Outline of presentation

1. Postpartum Family planningMulat Adefris, MD,MPH Associate prof of Obstetrics and gynecology University of Gondar

2. Outline of presentation Objectives Reason for using postpartum family planning Benefit of postpartum family planning Potential side effects and complications Timing of insertion Counseling PPIUD Women who are not eligible for PPIUD

3. Objectives Articulate the reasons for using post partum family planning Discuss the benefits of postpartum family planning (PPFP) Describe the potential side effects and complications of PPIUD Recognize the appropriate time of PPIUD insertion Identify women who are not eligible for PPIUD

4. Reason for using PPFP Why is postpartum family planning important? Prevent unintended pregnancy Prevent closely spaced pregnancies

5. Reasons for unintended pregnancy Unpredictability of return to fertility Resumption of sexual activity Misconception of breast feeding as contraception

6. When should contraception be provided postpartum? Before the risk of pregnancy returns after childbirth Highly motivated to start using an effective method

7. Benefit of postpartum family planning Prevent maternal death Reduce child mortality

8. Benefit of postpartum family planning

9. Healthy spacing of pregnancies After a live birth 24 months After abortion 6 months 3. Adolescents should delay pregnancy at least 18 years

10. Which methods of contraception can be provided ?

11. Timing of PPIUD Insertion • Immediate postpartum period • Within 10 minutes of delivery • Postplacental and intracesarean • Have the highest rate of retention • Early postpartum period • Up to 48 hours after birth

12. Types of PPIUD insertion Postplacental • After the delivery of the placenta in a vaginal birth • Inserted before the woman leaves the delivery room  Intracesarean • After removal of the placenta during cesarean section Early postpartum • Within 48 hours of the birth • Preferably within 24 hours

13. PPIUD Limitations • Minimal and same as for interval IUCD • Does not protect against HIV or other STIs • Strings not visible after insertion initially

14. Sideeffects • Changes in bleeding patterns • Menorrhagia • Dysmenorrhea • Spotting • Discomfort/cramp • May be considered as normal part of recovery • Better tolerated than the interval IUCD

15. PPIUD complications • Uterine perforation • No reported cases in reviewed studies • Infection • No significant effect on the risk of infection • Expulsion • Immediate postpartum has lower risk of expulsion • Most occur within the first 3 months

16. Rupture of membrane for 18 hours or longer Postpartum hemorrhage Sepsis Extensive genital trauma

17. PPIUD Counseling • Begin during antenatal care (ANC) • Provided as • General health education   • Individual • Method-specific • Post-insertion

18. PPIUD insertion Manual insertion • Instruments • Kelly or ring forceps • Techniques for insertion

19. Case Study A 29 year old para II mother at gestational age 37 weeks Gave birth to a male neonate by repeat cesarean section She had a leakage of liquor an hour back She had previous cesarean section She wants to delay her next pregnancy for the next three years What options of contraception do you counsel her? What type of IUCD will you provide her if she opted for it?

20. Conclusion Postpartum women are at high risk of unintended pregnancy Postpartum women have a range of contraception options to use PPIUD can be provided before they leave health facilities PPIUD can be inserted 10 min or with in 48 hours after delivery Risks of PPIUD are low