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Updated: Apr 2 2020

Postpartum Contraception

  • Snapshot
    • A 38-year-old G3P2 woman visits her obstetrician for a routine prenatal visit. She is at 28 weeks of gestation and has had an uneventful, normal pregnancy so far. Her obstetrician presents various options for postpartum contraception, including permanent sterilization, progestin implants, intrauterine devices (IUD), and short-acting hormonal contraception. The woman elects to have a copper intrauterine device implanted after her delivery. Years later, a pelvic radiograph is obtained for the woman and the position of her IUD can be observed, as seen in the image.
  • Introduction
    • Overview
      • postpartum contraception is a method to prevent unintentional pregnancies and avoid short interpregnancy intervals after giving birth
        • important as pregnancies in the postpartum period within 12-18 months of a live birth have significant risks for adverse maternal, perinatal, and infant outcomes
          • obstetricians are advised to counsel pregnant women and discuss options for postpartum contraception in the weeks before delivery
    • Methods
      • Permanent sterlization of the female or male partner
        • efficacy rates > 99%
          • female
            • bilateral partial salpingectomy or bilateral complete salpingectomy
              • can be performed within 24-48 hours and up to 6 days postpartum or at the time of cesarean delivery
          • male
            • vasectomy
      • progestin-only implants
        • i.e., etonogestrel (Nexplanon) and levonorgestrel (Jadelle) implants
          • can be safely inserted at any time after delivery
      • intrauterine devices (IUDs)
        • i.e., copper IUD and levonorgestrel-releasing IUD
          • can be inserted at any time after delivery in most cases
            • postplacental (immediate postpartum) IUD placement is contraindicated in women with chorioamnionitis, endometritis, or significant postpartum bleeding
          • copper IUDs may ↑ menstrual bleeding and result in painful cramping
          • hormonal IUDs may ↓ menstrual bleeding, though may cause daily spotting for several months after insertion
      • short-acting hormonal contraception
        • i.e., progestin injections, oral pills, patch, and vaginal ring
        • progestin-only methods can be started at any time in the postpartum period
        • combined estrogen-progestin hormonal contraception should NOT be initiated earlier than 21 days postpartum
          • ↑ risk of venous thromboembolism
  • Complications
    • Venous thromboembolism
      • incidence
        • 3-7x higher in women who use combined hormonal contraceptives in the initial postpartum period
      • risk factors
        • use of combined estrogen-progestin hormonal contraception in the initial 3-6 weeks postpartum period
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