Emergency and terminal contraception

Contraceptive methods, family planning

1. PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD

2. FAMILYPLANNING

3. FAMILYPLANNING
Familyplanningistheabilityfora
womanorcoupletodeterminewhen
andhowmanychildrentheyaregoing
tohavebypracticingsafesexual
practices.

4. OBJECTIVES FAMILYPLANNING
( WHO ) “the use of a range of methods of a fertility
regulationtohelpindividualsorcouplesattain
certain objectives:
avoid unwantedbirth.
bring about wantedbirth.
Produceachangeintheno.ofchildrenborn.
Regulate the intervals betweenpregnancies.
Control time at which birthoccur.”

5. DEFINITION OF TARGETCOUPLE
Thetermtargetcouples areappliedwho have2-3
living children, and family planning was largely
directed to suchcouples.

6. DEFINITIONOF SMALL FAMILYNORM
it is composed of mother , father and fewchildren.
Slogan for SMN
•Hum Do, Hamara Ek
•Hum Do, Hamara do (1970)
•A Small Family is a happy Family.
• Small family-small conflicts
• Small family-small demands
•two child complete the family
•ChotaParivarGharSansar.

7. HEALTH ASPECT OF FAMILYPLANNING
ADVANTAGES TOMOTHER
Reasonablegapbetweentwochildrenwillgivethe
mothersufficienttimetoreplenishherbodynutrients
depletedduetotheearlierpregnancy.
Lossoffearaboutunwantedpregnancy.
Moretimeandenergytogiveproperattention
andlovetoherchildren.
Moretimetoparticipateinotherfruitfulactivities
likeeducation,vocationaltraining,community
projectsetc.
Canavailofbetterjobopportunitieswhennot
tieddownbysmallchildren..

8. HEALTH ASPECT OF FAMILY
PLANNING
ADVANTAGES TOFATHER
Can provide sound economic base for thefamily.
Can provide children with better education,
comfort, food, clothing, recreationetc.
Can be more relaxed and enjoy good
health.
Improved living standards, better health,
more productive labourforce

9. HEALTH ASPECT OF FAMILYPLANNING
ADVANTAGES TOCHILD
Lesschancesoffoetaldeath,birth
defects,mortalityduringinfancyand
childhood.
Conducive atmosphere forproper
physical and psychological growth of thechild.
Get proper nutrition, education,
parental care andlove.

10. HEALTH ASPECT OF FAMILYPLANNING
ADVANTAGES TO COMMUNITY AND COUNTRY
-Conversation of natural resources andsavings.
-Enough schools, hospitals and other basicservices.
-Moreemployment
-Planned families would gradually bring happiness,
peace, harmony,prosperity.

11. CONCEPTION
It is the fertilization of a
female ovum by a male
sperm. Every 28 days, in an
adult female, one ovum
leaves the ovary and is
directedinto fallopian tube
by the fimbriated end,
which passes along with
thetube.

12. •Humanfertiliz
ationis the
union of a
human egg
and sperm,
usually
occurring in
the ampullaof
the fallopian
tube.

13. CONTRACEPTION
it is the voluntary prevention of pregnancy, a
process with individual and socialimplications.
Contraception (birth control) prevents pregnancy
by interfering with the normal process of ovulation,
fertilization, and implantation. There are different
kinds of birth control that act at different points in
theprocess.

14. Emergencycontraception
Emergencycontraceptionrefers to back up
method for contraceptive emergencies which
woman can use within the first few days after
unprotected intercourse to prevent an unwanted
pregnancy. Emergency contraceptive is not
suitable for regularuse.
(WHO,2005)

15. •After voluntary sexual act without contraceptiveprotection.
•Incorrect or inconsistent use of regular contraceptive
methods. Failure to take oral contraceptive for more than
threedays.
•In case of contraceptive failure or mishap, miscalculation of
infertile period, expulsion of an intrauterine device and
failed coitus interruptus or in case of leakage ofcondom.
•In the case of sexualassault.
•Emergency contraception should not be used as regular
birth control. Other birth control methods are much better
at keeping women from becomingpregnant.
INDICATIONSOFEMERGENCY
CONTRACEPTIVES

16. METHODSOFEMERGENCY CONTRACEPTION
Emergency contraceptive pills (ECPs) emergency
contraceptive pills;ECPs
Medication containing synthetic hormones for preventing
pregnancy after unprotected vaginalintercourse.
Allthehormonaloralcontraceptivepills(combinedaswell
assingle)invaryingdosesandIUDcanbeusedforEC.The
methodcurrentlyusedinindiaare:
High dose of progesterone only pill containing
levonorgestrel(LNG).
high dosesofcombinedoral contraceptive containing
ethylestradiolandlevonorgestrol (yuzperegimen).

