PERMANENT CONTRACEPTION (2).pptx

SLIDE SHOW ABOUT PERMANENT CONTRACEPTION IN MALE AS VASECTOMY AND IN FEMALES TUBECTOMY

1. Vasectomy for men Tubal ligation in women Permanent contraception

2. Introduction to Permanent Family Planning Surgical procedure to permanently and intentionally terminate male and female reproductive function Appropriate for men and women who made a fully informed and well considered decision Most are not reversible Vasectomy for men Tubal ligation in women Permanent Family Planning

3. Vasectomy For men who do not want more children Transection and occlusion of the vas deferens Also called male sterilization, male surgical contraception No interference with sexual performance Outpatient procedure by local anesthesia

4. Facts about vasectomy It is simple, safe and effective method of permanent contraception. Can be done on OPD basis under local anesthesia. No effect on sexual activity, semen volume and general physical health. Sterility doesn't occur immediately. It requires approx 20 ejaculation to completely evacuate vas, which takes 3month. Absence of sperm should be confirmed by microscopic examination(HSA). Reversal is possible but sperm recovery rate after procedure declines with time particularly after 7 years.

5. Procedure should be delayed if… Patient has scrotal skin infection Active STDs Epididymitis or orchitis Filariasis Intrascrotal mass Coagulation disorders Psychosexual disorder

6. Techniques of Vasectomy Scalpel (conventional) and Non-scalpel Palpate the vas through the scrotum Grasp the vas with fingers or forceps Pull loop of vas and remove segment Ligate both ends of the vas Bury the proximal stump Skin stitch and dressing

7. Vasectomy (cont’d)

8. Post surgery care Painkiller SOS Antibiotics not required. Dry dressing only, avoid bath for 24 hours. Avoid cycling and moderate exercise for 1 weeks. Scrotal support for initial few days. Take contraceptive measures for next 3 months or confirm sperm free ejaculate by 2 separate microscopic examinations.

9. Benefits of Vasectomy Failure is less than 1% Reason for failure can be: Unprotected intercourse soon Failure to occlude the vas Recanalization Safer and more effective than tubal ligation 0.5 deaths per 100,000 vasectomies

10. Complications of Vasectomy Side effects are uncommon to very rare Testicular and scrotal pain lasting for months Surgical site infection Hematoma Sperm granuloma

11. Female sterilization

12. For women who do not want more children. Also called tubal sterilization, tubal ligation or tubectomy . Most widely used procedure globally.

13. counselling About permanent procedure. Its failure rate. Alternative methods of long term contraception. complications

14. Different types According to time  post partum Interval Postabortal According to approach Abdominal conventional 3-4 cm Minilaparotomy2.5 to 3cm laparoscopic Vaginal hysteroscopic

15. Procedure 1. Before operations: confirm patient's last menstrual period, exclude pregnancy and take necessary consents 2. Ensure empty urinary bladder 3 . After proper gowning and scrubbing, the operative area is cleaned and draped. 4. Determine the incision site and size - 2 fingers from the symphysis pubis superiorly. 5. Make the skin incision about 3 to 4 cm long. 6. Open the abdomen in layers until the rectus sheath. 7. Open the rectus sheath using the scissors and push the muscle laterally. 8. Proceed to open the peritoneal cavity with two artery forcep and the maximburm scissors. 9. By using 2 fingers - identify the uterine body and move laterally to identify the fallopian tube. 10. Grasps the tube using the babcock . The tube can be determined by identifying the fimbriae end of the tube. 11. Lift the tube gently and clamp the area for incision using the artery forceps. 12. Make a knot on one side and subsequently on the opposite site. Be sure to relief the artery forceps temporally when making the knot. 13. Any absorbable suture size 2/0 can be used - eg . Vicryl or catgut 14. The tube can then be excised using the scissors. 15. The stump is then inspected for any residual bleeding. 16. The same procedure is employed for the contralateral tube. 18 . Finally close the abdomen and skin

16. Occlusion methods Partial salpingectomy Tubal clip Tubal rings/ fallopes rings Fimbriectomy Electrocoagulation or cautrization

17. Pomeroy Method

18. kroner method

19. Minilaparotomy for Tubal Ligation Ligation of the fallopian tubes through 3-4cm incision on the abdomen, can be done: A s an outpatient procedure B y local anesthesia and sedation Minilaparotomy following vaginal delivery: E nlarged uterus, tubes in the mid abdomen, 3-4 cm sub umbilical incision Interval minilaparotomy: Short transverse suprapubic incision Uterine elevator used through the vagina

20. Laparoscopic sterilization Simple and effective procedure. Can be done single port or two port technique, under local anesthesia. Position modified lithotomy. LA infiltrated. Pneumoperitoneum is created. Small stab incision given, trocar inserted followed by loaded laprocater . Fallope rings or filshie clips are applied bilaterally

21. Indications to Delaying lap Tubal Ligation Current pregnancy Less than 6 weeks postpartum Severe postpartum or post abortion complications Unexplained vaginal bleeding Pelvic inflammatory disease and STIs Pelvic malignancies

22. Benefits of Female Sterilization No known side effect Helps to protect against unwanted pregnancy Nothing to remember and no worries about contraceptives again Prevents against pelvic inflammatory disease (PID) May protect against ovarian tumor

23. Risks of Female Sterilization Few complications Related with surgery, anesthesia, previous surgery, PID, Obesity, and DM 1-2 deaths /100,000 cases 2 pregnancies per 100 women over 10 years Possibility of future regret Young age Lost a child Few or no children Not married/ Marital problems

24. Newer methods ESSURE

25. Immunocontraceptions /FRV Fertility regulating vaccines/FRVs Anti HCG vaccine Anti zona vaccine Anti sperm vaccine

26. Summary Permanent methods are irreversible Non-scalpel vasectomy in men and minilaparatomy for women are preferred Permanent methods are less popular in Ethiopia Detailed counseling is essential Rare complications - not related to method