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Conseils contraceptifs pour le postpartum.

Auteurs : Couvreur I, Delcroix MDate 1984 Avril, Num 35, pp 39-41Revue : Soins. Gynécologie, obstétrique, puériculture, pédiatrieType de publication : article de périodique;
Résumé

The immediate postpartum period and the week of hospitalization is a privileged time for imparting information about the physiology of reproduction and contraception. Contraceptive counseling at this time may be done in groups or in individual sessions. Apart from the usual requirements of efficacy, innocuity, acceptability, and reversibility, postpartum contraception must respect lactation and the return of menstruation. 3/4 of women ovulate before the 1st postpartum mentstrual period, but never before the 25th postpartum day. In the absence of lactation, about 80% ovulate within 9 weeks. If lactation occurs ovulation is delayed and usually 1 or more anovulatory cycles occur, but the rate of conception is difficult to estimate. Methods that are unsuitable for postpartum use include the temperature method because of the absence of the hyperthermic plateau, cervical caps and diaphragms because correct measurements cannot be made until 5-6 months after delivery, and IUDs becuase of the large size of the uterine cavity, the fragility of the walls, the presence of lochia, the large size of the cervix, and the absence of cervical mucus which protects against infection. Local contraception with tablets, spermicidal gels, or condoms is a good choice, especially for breastfeeding women, because of improved success rates, good tolerance, and acceptability. In prescribing oral contraceptives, pathologies of pregnancy such as hypertension and phlebitis must be considered along with the classical contraindicatins. The formulation must not affect the quality or quantity of milk. Standard dosed combined pills and monophasic and biphasic minidose pills increase the thromboembolic risk if they are taken soon after delivery, used by women who smoke, if the estrogen component is large, or if the women's cholesterol level is elevated. Minipills and progestagen-only micropills are interesting choices for postpartum women because of the reduced steroid doses. Micropills should be chosen if lactation is expected to continue for more than 2 months. Injectable medroxyprogesterone acetate can be used for long acting progestagen contraception, but the patient should be warned of possible side efforts including menstrual problems, amenorrhea, delayed reversibility, weight gain, and headaches. Postpartum voluntary sterilization is often requested and may be indicated for a number of medical or socioeconomic conditions. It is preferable to wait a few months before carrying out the procedure because of the risk of psychological problems following loss of fertility.

Mot-clés auteurs
Barrier Methods; Cervical Cap--contraindications; Clinic Activities; Condom; Contraception--contraindications; Contraception--indications; Contraceptive Agents; Female; Contraceptive Agents; Progestin--indications; Contraceptive Agents--indications; Contraceptive Methods--contraindications; Counseling; Family Planning; Family Planning Programs; Family Planning; Behavioral Methods; Female Sterilization; Iud--contraindications; Natural Family Planning; Oral Contraceptives--contraindications; Organization And Administration; Ovulation; Postpartum Programs; Postpartum Women; Program Activities; Programs; Puerperium; Reproduction; Spermicidal Contraceptive Agents--indications; Sterilization; Sexual; Sympto-thermal Method--contraindications; Vaginal Barrier Methods--contraindications; Vaginal Diaphragm--contraindications;
 Source : MEDLINE©/Pubmed© U.S National Library of Medicine
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Couvreur I, Delcroix M. Conseils contraceptifs pour le postpartum. Soins Gynecol Obstet Pueric Pediatr. 1984 Avr;(35):39-41.
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Dernière date de mise à jour : 20/10/2016.


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