POSTPARTUM CONTRACEPTION:

1
POSTPARTUM CONTRACEPTION Systematic Review of
the Literature What do the RCTs tell us?
Cheryl Levitt MBBCh CCFP FCFP Professor and
Chair Department of Family Medicine McMaster
University Presented at NAPCRG 2002
2
Credit to my colleagues The Evidence-Based
Postpartum Research Group Cheryl Levitt, Liz
Shaw, Janusz Kaczorowski, Sharon Brownlee, Russ
Springate, Murray Enkin, John Sellors, Barbara
Stroskopf, Maria Patriquin Supported by a grant
from the Bureau for Reproductive and Child
Health-Health Canada
3
RESULTS

671 studies
140 Articles
Sorted by Topic
66 Articles Other
33 Articles Perineal Pain
41 Articles Breastfeeding
63 Articles
Consensus Reached for Clinical Relevance
4

• 63 other

• pap smear
• rubella immunization
• contraception
• postpartum support
• early discharge
• postpartum depression and anxiety
• postpartum medical disorders UTIs,
  haemorrhoids, constipation, weight loss. Anemia
• smoking cessation
• nutritional supplements (other than BF)
• effects of pelvic floor exercises
• effect of early newborn contact

5
(No Transcript)
6
Contraception

• BCP
• IUDs
• Rhythm method
• Barrier methods
• Exclusive breastfeeding

7
Contraception

• Clinically relevant Questions?
• Choice of contraception
• Timing
• Early vs. late insertion of IUD
• Efficacy, side effects, complications etc
• Ethical issues

8
Contraception
5 RCTS meet our inclusion criteria 4 on IUDs
1 on progesterone vaginal ring 1 COCHRANE
review on immediate postpartum insertion of
IUDs NONE on BCP NONE on barrier methods NONE
on rhythm
9
Contraception
Methodological quality - Jadad Scale 2/5 (Van
Kets) 2/5 (Hëikkla) 3/5 (Landgren) 2/5 (Thierry
1980) 2/5 (Thierry 1983) The randomization
method was unclear in the first two trials and
none of the studies were double-blinded.
10
IUD
Clinical question What is the efficacy and side
effect rate of the various IUDs inserted
postpartum?
11

• Result
• Heikklä et al compared the Nova-T with two
  Levo-Norgestrel releasing devices.
• Van Kets et al compared the Nova-T with the
  Nova-T PP.
• Thierry Ml Cu 250 T Cu 200 (immediate
  insertion)
• Thierry Delta Lippes Loop, Delta T Cu 220 T
  Cu 220C (interval insertion)
• Main outcomes were expulsion, removal for
  bleeding and pain and pregnancy rates in both
  studies.

12
(No Transcript)
13
Clinical question Compared with delayed
insertion, is immediate postpartum insertion
associated with decreased efficacy and increased
side effects?