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Family Planning

Family Planning . Clifford dela Cruz Harmony Que Paula Valera. Intrauterine Devices. Main benefits. High levels of effectiveness Lack of systemic side effects Single act for long term use Does not require frequent use. Failure Rates. Copper T 380A IUD and levonorgestrel IUD

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Family Planning

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  1. Family Planning Clifford dela Cruz Harmony Que Paula Valera

  2. Intrauterine Devices

  3. Main benefits • High levels of effectiveness • Lack of systemic side effects • Single act for long term use • Does not require frequent use

  4. Failure Rates • Copper T 380A IUD and levonorgestrel IUD • Less than one 1% • Clinician dependent • Correct insertion • Lower incidence of expulsion • Lower pregnancy rates • Cumulative pregnancy rate • Copper T 380A IUD- 1.7% (12 years) • LNG-UIS -1.1% (5 years)

  5. Major adverse events • Pregnancy • Expulsion • Removal for bleeding or pain

  6. More suited for older parous women who wish to prevent pregnancies

  7. Types of IUDS • 1960s- plastic polyethylene with barium sulfate • 1970s- smaller devices • 1980s- Copper IUDs were made (T380A, T220C, Multiload CU250, CU375)

  8. Copper 380A is approved- 12 years effectiveness • T Shaped devises • LevonorgestrelIntrauterine System (LNG IUS) • 20 mg of LNG is released onto the endometrial cavity • Thickens cervical mucus

  9. Mechanism of Action • Spermicide • Inflammatory reaction, 1000% increase of leukocytes • Phagocytosis of the sperm, impedes cell transport and viability • Hence prevents fertilization • Inflammation disappears upon removal

  10. Time of Insertion • Any day of the cycle • Much preferred after the cycle to avoid bacterial growth

  11. Adverse Effects • Uterine bleeding • Copper T 380A causes 55% increase of menstrual blood loss • Perforation of uterine fundus

  12. Complications related to Pregnancy • No evidence of congenital anomalies • Increase of fetal death not increased • No conclusive evidence that IUDs cause sepsis during pregnancy • Ectopic pregnancy is increased to threefold if woman becomes pregnant with IUD in place • Increased risk of prematurity with pregnant women with IUD in place

  13. Contraindications • Pregnancy or suspicion of pregnancy • PID • Postpartum endometritis • Infected abortion • Known/suspected uterine or cervical malignancy • Genital bleeding • Untreated acute cervicitis • Previously inserted unremoved IUD

  14. Overall Safety • Not associated with endometrial or cervical carcinoma • May be associated with reduction in risk of these neoplasms

  15. sterilization

  16. Popular choice • If the wife is older than 30 • Couple has been married more than 10 years • Couple does not desire to have more children

  17. Male Sterilization • Vasectomy • Procedure • Vas deferens is isolated and cut • Ends of the vas are closed either by ligation and fulguration • Complications • Hematoma • Sperm granulomas • Spontaneous reanastomosis

  18. Female Sterilization • Tubal ligation • Pomeroy • Modified Irving

  19. INDUCED abortion

  20. Still not legal in the Philippines • Done in selected states in the US and in some countries in Europe

  21. Three principal methods • Transcervical evacuation • Induction of labor • Major operations

  22. Curettage methods • Vacuum aspiration – more common in the first trimester • Endometrial aspiration • Dilatation of cervix • Dilatation and evacuation- more common beyond first trimester • Greater amount of cervical dilatation

  23. Induction of Uterine Contractions • More common in 2nd trimester abortions • Methods • Infusion of hypertonic solution in amniotic cavity • Administration of prostaglandin E2 (misoprostol) • Major Operations • Hysterotomy and hysterectomy

  24. Pharmacologic Agents • Progesterone antagonists • Examples • Mifepristone • Mechanism of action • High receptor affinity prevents progesterone from binding to its receptors • Inhibits the action of circulating progesterone • Endometrial decidua degeneration, cervical softening, promoting contractions

  25. Prostaglandin analogues • Misoprostol • Binds to myometrial cells to cause contractions leading to expulsion of tissues • Also causes cervical ripening and dilatation of cervix

  26. Antimetabolite • Methotrexate • Blocks dihydrofolatereductase (enzyme for DNA synthesis), inhibiting growth of rapidly dividing cells • Must be followed by a uterotonicto increase uterine contractions and expulsion of products of conception

  27. Complications • Infection • Heavy uterine bleeding • Uterine perforation • Mortality < 1/100,000 • Slight complications: <6 weeks or less • Beyond 10 weeks: complications increase progressively with gestational age

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