Postpartum Contraception

Potpourri

100

What is required prior to performing a surgical sterilization on a patient with government insurance?

MA-31 signed one month prior

200

What is the percentage of women who resume sexual intercourse prior to postpartum visit?

>50%

300

When should the discussion regarding postpartum contraception occur? (Per ACOG)

Second trimester

Ideally BEFORE postpartum rounding

400

When do you NOT need to wait 30 days for a MA-31?

If its been signed at least 72 hours in advance and/or preterm/emergent situation

500

How can you reasonably assume someone is not pregnant?

-No intercourse since last menses

-Reliable method used consistently and correctly

-<7d from start of menses or post abortion/miscarriage

-Within 4 weeks postpartum

-Lactational amenorrhea

Breastfeeding

100

Do progesterone only methods affect milk supply?

Not significantly

200

What is the effect of estrogen containing contraceptives on milk supply?

-If breastfeeding is not yet established it significantly reduces milk supply

-Thought to not have a large impact if initiated once milk supply established (some women still notice large reduction)

300

In which population of women would you delay progesterone contraceptives?

Women with depression or at high risk of postpartum depression delay 3-6 weeks

400

When does ovulation occur in a breastfeeding mom?

-Prior to first menstrual cycle in 30% of women within first 3 months

-Frequency of ovulation prior to first period increases the further from delivery you get

500

What is the Lactational Amenorrhea Method?

-Within 6 months postpartum

-Exclusive breastfeeding (including overnight)

-Amenorrhea

MOA

100

What are the two kinds of hormones we use for contraceptives?

Estrogen & Progesterone

200

What is the MOA of COC pills? POPs?

COC: suppresses ovulation 90-95% of time plus all the stuff the progesterone ones do

POP: thickens cervical mucous to prevent sperm entry, impairs tubal and sperm motility and somewhat atrophic endometrium

300

How does Depo work?

Suppresses ovulation by inhibiting the LH and FSH surge

Thickens cervical mucous

Affects sperm and tubal motility 

Thins endometrium

400

How does the copper T work?

10+ years

Acts primarily as a spermicide, the copper ions inhibit sperm motility and acrosomal enzyme activation

500

Of all contraceptive methods, which does NOT reliably suppress ovulation

Copper T, Levonorgesterol IUD, POP

Timing

100

When can you start Depo?

Before discharge from hospital

200

When can you start progesterone pills?

At discharge

300

When can you insert a nexplanon?

In the hospital 

We do six weeks- if you are going to do this you should bridge with Depo

400

When can you start estrogen containing birth control?

No sooner than 3 weeks 

Ideally wait at least 6 weeks due to VTE risk

500

What is the rate of expulsion of immediate postpartum IUD insertion

Up to 30% (But no show rate for postpartum IUD in women who identify that is their contraceptive method of choice during the pregnancy is almost 75%)

Effectiveness

100

What is the MOST effective form of contraception?

Nexplanon

Followed by vasectomy

200

What is the failure rate of nexplanon

0.05% or 5 pregnancies in first year (10,000 women)

300

What is the failure rate of condoms?

18%

400

What is the difference between typical use and perfect use when looking at effectiveness of contraceptive methods?

Typical use: How patients often use it, missing pills, different times, etc

Perfect use: if the med was taken exactly as prescribed on a consistent basis

500

What are the different types of surgical sterilization and which is the most effective?

Vasectomy (most effective)

Laparoscopic salpingectomy, fulguration, clips, open partial salpingectomy or salpingectomy (pomeroy/parkland) 

Most effective female surgical sterilization is the Irving where you remove a portion of the tube and then you suture the other portion into the uterus