CDC updates its guidelines on postpartum contraception

Don’t offer your patients combined hormonal contraceptives during the first 21 days after delivery

The use of combined hormonal contraceptives are not recommended during the first 21 days after delivery due to the high risk for venous thromboembolism (VTE), according to a report in the July 8 issue of the U.S. Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.

The CDC evaluated evidence regarding the safety of combined hormonal contraceptive use during the postpartum period and provided updated recommendations to the U.S. Medical Eligibility Criteria for Contraceptive Use, 2010.

Due to the high risk for VTE in the weeks immediately following delivery, the CDC recommends that postpartum women should not use combined hormonal contraceptives during the first 21 days after delivery. Women without risk factors for VTE can initiate combined hormonal contraceptives between 21 and 42 days postpartum; however, women with risk factors for VTE should not use these methods, according to the updated guidelines. After 42 days postpartum, no restrictions based on postpartum status apply.

“Health care providers assessing a woman’s individual risk also should consider any other characteristics or medical conditions that might impact the classification,” the authors write. “For postpartum women, this might include examining the recommendations for other risk factors for VTE, such as known thrombogenic mutations (category 4) or history of VTE with risk factors for recurrence (category 4), both of which pose an unacceptable health risk for combined hormonal contraceptive use, whether or not women are postpartum.”

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Look for in-depth expert discussion on the topic of providing postpartum contraception in an upcoming issue of OBG Management.