contraception.pptx

Contraception
Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures.
The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.
Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.
Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods
Natural
Barrier
IUDs
Emergency contraception
Terminal methods
Male fertilisation
Female fertilisation
Natural Methods
Coitus inteyrruptus / withdrawal
Rhythm Method
Lactational Amenorrhoea
Barrier Methods
Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
Combination
Combined use of Chemical and Mechanical methods.
Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.
Female condom
Femidom
Diaphragm
Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
Intrauterine Contraceptive Devices
Cu T200
T shaped device Polyethylene frame.
215 mm2 surface area of Cu wire.
Contains 124 mg of copper
Cu is lost at the rate of 50 µg/day.
Polyethylene monofilament tied at vertical stem.
Cu is radio opaque so additionally barium is
incorporated in the device.
Supplied in a sterilised sealed packet.
Lifetime 4 years.
Cu T 380A
380 mm square surface area of copper wire.
Replacement 10 years.
Multiload Cu 250
60-100 ug/day
Replacement 3 years
Multiload - 375
Mode of action
Biochemical and histological changes in endometrium.
Increased tubal motility.
Endometrial inflammatory response.
Prevents implantation.
Contraindication for insertion of IUCD
Presence of pelvic infection
Genital tract bleeding (undiagnosed)
Suspected pregnancy
Uterine fibroid
Severe dysmenorrhoea
Ectopic pregnancy history
Caesarean section
Cu allergy
Time of insertion
Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
Postabortal
Done immediately following termination of pregnancy.
Postpartum
After 6 weeks of delivery.
Postplacental delivery
Post delivery of placenta.

Method of Insertion
Preliminary steps:
History taking and examination
Patient is informed and consent is obtained.
Insertion is done in OPD aseptic conditions.
Placement of device in inserter.
Steps of operation
The patient is asked to remain empty bladder.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
The device is placed in the inserter and introduced through cervical

1. Contraception Dr. Yashika

2. Contraception Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures. The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.

3. Need for contraception • To avoid unwanted pregnancies. • To regulate the timing of pregnancy. • To regulate the interval between pregnancy.

4. Ideal Contraceptive • Safe • Effective • Acceptable • Reversible • Inexpensive • Long lasting • Requires little or no medical supervision

5. Contraceptive methods Spacing methods Natural Barrier IUDs Emergency contraception Terminal methods Male fertilisation Female fertilisation

6. Natural Methods Coitus inteyrruptus / withdrawal Rhythm Method Lactational Amenorrhoea

7. Barrier Methods Mechanical Male : Condom Female : Condom, Diaphragm, Cervical cap Chemical Creams - Deleen Jelly – Koromex , Volpar paste Foam tablets – Aerosol foams, Chlorimin T or Contab Combination Combined use of Chemical and Mechanical methods.

8. Male condom • Most commonly known and used contraceptive. • Better known in India as NIRODH.

9. Female condom Femidom

10. Diaphragm

11. Spermicides Spermicides are surface active agents which attach themselves to spermatozoa and kill them. Available in various forms like 1. Foams 2. Creams 3. Suppositories 4. Soluble films

12. Intrauterine Contraceptive Devices Types Example i . Open Lippe’s loop, Cu T, Cu 7, Multiload ii. Closed Grafenberg Ring, Birnberg Bow iii. Hormone containing IUD Progestasert LNG-IUS

13. Cu T200 T shaped device Polyethylene frame. 215 mm 2 surface area of Cu wire. Contains 124 mg of copper Cu is lost at the rate of 50 µg/day. Polyethylene monofilament tied at vertical stem. Cu is radio opaque so additionally barium is incorporated in the device. Supplied in a sterilised sealed packet. Lifetime 4 years.

