[Postnatal visit: Routine and particularity after complicated pregnancy--Guidelines for clinical practice].

OBJECTIVE

To propose guidelines for clinical practice for routine postnatal visit and after pathological pregnancies.

METHODS

Bibliographic searches were performed with PubMed and Cochrane databases, and within international guidelines references.

RESULTS

Postpartum visit should be planned 6 to 8 weeks after delivery and can be performed by an obstetrician, a gynecologist, a general practitioner or a midwife, when after normal pregnancy and delivery (Professional consensus). If any complication occurred, this visit should be handled by an obstetrician (Professional consensus). Physical examination should focus on patient symptoms and pregnancy complications (Professional consensus). Gynecological examination is not systematic (Professional consensus). Pap smear should be performed if previous exam was done more than 2years ago or when the previous exam was abnormal (Professional consensus). Weight should be measured to encourage weight loss (Professional consensus), with the aim to catch up preconceptional weight within 6 months after delivery (gradeC). Professional intervention may reduce weight retention (professional consensus). Tobacco, alcohol and illicit drugs cessation should be promoted (grade B) and supported by a professional (grade A). Obstetrical risks consecutive to short interval between pregnancies should be explained (evidence level [EL]: 3) and contraception discussed regarding family project (Professional consensus). Mother mood, mother to child relationship and breastfeeding troubles should be systematically evaluated (professional consensus). Pelvic-floor rehabilitation should be performed only when urinary of fecal incontinence persist 3 months after delivery (Professional consensus). Serological screening for toxoplamosis (grade B) and blood hemoglobin concentration should not be systematically performed (gradeC). After spontaneous preterm birth, women should be screened for uterine anomalies and treatment should be discussed (Professional consensus). Evidence is lacking to recommend any exploration to diagnose cervical incompetence (Professional consensus). When investigations are performed, there is no argument to recommend a specific exam (Professional consensus). Women should be screened for antiphospholipid antibodies after severe or early pre-eclampsia, IUGR or intra-uterine fetal death (Professional consensus) but screening for inherited thrombophilia is not recommended (grade B). Women with persistent proteinuria and/or hypertension 3 months after pre-eclampsia should be referred to a nephrologist (Professional consensus). Normalization of liver enzymes should be checked 8 to 12 weeks after intrahepatic cholestasis of pregnancy (Professional consensus). A synthetic document should be send to the women corresponding physicians (Professional consensus). Preconceptional counseling is recommended (Professional consensus).

CONCLUSIONS

A postpartum visit is recommended 6 to 8 weeks after delivery, including mother physical and psychological evaluation and information about contraception, short interval between pregnancy, weight loss, smoking cessation (Professional consensus). To ensure continuity in the management of women health, relevant medical elements will be pass on to the corresponding physicians (Professional consensus).