TOG 7 sep 2017
- Fertility resumes 3-4 weeks post delivery
- 50% resume sexual activity
- 1/3 pregnancies are unintended
- 1 in 13 women in UK presenting for abortion conceived with in a year
- Implants &Pop can b used in all scenarios after child birth
- Progesterone only implants has the least unintended pregnancies 0.05 (typical and perfect use)
- 98% effective if all criteria met(<6months PP, exclusive BF, fully amenorrhoeic
- 28.5% reported exclusive BF for 6-8weeks in UK
- 40% in Scotland
- 6.2%. In young Scottish mothers <20years
- IU METHODS
- non contraceptive benefit ,decreases uterine bleeding with LNG-IUS
- PPIUC with in 48 hrs of Child birth
with in 10 mins of placental delivery
expulsion rate 0-17%
- CI postpartum sepsis, PPROM, unresolved PP hemorrhage active tubal infection, unexplained V bleeding, abnormal uterine anatomy.
Reference: TOG_june, 2018 by Michelle Cooper
- Fertility can return shortly after childbirth as early as 3or 4 weeks post delivery n so PPC is important.
- Most methods of contraception can be initiated immediately following delivery., including LARC which remains the most effective PPC method available. Nexplanon_ Etonogestrel, inserted subdermally into upper arm is effective for 3 yrs.
- Intrauterine contraception is one of the most effective methods- immediate postpartum intrauterine( PPIUC)contraception is safe n refers to fitting cuT or LNG_IUS 10 mins after placental delivery in CS or first 48 hrs after A vaginal or CS delivery. Cost effective.
- Combined hormonal contraception should commence after 3 weeks of delivery but delayed till 6 weeks if additional risk factors n breastfeeding women with additional contraceptive precaution.
- Performing sterilization which is permanent needs counselling n documentation 2 weeks before elective delivery as CS with concomitant sterilization is associated with subsequent risk of regret. Failure rate of female sterilization is 1 in 200 n vasectomy is 1 in 2000.
GTG- Late IUFD
- Stillbirth- common- 1 in 200 babies born dead
- Overall over one third stillbirths are SGA fetuses with half- unexplained
- Real time ultrasonography essential for accurate diagnosis-
a- absence of fetal cardiac activity
b- collapse of fetal skull with overlapping bones
c- hydrops or maceration
d- intrafetal gas (ht, bv, jts)
- Occult placental abruption- sensitivity as low as 15%
- No specific cause in almost half of SBs
- Moderate risk of DIC- 10% within 4 weeks and 30% thereafter
- Platelet count and coagulation studies repeat twice weekly if expectant mgt undertaken
- Kleihauer test recommended for all and to be repeated after 48 hrs in RhD negative to ensure clearance of fetal red cells
- 6% SBs—- chromosomal abnormality
- One tenth i.e 10%—-congenital malformations
- In 88%– major contributor in placentas
Depression 12%, anxiety 13%,
2.a. Genetic associated with chromosome 16
b. Obsteric factor:primiparity,female baby,shorter gestational age
c. change in medication like lithium,
d. sleep deprevation triggers bipolar disorder
3. Family history of posparturm psychosis in first degree relative increases chances of PP by 50%