Postpartum Contraception TOG 2018

Question 1

If not breast-feeding how soon after childbirth can ovulation occur?

Answer 1

3-4 weeks

50% women resume SI within 6 weeks

Question 2

Table with contraceptives effectiveness typical use and perfect use

Answer 2

Question 3

When does NICE advise 1st discussion about contraception should be held?

Answer 3

Within the 1st week

Question 4

Postpartum breastfeeding UKMEC criteria for IMP, DMPA, POP and CHC at
0-6 weeks
>6 weeks - <6 months
> 6month

Answer 4

Question 5

Postpartum non-
breastfeeding UKMEC criteria for IMP, DMPA, POP and CHC at
0-3 weeks
>3 weeks - <6 weeks
> 6 weeks

Answer 5

If not other RF for VTE COCP becomes UKMEC 2 after 3 weeks for non-breast feeding mothers

Question 6

UKMEC for CU-IUD/LNG-IUS
1) 0 - <48 hours
2) 48 hours - 4 weeks
3) > 4weeks
4) PP sepsis

Answer 6

1) 0 - <48 hours 1
2) 48 hours - 4 weeks 3
3) > 4weeks 1
4) PP sepsis 4

Question 7

If Hx high BP in pregnancy (non controlled) or Hx OC what is the UKMEC for CHC?

Answer 7

2

Question 8

What criteria should be met for lactational amenorrhoea to be effective?

Answer 8

• < 6 month
• Exclusively breast feeding
• Fully amenorrhoeic

Question 9

How effective is factional amenorrhoea?

Answer 9

98%

Question 10

What % of women are exclusively breastfeeding at
1) 6-8 weeks?

Answer 10

28.5%

Question 11

When should postpartum intrauterine device insertion occur?

Answer 11

Within 48 hours of childbirth
<10 mins after placenta delivered

Question 12

Expulsion rate immédiate PP IUD insertion

Answer 12

10-32%
LNG-IUS > Cu-IUD
VD>C/S

Question 13

RCOG recommendation of child insertion after vaginal delivery

Answer 13

Question 14

Excision criteria for PP insertion of IUD

Answer 14

Question 15

Is there increased risk of uterine perforation or infection with immediate PP insertion?

Answer 15

No

Lower than interval PP insertion (a few weeks later)

Question 16

In BF mother explained the risk of perforation of coil insertion > 4 weeks

Answer 16

If BF risk of perforation remains high for up to 36 weeks following birth.

6 x higher than non breastfeeding mothers

Question 17

What follow up should be arranged for immediate PP IUD insertion>

Answer 17

4-6 week FU with sexual health clinic/GP/PN clinic

Question 18

Risk of not seeing threads?

Answer 18

50%
→ USS

Question 19

What should be considered before commencing CHC postnatally?

Answer 19

• Breastfeeding?
• Time since delivery
• VTE risk

Question 20

When commenced hormonal therpies is additional barrier contraception needed?

Answer 20

If within 21 days - no
> 21 days
→ CHC/implant/Depo/IUS 7 Days
→POP 2 days

Question 21

When can diaphragm be used?

Answer 21

> 6 weeks

Question 22

If women would like sterilisation at CS, how long before delivery should this be discussed?

Answer 22

At minimum of 2 weeks
Higher risk of regret

Failure rate 1/200
Filshie clips have higher failure rate

Question 23

Failure rate of vasectomy? Azoospermia achieved by?

Answer 23

1/2000
12 weeks

Question 24

When is emergency contraception required? Options?

Answer 24

Unprotected SI > 21days
Note IUD should not be inserted < 28 days

Levonorgestrel dose should be doubled to 3g is BMI >35 or AEDS

Question 25

If emergency contraception and breastfeeding?

Answer 25

Ulipristal - stop BF and express for 1 week after