14. Cu T 380A 380 mm square surface area of copper wire. Replacement 10 years. Multiload Cu 250 60-100 ug /day Replacement 3 years

15. Surface area of Cu wire 375 mm 2 . Replacement 5 years. Multiload - 375

16. Polydimethylsiloxane membrane around stem. Levonorgestrel 52 mg 20 ug /day Replacement 7 years. Levonorgestrel IUS (LNG-IUS)

17. Mode of action Biochemical and histological changes in endometrium . Increased tubal motility. Endometrial inflammatory response. Prevents implantation.

18. Contraindication for insertion of IUCD Presence of pelvic infection Genital tract bleeding (undiagnosed) Suspected pregnancy Uterine fibroid Severe dysmenorrhoea Ectopic pregnancy history Caesarean section Cu allergy

19. Time of insertion Interval 2-3 days after menstrual phase. During lactational amenorrhoea. Postabortal Done immediately following termination of pregnancy. Postpartum After 6 weeks of delivery. Postplacental delivery Post delivery of placenta.

20. Method of Insertion Preliminary steps: History taking and examination Patient is informed and consent is obtained. Insertion is done in OPD aseptic conditions. Placement of device in inserter.

21. Steps of operation The patient is asked to remain empty bladder. The patient is placed in lithotomy position. Local antiseptic cleaning is done. Posterior vaginal speculum is introduced. Anterior lip of cervix is grasped with Allis tissue forcep . The device is placed in the inserter and introduced through cervical canal right upto the fundus . After, positioning off guard the inserter is withdrawn. Excess of nylon thread is cut beyond 2-3 cm of external os .

22. Instructions to the patient Possibility of pain Vaginal bleeding Advice the patient to feel the thread periodically by finger. Routine check up 1 month then annually.

23. Complications Immediate Cramp-like Pain Syncopal attack Partial or complete perforation Remote Pain Abnormal menstrual bleeding PID Spontaneous expulsion

24. Indications for removal of IUD Persistent excessive uterine bleeding. Flaring up of uterus. Expulsion of IUD. Pregnancy with device in situ. Missing thread. One year after menopause. Women desiring issue.

25. Steroidal Contraception Parenteral Injectables DMPA NET-EN Combined Implant Implanon Norplant LNG rod Oral Combined Prep Monophasic Biphasic Triphasic Emergency Single Prep Progestin only pill Oestrogen only

26. Device IUD LNG-IUS Vaginal ring LNG ring Combined Transdermal patch Nestorone

27. Combined Oral Contraceptives Mode of action Inhibition of ovulation. Producing static endometrial hypoplasia . Alteration of cervical mucosa. Alters tubal motility.

28. Progestin Only Contraceptive Contains very low dose of progestins in form of Levonorgestrel 75 ug . Mechanism of action: Thicker cervical mucous. Atrophic endometrium .

29. Injectable Progestins Depomedroxy progesterone acetate (DMPA). Norethisterone enethate (NET-EN). IM deltoid/gluteus muscle. OTC: Depo -Sub Q provera 104.

30. Implant Implanon progestin only delivering system containing 68 mg of 3 Ketodesogestrel . 3 years life The capsule is inserted subdermally .

31. Emergency Contraception Hormones IUD Anti-progesterone

32. Sterilisation Permanent surgical contraception. Voluntary sterilisation. Male - vasectomy Female - tubal occlusion/ tubectomy

33. Vasectomy A segment of vas deferens of both the sides are resected and both the ends are ligated . Methods: No-Scalpel Vasectomy. Electrocoagulation . Fascial interposition. Selection of candidate: Psychologically adjusted. Sexually active.

34. Precaution: The man doesn’t become soon after the operation. Hence, additional contraceptive are advised up to a period of 3 months.

35. Complications Immediate Wound sepsis Scrotal hematoma Remote Impotency Granuloma Pain and discomfort Testicular cancer

36. Female sterilisation Occlusion of fallopian tubes. Indication: Family planning Socioeconomic Medicosurgical indications

37. Time of operation: Post puerperium . Interval. Concurrent with MTP. Methods of female sterilisation: 1. Tubectomy 2. Minilaparotomy

38. Thank you