Postpartum examination, breastfeeding, and contraception in the postpartum period in the Czech Republic

Department of Obstetrics and Gynaecology, First Medical Faculty, Charles University in Prague, Prague, Czech Republic
Central European Journal of Medicine (Impact Factor: 0.15). 02/2011; 6(1):76-82. DOI: 10.2478/s11536-010-0055-0


In the majority of recent textbooks of obstetrics, a routine follow-up examination at the end of the postpartum period is
recommended. To date, no studies have been done in the Czech Republic addressing use of contraception and follow-up care in
the postpartum period. Questionnaires were sent to 672 participants who gave birth in the year 2008, inquiring about follow-up
examinations in the postpartum period and use of contraception. In total, 458 (68.2%) questionnaires were returned. 430 women
(93.9%) underwent routine examinations at 6 weeks into the postpartum period. At the time of examination, 36 women were asked
about their particular health problems (8.4%). In 130 instances, the question most often addressed by the outpatient gynecologist
concerned use of contraception (30.2%). However, only 34 physicians expressed concern about changes in sexual life or other
sexually related problems. 426 women (93.0%) were sexually active and 310 women (72.8%) did not use any contraception with
the exception of breastfeeding. The current practice of outpatient gynecological visits at 6 weeks postpartum and advice on
contraception both seem inadequate.

KeywordsPostpartal examination-Contraception-Breastfeeding-Sexuality-Puerperium

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    ABSTRACT: While many women and infants have an uneventful course during the postpartum period, others experience significant morbidity. Effective postpartum care in the community can prevent short, medium and long-term consequences of unrecognised and poorly managed problems. The use of rigorously developed, evidence-based guidelines has the potential to improve patient care, impact on policy and ensure consistency of care across health sectors. This study aims to compare the scope and content, and assess the quality of clinical guidelines about routine postpartum care in primary care. PubMed, the National Guideline Clearing House, Google, Google Scholar and relevant college websites were searched for relevant guidelines. All guidelines regarding routine postpartum care published in English between 2002 and 2012 were considered and screened using explicit selection criteria. The scope and recommendations contained in the guidelines were compared and the quality of the guidelines was independently assessed by two authors using the AGREE II instrument. Six guidelines from Australia (2), the United Kingdom (UK) (3) and the United States of America (USA) (1), were included. The scope of the guidelines varied greatly. However, guideline recommendations were generally consistent except for the use of the Edinburgh Postnatal Depression Scale for mood disorder screening and the suggested time of routine visits. Some recommendations lacked evidence to support them, and levels or grades of evidence varied between guidelines. The quality of most guidelines was adequate. Of the six AGREE II domains, applicability and editorial independence scored the lowest, and scope, purpose and clarity of presentation scored the highest. Only one guideline provided comprehensive recommendations for the care of postpartum women and their infants. As well as considering the need for region specific guidelines, further research is needed to strengthen the evidence supporting recommendations made within guidelines. Further improvement in the editorial independence and applicability domains of the AGREE ll criteria would strengthen the quality of the guidelines.
    Full-text · Article · Jan 2014 · BMC Pregnancy and Childbirth