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Family Planning

Family Planning. DI WEN M.D., Ph.D. Professor & Chairman Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine.

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Family Planning

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  1. Family Planning DI WEN M.D., Ph.D. Professor & Chairman Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine

  2. Birth Control, Pregnancy, and Childbirth:Managing Your Fertility

  3. Methods of Fertility Management Hormonal methods • Oral contraceptives • Pills • Depo-Provera • Ortho-Evra • Nuva ring • Lunelle and Norplant (currently off the market)

  4. Methods of Fertility Management Surgical methods of sterilization • Female • Tubal ligation • Male • Vasectomy

  5. Methods of Fertility Management Other methods of contraception • IUDs • Progestasert • ParaGuard • Withdrawal • Emergency contraceptive pills • Emergency minipills • Abstinence and “Outercourse”

  6. Contraceptive Variables • Effectiveness • Compliance and desire to avoid pregnancy • Frequency of intercourse • Patient’s age • Cost of method • Side effects • Patient’s perceptions and misperceptions • Patient’s concomitant drug use • Patient’s health status and habits

  7. Oral Contraceptives

  8. Hormonal Methods • Oral contraceptive: • Combined oestrogen/progestogen • Progestogen only • Depot progestogen: • Injections(Progestogen) • Subcutaneous silicone implants • Vaginal: Silicone rings releasing oestrogen • and progestogen

  9. Oral Contraception • Prevents ovulation. • FSH secretion is depressed • LH peak is abolished. • Urinary androgen excretion is much increased. • Changes in cervical mucus make sperm penetration less likely.

  10. OC Formulations & Mechanism of Action • Formulations • Monophasics • Biphasics • Triphasics • Mechanism of action • Suppress ovulation • Alter cervical mucus and endometrium

  11. OC Health Risks-breast Cancer • No significant increased risk among current or former users • Small increased risk of breast cancer diagnosis • Link to earlier diagnosis of breast cancer

  12. OC Health Risks-cervical Cancer • Numerous studies have linked OC use and cervical neoplasia • Findings are difficult to interpret

  13. OC Health Risks • Nonfatal venous thromboembolism • Similar low risk of VTE associated with all low-dose OCs • Myocardial infarction • No increase in risk • Further studies may prove OCs protective • Stroke • No increase in risk

  14. OC Noncontraceptive Benefits • Reduced risk of ovarian and endometrial cancer • Menstrual benefits • Improvement in benign breast conditions and ovarian cysts • Improvement in acne • Reduced incidence and severity of PID • Protection against ectopic pregnancy • Maintenance of bone density

  15. OC Contraindications • Thrombophlebitis or thromboembolic disorders • Past history of DVT or thromboembolic disorders • Cerebral vascular disease or coronary artery disease • Known or suspected carcinoma of the breast • Carcinoma of the endometrium • Undiagnosed abnormal genital bleeding • Jaundice • Hepatic adenomas or carcinomas • Known or suspected pregnancy • Smoker over age 35

  16. OC Side Effects • Nausea • Breast tenderness • Menstrual changes • Weight gain • Headache

  17. Progestin-Only Pills • Formulation: • Contains norethindrone or nogestrel • 28 days of active hormones • Candidates: • Women who cannot or will not take estrogen • Postpartum and lactating women

  18. Long-Acting Contraceptives Currently available: • Injectable DMPA (Depo-Provera) • Copper IUD (Paragard) • Progestin IUD (Mirena)

  19. DMPA Injections

  20. DMPA Side Effects • Menstrual changes • Delayed return of fertility • Alopecia • Reduced libido • Weight gain? • Depression?

  21. DMPA Health Risks & Benefits • Loss of bone mineral density? • Lowered HDL level • Protection against endometrial cancer, no impact on risk of other types of cancer • Reduces PMS symptoms, iron-deficiency anemia, risks of PID, ectopic pregnancy

  22. Levonorgestrel Implants

  23. Side effects & risks Irregular bleeding Amenorrhea Headache Hair loss Weight gain Functional ovarian cysts Benefits Improvement of dysmenorrhea Improvement of PMS Implant Side Effects, Health Risks & Benefits

  24. Intra Uterine Devices • Inert • Copper bearing • Progestogen releasing

  25. IUDs

  26. IUD Insertion Risks • Risks: • Perforation of the uterus (rare) • Infection (antibiotic prophylaxis not needed) • Expulsion rates: • Copper T (Paragard) = 6% • Progesterone-releasing IUDs = 3~8%

  27. IUD Insertion Side Effects • Copper T: increased menstrual bleeding and dysmenorrhea • Mirena: irregular bleeding and spotting before eventual amenorrhea

  28. IUD: Major Contraindications • Multiple sexual partners • Pregnancy • Abnormalities of the uterus • PID • Postpartum endometritis or septic abortion • Uterine or cervical malignancy • Undiagnosed genital bleeding • Vaginitis or cervicitis • Increased susceptibility to infection • Previously inserted IUD still in place

  29. Complications of IUDS • Increased menstrual loss. • Infection • Pregnancy • Expulsion • Translocation

  30. Barrier Contraceptives • Condoms • Male latex, polyurethane, animal skin • Female polyurethane • Diaphragms • Cervical cap • Spermicides

  31. Male Condoms

  32. How to Use a Condom Figure 6.1

  33. The Female CondomBrand Name: Reality

  34. The Diaphragm

  35. The Cervical Cap

  36. Spermicides

  37. Spermicides • Creams • Films • Foams • Jellies • Pessaries • Sponges (All of these are mainly Nonoxynol based.)

  38. Natural Family Planning • Also called periodic abstinence or fertility awareness • Calendar (“rhythm”) method • Cervical mucus (ovulation or billings) method • Basal body temperature method • Symptothermal method

  39. Rhythm Method(“safe Period”) • 24 hours are allowed for ovum survival • 3 days are allowed fro the sperms • Coitus must be avoided from the 9th to the 15th day

  40. The Fertility Cycle Figure 6.4

  41. Billings’ Method Identify the peri-ovulatory phase by noting the vaginal sensations associated with changes in cervical mucus.

  42. Emergency Contraception • High doses of combined OCs • High doses of progestin-only pills Emergency contraceptive pills prevent pregnancy by inhibiting or delaying ovulation. They may also alter the endometrium, making it inhospitable to the implantation of ova. They may alter sperm or ovum transport. • IUD The mechanism of action of the IUD as emergency contraception remains undefined.

  43. NEW METHODS: OrthoEvra “The Patch”

  44. Surgical Methods 1.Laparoscopic sterilisation Rings,Clips-Bipolar diathermy,Laser 2.Tubal ligation

  45. Artificial Abortion Definition: An abortion that is brought about intentionally(family planning et al.), Also called an induced or therapeutic abortion The termination of a pregnancy befor the 24th week.

  46. Abortion of Methods Vacuum aspiration – 1st trimest Dilation and Evacuation (D&E) – 2nd trimester Dilation and Curettage (D&C) – 2nd trimester4)

  47. Amniocentesis Figure 6.7

  48. Abortion of Methods Prostaglandin or induction abortions – 2nd trimester Hysterotomy – removal of the fetus surgically Intact dilation and extraction (D&X) – late term abortion Mifepristone (RU-486) – induces abortion by blocking progesterone used with Misoprostil (a prostaglandin)

  49. Complications *Incomplete uterine evacuation *Uterine perforation and/or damage to abdominal viscera. *Sepsis. *Haemorrhage. *Rhesus isoimmunisation

  50. Medical Termination Mifepristone(RU 486) 600mg orally + Gemeprost (PG analogue ) 1mg vaginally (36-48 hours later)

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