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Family planning in the puerperium (History (PGH Menses (regular, bleeds)…
Family planning in
the puerperium
Definition
Contraceptive methods
in the first 6w post-partum
Importance
Increased risk of VTE during this period
Some hormones may transmit
to the baby via breastmilk
IUDs may cause perforation; insert <48h or after 4w
History
PGH
Menses (regular, bleeds), have they restarted,
STI history, cervical smears, previous contraception use
PMH
Chronic conditions e.g. CHD, VTE, migraines with aura,
chronic liver disease, breast cancer, other cancer
Previous surgeries
POH
Scans, bloods, growth, gestation, delivery, complications
Gravity/parity, future conception plans
DH
Meds, previous contraception, allergies
PC/HPC
Contraception ideas, concerns, expectations
FH
CVD, migraines, stroke, MI, VTE
SH
Living arrangements, diet, smoking, alcohol,
support at home, domestic violence
Options
Not breastfeeding
>21d postpartum
Combined (COCP, patch, ring)
Progesterone only (POP, injection, implant)
Barrier contraception
<21d postpartum
Progesterone only (POP, implant, injection)
Barrier methods
Breastfeeding
6w-6m postpartum
Progesterone only (POP, injection, implant)
Barrier contraception
IUDs
Sterilisation
>6m postpartum
Combined (COCP, patch, ring)
Progesterone only (POP, injection, implant)
Barrier methods
IUDs
Sterilisation
<6w postpartum
Progesterone only (POP, implant) NOT injection
(risk sex steroids to baby)
Barrier contraception
Lactational
amenorrhoea
Pathophysiology
Breastfeeding delays ovulation by interrupting
gonadotrophin surges from the pituitary
Effectiveness
98% if fully breastfeeding,
<6m postpartum and amenorrhoiec
Reduced after 6m or if any of the above change