Contracepção no puerpério

Abstract

Revisão ResumoUma adequada contracepção no puerpério é recomendada para prevenir morbidades maternas e infantis. Os benefícios materno-fetais da lactação são indiscutíveis e a amamentação exclusiva em pacientes amenorréicas é um método contraceptivo eficaz. No entanto, o reinício da fertilidade é variável entre as mulheres e deve-se considerar que o acesso ao serviço de saúde em muitas regiões não é garantido, comprometendo a prescrição de um método eficaz, quando ocorre o retorno dos ciclos ovulatórios. Foram pesquisados no Medline (PubMed) os artigos relacionados ao tema publicados entre 1971 e abril de 2008 e selecionados os artigos relevantes na literatura sobre contracepção no puerpério. Curtos intervalos intergestacionais aumentam complicações maternas e fetais, portanto uma contracepção eficaz no puerpério é imperiosa. O ideal é que o método prescrito seja eficaz e seguro (não interfira na lactação e nem altere o sistema hemostático). Apesar do método contraceptivo da lactação-amenorréia representar um método eficaz de prevenção de gestação, o retorno à fertilidade é impreciso. Em populações de risco para intervalo intergestacional curto e/ou acesso difícil ao serviço de saúde, outros métodos deverão ser associados após seis semanas, como os não hormonais ou os de progestagênios isolados, podendo ser utilizados antes em situações especiais. AbstractAdequate postpartum contraception is recommended in order to prevent mother and infant morbidity. The mother-infant benefits of lactation are well recognized, and exclusive, regular and frequent breastfeeding is an effective contraceptive method for amenorrheic patients. However, the resumption of fertility varies among women and access to health services is not guaranteed in many regions of the world. We searched the articles in Medline (PubMed) related to the subject published between 1971 to April 2008 and selected the most relevant articles in the literature about postpartum contraception. Short interpregnancy intervals increase maternal and fetal complications and therefore effective postpartum contraception is imperative. The ideal method prescribed should be effective and safe, id est, should not interfere with lactation or alter the hemostatic system. During the postpartum period, ideally non-hormonal methods should be used because they do not alter lactation or hemostasis. However, in populations with difficult access to health or with an early start of calorie supplementation to the newborn, the option should be for progestogens-only contraceptives, ideally initiated after six weeks or earlier in special situations.

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“…However, considering that the women who had liveborn children in 2018 were pregnant up to 42 weeks in the year, with late postpartum up to the 6th week after delivery (the period in which the postpartum follow-up appointment is supposed to be scheduled) 25 , we believe that by using the number of live births during a year, the prevalence of pregnant and postpartum women in the general population may be overestimated. Importantly, there are discrepancies in the literature concerning the duration of the postpartum period, which may lead to non-standardized completion of this variable in the SIVEP-Gripe database 26 , in addition to possible problems of underreporting of this information.…”

Factors related to women's health in puerperium and repercussions on child health

“…The measures of family planning in the postpartum period represent a fundamental strategy for maternal and child health by preventing an unplanned pregnancy and its consequences 11 . Enabling the experience of sexuality without the burden of an unwanted pregnancy is a right to health with the great potential of improving the quality of life of the family and the conditions for growth and development of their children.…”

“…The benefits of breastfeeding for the mother and the child are indisputable and exclusive breastfeeding in amenorrheic women is an effective contraceptive method 11 . Thus, because of the benefits to the health of women and children arising from breastfeeding and family planning, we point out that such measures should be supported and strengthened.…”

“…Moreover, families with poor social conditions tend to have more children in smaller intervals between pregnancies, increasing the demand for resources and reducing consumption possibilities and levels of family welfare, health and quality of life, in which case children are the most vulnerable ones to the morbid conditions of this context. Thus, adequate postpartum contraception for the prevention of maternal and child morbidity is recommended 11 . When women or couples plan pregnancy, they tend to have more harmonious relationships and greater availability and interest in child care, better adhering to the guidelines provided by health professionals, adopting healthy lifestyle habits and especially protecting the child health, taking into view that a healthy family environment fosters child growth and development.…”

Contraception in Adolescent Postpartum: Attitude Assessment in Preventing Recurrent Pregnancy

“…Such data raise concerns, because faced with this reality there is a reduced expectation of these girls to complete their studies, to have a stable job, and to be independent [6,7]. Also, with short intergestational intervals, teenagers with recurrent pregnancies are more exposed to hemorrhages in the third trimester, anemia, puerperal endometritis, premature rupture of membranes, obesity, and gestational diabetes [8].…”