copper t and oral pills.pptx

Knowledge regarding family panning

1. Method of Emergency Contraception and Copper-T

2. Definition The contraceptive device provided to woman to prevent unintended pregnancy following an unprotected act of sexual intercourse is known as emergency contraception. The term is also preferred over post coital contraceptives because it also implies that the method is not for regular use.

3. Methods of emergency contraception There are two main methods mainly available in N epal. 1.Oral contraceptive pills , both combined pills and progestin only pills. 2.Intrauterine devices ;I e IUD Several method can also be used within as short time after unprotected intercourse . They are often called ‘Morning after Pills’ .It is also appropriate to call them secondary contraception.

4. Oral contraceptive pills

5. Mechanism of action The precise mode of action of emergency contraceptive method is uncertain and may be related to the type of emergency contraceptive and the time .It is used in a woman’s menstrual cycle . It is thought to prevent ovulation , fertilization and implantation . It cannot disrupt an implanted pregnancy.

6. Indications Contraceptive accident or misuse Condom ruptures, slippage or misuse Failed coitus interrupts IUD expulsion Unprotected intercourse prior to the effective time of vasectomy Miscalculation of the periodic abstinence method Ready access is important because of the short time period after unprotected intercourse during which emergency contraception is likely to be effective.

7. Method of Emergency contraception Method Timing Remarks Client Instruction COCs (the Yuzpe method) Should be taken within 72 hours of unprotected sex and repeated after 12 hours Effective (2% become pregnant) Side effects Nausea Vomiting Breast tenderness, headache , dizziness Irregular uterine bleeding , spotting, delayed menstrual cycle. If pregnancy is not prevented , counsel client for ANC COCs low dose(30-33mgEE) Take 4 tablets within 72hours of unprotected sex 12hours later Take 4 more tablets Total= 8 tablets

8. Cont …. Progestin only pills (POPs) Should be taken within 72 hours of unprotected sex and repeated after 12 hours Same side effect as with COCs but significantly less severe and nausea/vomiting is minimal -if pregnancy is not prevented ,counsel client for ANC. POPs (750 mcg or 0.75 mg LNG e. g, prostinor ) Take 1 tablet within 72 hours 12 hours later Take 1 more tablet (Total dose=1500 mcg of 1.5 mg of levenorgestrel ) OR POPs (0.075 mg Norgestrel e.g , ovrette ) Take 20 tablets within 72 hours 12 hours later Take 20 more tablets (Total dose=3 mg of norgestrel )

9. Cont ….. IUDs Should be inserted within 5 days of unprotected intercourse Very effective less than 1 % pregnant Few side effects Provide long term contraception as well Failure increases with longer interval between unprotected intercourse & insertion May not be advisable for young nulliparous clients Counsel client about post insertion bleeding, help her understand how to distinguish this from a menstrual period

10. Management of Nausea &Vomiting Because of the high dose of estrogen in COCs ,nausea is a common side effect . If accompanied by vomiting within 72 hours ,the effectiveness of COCs when used for emergency contraception may decreased. To minimize nausea and vomiting , advice the clients to take each dose with food/taking the first dose at bed time. Anti emetics can be used prophylactically but routine is not recommended. If vomiting occurs within 2 hours of taking the first or the second dose, the clients may repeat the dose or consider administering the dose vaginally.

11. Follow up care Clients should be counseled to expect a menses within 3-4 weeks. If they have not had a menses they should return to the clinic and a pregnancy test should be performed. If the result is positive ,they should receive counseling and referral for antenatal care.

12. Intrauterine Contraceptive Device (IUCD) The intrauterine device (IUD)has become one of the most widely used and safest methods of contraception available to women. It is based on the principles of introducing foreign body in the uterus. The original device was first used in 1909 which was made up of silkworm gut. The IUD T cu 380 A was recently approved for 12 years. The copper T 380 A is shaped like a ‘T’ and has a copper notch stem and the arms, with a total exposed copper area of 380 square mm. It has white string at its base, which extends through the cervix so that the IUD can be removed.

