Obstetrics and Gynaecology
Puerperium, Contraception and Family Planning
Puerperal recovery and complications plus contraception and sterilisation for MBBS, including LARC and emergency contraception, mapped to NMC codes OG19 and OG21.
MedNext Academy | 3 min read
Puerperium, Contraception and Family Planning
Puerperal recovery and complications plus contraception and sterilisation for MBBS, including LARC and emergency contraception, mapped to NMC codes OG19 and OG21.
This chapter covers recovery after childbirth and the full range of contraception and family planning. It describes normal puerperal changes and their complications including pyrexia, secondary haemorrhage and mood disorders, then compares contraceptive methods by efficacy, safety and suitability, including long-acting reversible methods and permanent sterilisation.
High-yield: Puerperium, Contraception and Family Planning
- The puerperium is the six-week period after delivery during which the reproductive organs return to their non-pregnant state.
- Uterine involution returns the uterus from about 1 kilogram to 50 to 60 grams, becoming a pelvic organ by about two weeks.
- Lochia changes from red (rubra) to pinkish (serosa) to whitish (alba) over the puerperium.
- Puerperal pyrexia is a temperature of 38 degrees Celsius or more on two occasions after the first 24 hours, commonly from genital tract sepsis or urinary infection.
- Postpartum blues are common and self-limiting, whereas postpartum depression and psychosis need active treatment.
- Secondary postpartum haemorrhage occurs between 24 hours and 6 weeks and is often due to retained products or endometritis.
- Lactational amenorrhoea gives natural contraception only if the woman is fully breastfeeding, amenorrhoeic and within six months of delivery.
- Combined oral contraceptives are avoided in breastfeeding women in the early postpartum period; progestogen-only methods are preferred.
- The copper intrauterine device is a highly effective long-acting method and also works as emergency contraception.
- Combined hormonal contraceptives are contraindicated in smokers over 35 and in women with a history of thromboembolism.
- Emergency contraception with levonorgestrel is most effective the sooner it is taken after unprotected intercourse.
- Female sterilisation by tubal ligation and male sterilisation by vasectomy are permanent methods; vasectomy is simpler and safer.
- Long-acting reversible contraceptives such as implants and intrauterine devices are the most effective reversible methods.
- Contraceptive counselling should be non-coercive and based on informed choice, efficacy and the woman's circumstances.
Contraception essentials
- **Postpartum choice:** Progestogen-only methods preferred in breastfeeding; avoid early combined pills.
- **Most effective reversible:** Long-acting reversible contraceptives: implants and intrauterine devices.
- **Emergency contraception:** Levonorgestrel or copper IUD; sooner is more effective.
- **Combined pill caution:** Avoid in smokers over 35 and history of thromboembolism.
NMC competencies in this chapter
- **OG19.1:** Normal puerperium
- **OG19.2:** Puerperal complications
- **OG19.3:** Postpartum care
- **OG19.4:** Postpartum exercises, counselling and follow-up
- **OG21.1:** Contraception: methods, efficacy and counselling
- **OG21.2:** Sterilisation and comparative contraceptive effectiveness
Frequently Asked Questions
How long is the puerperium and what happens to the uterus?
It lasts about six weeks, during which the uterus involutes from around 1 kilogram back to 50 to 60 grams and becomes a pelvic organ within about two weeks.
What is lactational amenorrhoea as a contraceptive?
It offers natural contraception only when the woman is fully breastfeeding, still amenorrhoeic and within six months of delivery. Outside these conditions it is unreliable.
Which contraceptives are preferred after childbirth?
Progestogen-only methods are preferred while breastfeeding in the early postpartum period, as combined hormonal contraceptives are best avoided at that time.
Which are the most effective reversible methods?
Long-acting reversible contraceptives, namely implants and intrauterine devices, because they do not depend on daily user action and have very low failure rates.
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