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Abstract：
OBJECTIVE: Establishment of guidelines for post-partum contraception.
METHODS: Systematic review of publications between 1960 and 2015 from database Medline, Embase, Cochrane Library and recommendations of international societies.
RESULTS: The most recent French data show that approximately 2% of women with induced abortion have deliver within 6 months before this abortion and 4% had a child six to twelve months earlier (Evidence Level [EL] 3). A contraceptive counseling is ideally recommended after delivery to avoid unplanned pregnancies (grade C). Among non-breastfeeding women, the shorter median delay for recovery ovulation is 39 days after delivery (EL4). Starting effective contraception later 21 days after delivery in women who does not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). In breastfeeding women, the recovery of ovarian activity is dependent on breastfeeding characteristics. Only exclusive breastfeeding with very specific conditions can be used for contraception over a six months period (EL2). For all other breastfeeding conditions, contraceptive strategies are the same than without breastfeeding (grade B). According to the post-partum risk of venous thromboembolism, the combined hormonal contraceptive use before six post-partum weeks is not recommended (grade B). In women with vascular risk factors, the evaluation of benefit risk balance of this use between 6th and 12th post-partum weeks is recommended (Professional consensus). Progestin only contraceptives with low dose are allowed in earlier post-partum (grade B), except at the acute phase of severe thromboembolic event (Professional consensus). In women who want intra-uterine device (IUD) as contraception, it is recommended to prescribe IUD at the hospital and to insert the IUD during the postnatal consultation (grade B). In breastfeeding women, progestin contraception\'s (oral or subcutaneous) are permitted immediately after delivery (grade B). For women at short interpregnancy interval risk, long acting reversible contraceptives (implant or IUD) started at the hospital is suggested (grade B).
CONCLUSIONS: The wide contraceptive choice permits to find the best strategy for each woman while respecting post-partum period specificities.
METHODS: Systematic review of publications between 1960 and 2015 from database Medline, Embase, Cochrane Library and recommendations of international societies.
RESULTS: The most recent French data show that approximately 2% of women with induced abortion have deliver within 6 months before this abortion and 4% had a child six to twelve months earlier (Evidence Level [EL] 3). A contraceptive counseling is ideally recommended after delivery to avoid unplanned pregnancies (grade C). Among non-breastfeeding women, the shorter median delay for recovery ovulation is 39 days after delivery (EL4). Starting effective contraception later 21 days after delivery in women who does not want closely spaced pregnancy is recommended (grade B), and to prescribe it at the maternity (Professional consensus). In breastfeeding women, the recovery of ovarian activity is dependent on breastfeeding characteristics. Only exclusive breastfeeding with very specific conditions can be used for contraception over a six months period (EL2). For all other breastfeeding conditions, contraceptive strategies are the same than without breastfeeding (grade B). According to the post-partum risk of venous thromboembolism, the combined hormonal contraceptive use before six post-partum weeks is not recommended (grade B). In women with vascular risk factors, the evaluation of benefit risk balance of this use between 6th and 12th post-partum weeks is recommended (Professional consensus). Progestin only contraceptives with low dose are allowed in earlier post-partum (grade B), except at the acute phase of severe thromboembolic event (Professional consensus). In women who want intra-uterine device (IUD) as contraception, it is recommended to prescribe IUD at the hospital and to insert the IUD during the postnatal consultation (grade B). In breastfeeding women, progestin contraception\'s (oral or subcutaneous) are permitted immediately after delivery (grade B). For women at short interpregnancy interval risk, long acting reversible contraceptives (implant or IUD) started at the hospital is suggested (grade B).
CONCLUSIONS: The wide contraceptive choice permits to find the best strategy for each woman while respecting post-partum period specificities.
摘要：
目的：制定产后避孕指南。
方法：从Medline数据库对1960年至2015年之间的出版物进行系统回顾，Embase,科克伦图书馆和国际社会的建议。
结果：最新的法国数据显示，大约2%的人工流产妇女在流产前6个月内分娩，4%的妇女在流产前6至12个月前有孩子（证据等级[EL]3）。最好在分娩后进行避孕咨询，以避免意外怀孕（C级）。在非母乳喂养的妇女中，恢复排卵的中位延迟较短为分娩后39天(EL4).建议在不希望紧密间隔妊娠的妇女分娩后21天后开始有效避孕（B级），并规定它在产妇（专业共识）。在母乳喂养的女性中，卵巢活动的恢复取决于母乳喂养的特点。只有在非常特殊的条件下的纯母乳喂养才能在六个月内用于避孕（EL2）。对于所有其他母乳喂养条件，避孕策略与不母乳喂养（B级）相同。根据产后静脉血栓栓塞的风险,不建议在产后6周之前使用联合激素避孕药(B级).在有血管危险因素的女性中，建议在产后第6-12周期间评估这种使用的获益风险平衡(专业共识).孕激素仅允许在产后早期使用低剂量的避孕药（B级），严重血栓栓塞事件急性期除外(专业共识).想要使用宫内节育器（IUD）作为避孕工具的女性，建议在医院开IUD，并在产后咨询期间插入IUD（B级）。在母乳喂养的女性中，孕激素避孕（口服或皮下）在分娩后立即允许（B级）。对于妊娠间隔时间短的女性，建议在医院开始使用长效可逆避孕药（植入物或IUD）（B级）。
结论：广泛的避孕选择允许为每个妇女找到最佳策略，同时尊重产后的特殊性。
方法：从Medline数据库对1960年至2015年之间的出版物进行系统回顾，Embase,科克伦图书馆和国际社会的建议。
结果：最新的法国数据显示，大约2%的人工流产妇女在流产前6个月内分娩，4%的妇女在流产前6至12个月前有孩子（证据等级[EL]3）。最好在分娩后进行避孕咨询，以避免意外怀孕（C级）。在非母乳喂养的妇女中，恢复排卵的中位延迟较短为分娩后39天(EL4).建议在不希望紧密间隔妊娠的妇女分娩后21天后开始有效避孕（B级），并规定它在产妇（专业共识）。在母乳喂养的女性中，卵巢活动的恢复取决于母乳喂养的特点。只有在非常特殊的条件下的纯母乳喂养才能在六个月内用于避孕（EL2）。对于所有其他母乳喂养条件，避孕策略与不母乳喂养（B级）相同。根据产后静脉血栓栓塞的风险,不建议在产后6周之前使用联合激素避孕药(B级).在有血管危险因素的女性中，建议在产后第6-12周期间评估这种使用的获益风险平衡(专业共识).孕激素仅允许在产后早期使用低剂量的避孕药（B级），严重血栓栓塞事件急性期除外(专业共识).想要使用宫内节育器（IUD）作为避孕工具的女性，建议在医院开IUD，并在产后咨询期间插入IUD（B级）。在母乳喂养的女性中，孕激素避孕（口服或皮下）在分娩后立即允许（B级）。对于妊娠间隔时间短的女性，建议在医院开始使用长效可逆避孕药（植入物或IUD）（B级）。
结论：广泛的避孕选择允许为每个妇女找到最佳策略，同时尊重产后的特殊性。
