Post pregnancy contraception

This is a new guideline from the FSRH on contraception after pregnancy. There is nothing particularly new about specific methods, but there are a few new interesting points (including a reminder that the COC can be used when breastfeeding from 6 weeks after delivery).

Contraceptive options should be discussed antenatally. Ideally the chosen method of contraception should be started before discharge from hospital (if appropriate). If this is not possible, then a bridging method should be offered. We may therefore start seeing women discharged and already on contraception.

Intrauterine contraception (IUC) and Implants

Intrauterine contraception (IUC) and the implant can be inserted immediately after delivery (and the FSRH advises that there should be provision for this to be done before women go home). Both methods delivered in this way have been shown to be 'highly acceptable' to women, to have high continuation rates and to reduce the risk of unwanted pregnancy. If the IUC is not inserted within 48 hrs, you have to wait 28d.

Combined Oral Contraceptive (COC)

Assess the woman for risk factors for VTE (including smoking, BMI > 30 and post-caesarean section among others). Women with risk factors should wait 6w before initiation. Other women should wait 21 days.

Breastfeeding and COC use

The COC can be used from 6 weeks if the woman is breastfeeding. Better quality studies have found no evidence of reduced success of breastfeeding, nor adverse infant outcomes. Women should be advised that the evidence is however limited.

Recurrent early miscarriage

Where there is recurrent early miscarriage, antiphospholipid syndrome must be ruled out before the COC is started.

Progesterone Only Pill (POP)

Can be started immediately after delivery.

Depot injection after termination of pregnancy (TOP)

This can be used from the time that mifepristone is given, but women should be aware that there is a slightly higher increased rate of failed TOP.

Emergency Contraception (EC)

The copper coil can be used from 28d for emergency contraception. Ulipristal acetate (Ella-One) can be used when breastfeeding, but women should express and discard the milk for a week after use.

After termination of pregnancy, ectopic pregnancy or miscarriage, EC should be used if UPSI has occurred  from 5d.

Other contraception after abortion, ectopic pregnancy or miscarriage.

Additional precautions will be required from 5d after a termination of pregnancy, ectopic pregnancy or miscarriage. Most methods can be started immediately.

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