Systematic Review of the Literature on Postpartum Care: Selected Contraception Methods, Postpartum Papanicolaou Test, and Rubella Immunization


  • Cheryl Levitt is Professor, Elizabeth Shaw is Associate Professor, Sharon Wong is Senior Research Associate, Janusz Kaczorowski is Associate Professor, and Russ Springate is Associate Professor in the Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada; John Sellors is Clinical Professor in the Department of Family Medicine at McMaster University and Senior Medical Advisor, Reproductive Health at PATH (Program for Appropriate Technology in Health) in Seattle, Washington, USA; Murray Enkin is Professor Emeritus in the Department of Obstetrics and Gynecology and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

  • Source of funding for this research project is the Bureau of Reproductive and Child Health, Laboratory Centre for Disease Control, Health Protection Branch, Health Canada, Ottawa, Canada.

Dr. Cheryl Levitt, Department of Family Medicine, McMaster University, 1200 Main Street West, Room 2V11, Hamilton, Ontario, L8N 3Z5, Canada.


Abstract: Background: The postpartum period is a time when many routine interventions are provided to mothers. This review examined the published evidence for the effectiveness of selected contraceptive methods, Papanicolaou (Pap) tests, and rubella immunization. Methods: MEDLINE, Cinahl, PsycINFO, and the Cochrane Library were searched for randomized controlled trials of interventions initiated from immediately after birth to 1 year in postnatal women. The initial literature search was done in 1999, and was enhanced in 2003. Studies were categorized and reviewed by topic areas. Data were extracted in a systematic method, and the quality of each study was reviewed. Results: In the 1999 search, 140 studies were randomized controlled trials that met the selection criteria: 5 related to postpartum contraception, 1 to timing of the postpartum Pap test, and 2 to postpartum rubella immunization. In the 2003 searches, 1 additional study related to postpartum contraception was identified. From the published literature on selected contraceptive methods, the intrauterine devices examined were effective in preventing pregnancy and had comparable side effect profiles. No clear recommendation can be made because insertion timing was not randomized in the included trials. Although delaying the postpartum Pap smear until 8 weeks reduces the proportion of inflammatory smears, it is uncertain whether a Pap smear is of benefit to postpartum women. The RA 27/3 postpartum rubella vaccine appears to be more effective than the Cendehill vaccine, but a small proportion of women may develop acute and chronic joint manifestations. Conclusions: Some evidence is available to support selected postpartum contraceptive methods and the postpartum rubella vaccine, but data are lacking on the effectiveness and optimal timing of the postpartum Pap smear.