17. Cont…..
•Copper releasing intrauterine devices (IUCD) such
asCuT380A.
•Under the national family welfare programme, the
drug controller of india has only approved
levonorgestrel(LNG)0.75mgtablet for use as ECP.
LNG is the specially packaged at the correct doses
for use asECP.

18. MODE OF ACTION OFECPs
Inhibition or delay ofovulation.
Thickening of cervicalmucus.
Direct inhibition offertilization.
Alteration in endometrium leading to impaired
endometriumreceptivity to implantation ofthe
fertilizedegg..

19. MODE OF ACTION OFECPs
Alteration in transport of egg, spermand
embryo.
Interferencewith corpus luteum andluteolysis

20. Effectiveness ofECPs
The probability of conception after single act of
intercourse is approximately8%.
A normally fertile sexually active couple not using
contraception has an average monthly chance of
conceiving of 20-25% (counting on pregnancies that
result in livebirths.
ECPs taken within 72 hours of unprotected
vaginal intercourseare85%effective.
ECPs are more effective if used within 12-24 hours
of unprotected intercourse any delay in taking the
pills decrease theefficiencyofECPs.

21. ADVANTAGES OFECPs
Effective if taken correctly asprescribed.
Safe for all woman including those who have
conditions, that are listed as precautions in case of
other hormonal contraceptives.
Does not affectlactation.
Can be taken at any time during the monthly
cycle.
It is available without a prescription (over the
countermedicine)
Use not associated with foetal malformation or
congenitaldefects.

22. DISADVANTAGES
•Has to be used within 72 hours of the first act of
sexual intercourse as use of ECP beyond this
period increases the risk ofpregnancy.
•Effectiveness decreases with frequentuse.
•Does not protect fromSTIs/HIV.
•Side effects: nausea, vomiting, irregular bleeding
per vagina, breast tenderness, headache,
dizziness,fatigue.

23. MODE OFINTAKE
ECPs must be taken 72 hours of an unprotected
act of intercourse best to be taken as soon as
possible after the unprotected act and as a single
dose of 2 tabs of 0.75 mgeach.
There is an option of taking 2 doses of 1tablet
0.75 mg each, 12 hours apart.
However no woman should be denied the pills in
case she comes later than 3 days (maximum 120
hours) but should be counseled regarding the
decreasedefficacy).

24. EMERGENCYCONTRACEPTION
PILLS
Calculation of 72 hours (three daysinterval)
Calculation of 72 hours or three days should
start from the first unprotected penetrative
vaginal intercourse the woman has had
during the particular menstrualcycle.

25. Side effects ofECPS
Nausea andvomiting
.Headache,
dizziness,
irregularbleeding,
breasttenderness,
fatigue

26. INTRAUTERINE DEVICE(IUD

27. INTRAUTERINE DEVICE
(IUD)
•IUD is a small, T-shaped device placed into the
uterus by a doctor within 5 days after having
unprotectedsex.
•This preventsimplantation.
•The IUD works by keeping the sperm from joining
the egg or keeping a fertilized egg from attaching to
theuterus.
•It can remove theIUD afternext period. Or left in
place for up to 10years

28. STERILIZATION
Sterilization refers to surgical procedures intended
to render the person infertile. Most procedure
involve the occlusion of the passageways for the
ova andsperm.

29. TYPES OF TERMINALMETHODS
TYPES OF TERMINAL METHOD
FOR MALE
Vasectomy
Non scalpelvasectomy.
FOR FEMALE
Tubectomy
Minilapoperation
Laproscopic sterilization
Tuballigation.

30. MALE STERILIZATION -VASECTOMY
Male sterilization or vasectomy being a
comparativelysimple and permanentmethod.
can be performed even in primary health
centres by trained doctorsLA.
through a small scrotal incision on an out
patientbasis.
When carried out under strict aseptic
conditions,.

31. TECHNIQUE OF MALESTERILIZATION
The tubes through which sperm travels from the
testes to the penis are cut andblocked.
So that spermatozoa can no longer enter the
semen that is ejaculated.
It is customary to remove a piece of vas at least 1
cm afterclamping.
The ends are ligated and be then folded back on
themselves and sutured into portion so that the cut
ends face away from eachother.

32. MALE
STERILIZATION
.

33. MALESTERILIZATION
The passage of the sperm along with the vas
deferens isblocked,
so that the sperm that is ejaculated does not
containsperm.
It is important to stress that the acceptor is not
immediately sterile after theoperation,
usually until approximately 30 ejaculations have
takenplace.
During this intermediate period another method
of contraception must beused.

