Postpartum practice: guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF)

• Published in: European journal of obstetrics & gynecology and reproductive biology 2016-07, Vol.202, p.1-8
• Main Authors: Sénat, Marie-Victoire, Sentilhes, Loïc, Battut, Anne, Benhamou, Dan, Bydlowski, Sarah, Chantry, Anne, Deffieux, Xavier, Diers, Flore, Doret, Muriel, Ducroux-Schouwey, Chantal, Fuchs, Florent, Gascoin, Geraldine, Lebot, Chantal, Marcellin, Louis, Plu-Bureau, Genevieve, Raccah-Tebeka, Brigitte, Simon, Emmanuel, Bréart, Gérard, Marpeau, Loïc
• Format: Article
• Language: English
• Subjects: Breast Feeding; Cesarean and vaginal delivery; Consensus; Contraception; Contraception - methods; Delivery, Obstetric - methods; Female; Gynecology; Humans; Obstetrics; Obstetrics and Gynecology; Pelvic Floor - physiology; Pelvic floor muscle training; Postnatal Care - methods; Postpartum; Postpartum Period - physiology; Pregnancy; Psychological disorders
• ISSN: 0301-2115; 1872-7654
• DOI: 10.1016/j.ejogrb.2016.04.032

Abstract Objective To make evidence-based recommendations for the postpartum management of women and their newborns, regardless of the mode of delivery. Material and methods Systematic review of articles from the PubMed database and the Cochrane Library and of recommendations from the French and foreign societies or colleges of obstetricians. Results Because breast-feeding is associated with reductions in neonatal, infantile, and childhood morbidity (lower frequency of cardiovascular, infectious, and atopic diseases and infantile obesity) (LE2) and improved cognitive development in children (LE2), exclusive and extended breastfeeding is recommended (grade B) for at least 4–6 months (professional consensus). Pharmacological treatments for inhibition of lactation should not be given routinely to women who do not wish to breastfeed (professional consensus). Because of potentially serious adverse effects, bromocriptine is contraindicated in inhibiting lactation (professional consensus). For women aware of the risks of pharmacological treatments to inhibit lactation but choose to take them, lisuride and cabergoline are the preferred drugs (professional consensus). Regardless of the mode of delivery, only women with bleeding or symptoms of anemia should be tested for it (professional consensus). Immediate postoperative monitoring after cesarean delivery should be performed in the postanesthesia care unit (PACU). An analgesic multimodal protocol for analgesia, preferring oral administration, should be developed by the medical team and be available for all staff (professional consensus) (grade B). Thromboprophylaxis with compression stockings should begin the morning of all cesarean deliveries and maintained for at least 7 postoperative days (professional consensus) with or without the addition of LMWH, depending on the presence and severity (major or minor) of additional risk factors. It is recommended that women be informed of the dangers of closely spaced pregnancies (LE3), that effective contraception begin no later than 21 days post partum for women who do not want such a pregnancy (grade B), and that it be prescribed at the maternity ward (professional consensus). In view of the postpartum risk of venous thromboembolism, use of combination hormonal contraception is not recommended before six weeks post partum (grade B). Pelvic floor rehabilitation in asymptomatic women to prevent urinary or anal incontinence in the medium or long term is not recommended (pro