13. Different types of IUD

14. Types of IUD Non-medicated IUD and Medicated IUD

15. Generation of IUD First generation IUDs : Non-medicated or inert IUDs usually made of polyethylene or polymers. E g. loops, spiral, coils ,rings e t c Second generation IUDs: Comprise of copper in IUDs. It was found that metallic copper had a strong anti-fertility effect. E g. copper-7, copper T-200. Newer devices – copper T -220c Copper T -380 Multi load devices Third generation IUDs: based on principle of release of a hormone. The most widely used hormonal device is progestesert , which is a ‘T’ shaped device filled with progesterone. The hormone is released slowly at the rate of 65 mcg daily.

16. Mechanism of Action The exact mechanism of action is still unclear. The most studies have suggested that they are: Prevent implantation of developing embryo in the uterus by acting foreign body. Decrease the number of sperm reaching the fallopian tube and inactivating them. Ionized copper has local anti-fertility effect by preventing implantation through enzymatic interference. Prevent fertilization.

17. Effectiveness The effectiveness of IUDs is 99.2%. The failure rate is only 0.1-2 H.W.Y. *How soon after insertion of the IUD is effective The IUD is effective immediately and the client can have sex as soon as she wants .She should be told there might be some bleeding ,spotting or cramping during the first few weeks after insertion . *Return of fertility.

18. Indication Has one or more children Is breast feeding and need contraception Has no history of pelvic diseases Has successfully used an IUD in the past Is at low risk of contracting a sexually transmitted diseases(STD) Post abortion clients who do not have evidence of infection Prefers a method who provides highly effective, long term contraception but does not want a permanent method at this time.

19. Timing of insertion It can be inserted at any time during the menstrual cycle , if it is certain that the woman is not pregnant .The best time to insert the device is at the end of the menstrual cycle or 5 th to 7 th days of the menstrual cycle. Post abortion :Immediately for first trimester abortion and provided there is no evidence of infection . For 2 nd trimester abortion ,after the involution of uterus (6-8weeks)

20. Insertion

21. Side effects &its management Amenorrhea Provide counseling and advice the client Irregular bleeding with or without s/s of pregnancy Refer to appropriate for complete evaluation Cramping Treat accordingly and remove if indicated If no cause is found replace with new IUD Missing string Check for pregnancy and replace with other Vaginal discharge Obtain accurate history which facilitates diagnosis and treatment

22. Contraindications Absolute Suspected pregnancy Pelvic inflammatory diseases Undiagnosed vaginal bleeding Cancer of cervix , uterus and pelvic tumor Strong relative Pelvic infection risk factors Post partum endometriosis Acute cervicitis Recurrent pelvic infections Multiple sexual partner Other relative Anemia Menorrhagia Allergy to copper Within six week following c s

23. Advantages Highly effective Long term protection up to 12 years Immediate return to fertility after removal Few side effects Does not interfere with intercourse Suitable for breast feeding women Inexpensive Highly continuation rate

24. Disadvantages May increase the risk of PID Required trained person to remove Needs to check string after every menstruation The client cannot discontinue on her own

25. Follow up care Normally the clients should return to the IUD provider after the first post insertion menses (4-6) weeks but not later than 3 months for their first checkup. The routine follow up are: 1 st –After 1 week 2 nd –First menses 3 rd – After 2 months 4 th –After 6 months 5 th –After 12 months

26. RH protocol for COPPER -T RH protocol Client desires IUCD Assess if pregnant no yes Advice for ANC History Menstrual history Recent or current PID Valvular heart disease Multiple partner Vaginal bleeding or discharge Exam Heart Vaginal bleeding or discharge Investigation Hemoglobin Urine analysis normal abnormal Insert IUCD Instruct client Check string Warning signs Follow up Ensure to remove after 12yrs Ask if she can feel string If not appropriate counsel the client for alternative method & Manage identified health problem Client with an STD can use IUCD after the disease is treated

27. Thank you !!!