34. CONT……

35. MINOR COMPLICATION OF
VASECTOMY
Swelling
•Pain
•BloodClots
•Infection
•Epididimitis

36. CAREAFTER
OPERATION
•
Avoid heavy works for at least 3 days.
Avoid cycling for at least 7days.
Avoid taking bath for at least 24 hours
after theoperation.
Use contraceptives until aspermiahas
beenestablished

37. THE PATIENTNEEDS
Prescribemedicine.
Adequatediet.
Dry and cleandressing.
Scrotal support for onemonth.
Niroth to be used at least 12 ejeculation
afteroperation.
Suture removed after 3 rdday.


38. NONSCALPELVASECTOMY
This new method of sterilization is being
activelypromotedbytheW.H.O.
it was developed in 1974 by Dr. Li Shungiang at
chongging Family Planning Scientific Research
Institute, peoples republic ofchina.
In contrast to the standard incisional method
of vasectomy, which requires several pieces of
surgicalinstruments, this new technique needs
only two essentialinstrument.

40. TECHNIQUE OF NON SCALPEL
VASECTOMY
The first is the vas fixation clamp, used to grasp
the vas deferens from outside of the scrotalskin.
The second is the vasdissectingclamp,usedto
make a puncture into the skin over lying the fixed
vas . afterwideningtheessential punctured hole
withthe vas dissecting clamp, the vas can be seen
and elevated out for any preferred methods of vas
occlusion.

41. FEMALESTERILIZATION
Occlusion of the fallopian tubes in some form is
the underlying principle to achieve female
sterilization. It is most popular method of
terminalcontraception.
Time ofoperation
•Immediately after birth (within 24 to
48hours)
•At the time ofabortion.
•An interval procedure (during proliferative
phase of menstrual cycle)

42. METHOD OF FEMALE
STERILIZATION

43. LAPAROSCOPICSTERILIZATION
•This is a technique of female sterilization
through abdominal approach with a specialized
instrument called “laparoscope”. The abdomen
is inflated with gas(carbon dioxide, nitrous oxide
orair).
•Instrument is introduced into the abdominal
cavity to visualize thetubes.
•Once the tubes are accessible, the Falope rings
are applied to occlude thetubes.

44. LAPAROSCOPICSTERILIZATION

46. ADVANTAGES
•It is simple/small
incision.
•Easy toperform.
•Done in the shorttime.
•Hospitalization is
limited.
•Scars will not bevisible.
•The instrument is
expensive.
•Requiresadequate
maintenance.
•Requires sufficient
training to use the
instrument
DISADVANTAGES

47. MINILAP OPERATION
•Much simpler procedure requiring a smaller
abdominal incision of only 2.5 to 3 cm conducted
under localaneaesthesia.
•Minilap is used for tubal ligtion through the cutting
of the tubes or to application of the band orclip.

49. PUERPERALSTERILIZATION
Currently puerperal sterilization is becoming more
popular, an account for 85-90% and male
sterilization for 10-15% only in india. sterlization
services are provided free of charge in
governmentinstitution.

50. TUBECTOMY
•An operation in which
small piece of a tubeon
each side is removed.
The passage of the
sperm into the tube is
blocked, so that sperm
and ovum can not be
meet.

51. VAGINALTUBALLIGATION
Tubal ligation through vaginal route is also done.
This approach to the tube is through posterior
colpotomy.
It can be done in the interval period or following
delivery or abortion, provided the uterus is smaller
than 12 weekssize.

52. VAGINALTUBALLIGATION

53. COMPLICATION RELATED
TO STERILIZATION
General complication
•Loss ofweight
•Occasionalobesity
•Psychological upset.
•Gynaecologicalcomplication
•Chronic pelvicpain
•Congestive dysmenorrheal and.menstrual
abnormality such as menorrhagia,
hypomenorrhagia or irregular periods and
alteration inlibido.

54. Incentives of terminalmethods
The acceptor now receive a one time payment of
Rs 800 for vasectomy and 145 for laproscopic
tubectomy and Rs. 20 are given to IUDreceptor.
Motivator also received a small amount (Rs 10 for
tubectomy and Rs 40 forvasectomy).
State govt employees, who undergo sterilization
after two or three children are eligible for a special
increments after 2 children and one after 3 children).
Central Govt employees get one increment after
sterilization.

55. They get special leave (14 days for woman and 7
days for men). No maternity leave is allowed after 3
children.
In the event of death following sterilization,
recanalisation, or IUDinsertion,ex-gratiapayment
of Rs. 20,000 hasbeenauthorizedto be paid to the
surviving spouse, natural heir,etc.
The state Govt has been requested to: issue
Green cards to individual acceptors of terminal
methods after two children as a mark of recognition
and for priority attention in scheme where
preferential treatment wasfeasible.

56. Administrative role-
Supervisoryrole.
Functionalrole
Educationalrole-
Role inresearch
Roleinevaluation-
ROLE OF NURSE IN FAMILYPLANNING