Lower than interval PP insertion (a few weeks later)
In BF mother explained the risk of perforation of coil insertion > 4 weeks
If BF risk of perforation remains high for up to 36 weeks following birth.
6 x higher than non breastfeeding mothers
What follow up should be arranged for immediate PP IUD insertion>
4-6 week FU with sexual health clinic/GP/PN clinic
Risk of not seeing threads?
50%
→ USS
What should be considered before commencing CHC postnatally?
- Breastfeeding?
- Time since delivery
- VTE risk
When commenced hormonal therpies is additional barrier contraception needed?
If within 21 days - no
> 21 days
→ CHC/implant/Depo/IUS 7 Days
→POP 2 days
When can diaphragm be used?
> 6 weeks
If women would like sterilisation at CS, how long before delivery should this be discussed?
At minimum of 2 weeks
Higher risk of regret
Failure rate 1/200
Filshie clips have higher failure rate
Failure rate of vasectomy? Azoospermia achieved by?
1/2000
12 weeks
When is emergency contraception required? Options?
Unprotected SI > 21days
Note IUD should not be inserted < 28 days
Levonorgestrel dose should be doubled to 3g is BMI >35 or AEDS
If emergency contraception and breastfeeding?
Ulipristal - stop BF and express for 1 week after
