iud barrier 2 (2)
TRANSCRIPT
FAMILY PLANNING
‘a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and responsible decision by individual and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country.’-----WHO 1971
FAMILY PLANNINGOBJECTIVES::To avoid unwanted birth
To bring about wanted birth
To regulate the interval between pregnancy
To control the time at which the birth occur in relation to the ages of the parents
To determine the number of children in the family
ELIGIBLE COUPLE:CURRENTLY MARRIED COUPLE WHEREIN THE WIFE IN THE REPRODUCTIVE AGE(15-45)
TARGET COUPLE::COUPLES WHO HAVE HAD 2-3 LIVING CHILDREN. FP WAS LARGELY DIRECTED TO SUCH COUPLLES.
TWO CHILD FAMILY NORMNRR=1COUPLE PROTECTION RATE=60%
Physician obligations are:
First do no harm.
(primum non nocere, Hippocrates )400 B.C
Assessing the balance between risk and benefit
Temporary methodsTemporary methodsPermanent methodsPermanent methods
1.Natural Methods Periodic abstinence
Withdrawal Lactational Amenorrhea Method
2.Barrier methods3.Hormonal contraception
4.Intra uterine contraceptive devices
5.Emergency (Post coital ) contraception
Temporary methodsTemporary methods
Pearl index
• Method used for determination of pregnancy failure rate:
Pregnancy rate = no. of pregnancies x100women/12 months of use
BARRIER METHODS
• Condom male
female
• Diaphragm
• Sponge
• Spermicides
PHYSICAL METHOD
CHEMICAL METHOD
CondomsCondoms
BenefitsBenefits
No medical side-effects
Inexpensive, easily accessed
Protecting against STDs ( Latex )HPV that can cause genital warts HSV that can cause genital herpes
Hepatitis-B virus
Lower risk for cervical dysplasia and cancer
CondomsCondoms
Disadvantages
Can interrupt sexual activity
May sometimes tear or leak
Failure rate 2-3----14 HWY
Can cause an allergic reaction
INTRAUTERINE DEVICES (IUD)
1) Non medicated(inert) or first generation IUD:: lippes loop
Large size Good anti-fertility effect but higher removal rate due to pain and bleeding.
2) Copper IUD::( Second generation IUD) T Cu 380 A(2002 NFPP) no. SA(sq.mm) of Nova T, T Cu 380 Ag Cu on the device. ML-Cu-250, ML-Cu-375 Low side effect---low expulsion rate---great
efficacy—better tolerated by nullipara-----------but still bleeding be the commonest S/E.
INTRAUTERINE DEVICES (IUD)
3) Hormone releasing IUD::
Progestasert 38 mg of progesteronerelease @ 65mcg daily.
LNG-20 (MIRENA) release @ 20 mcg of levonorgestrel daily.
Low side effect---low expulsion rate---great efficacy—better tolerated by nullipara-----------and bleeding much less occurred than copper devices.
Mechanism of Action
Foreign body reaction altering cellular and biochemical changes in the endometrium impair the viability of gamete.
Cervical mucus is changed to obstruct passage of sperm through the cervix.
Prevent chances of fertilization rather than implantation
endometrial thinning which inhibits implantation of embryos
Inhibition of ovulation.(Probably)
T-CU 380 A PROGESTASERT MIRENA
FAILURE RATE 0.5-0.8 1.3-1.6 0.2
CHANGE AFTER (YRS)
10 1 7
Timing of insertion::::
During menstruation or within 10 days of beginning of menstrual period.
Immediate postpartum insertion1st wk after delivery chances of perforation
Post puerperal insertion6-8 wks after delivery.
ADVANTAGES
Long-term contraceptionVirtually free of systemic S/EWomen with contraindications to COC Emergency contraceptive.
DISADVANTAGES
BLEEDING
PELVIC INFECTION
UTERINE PERFORATION
ECTOPIC PREGNANCY
EXPULSION
Absolute Contraindications-Pregnancy. Post partum puerperal sepsis Immediately post-septic abortion
-Undiagnosed abnormal vaginal bleeding.
-Suspected gynecological malignancy.
(Cervical cancer, Endometrial cancer)
-Current STDs.
-Current PID.
Relative Contraindications
-Anaemia
-Menorrhagia
-H/O PID in last pregnancy
-Purulent cervical discharge
-Anatomical abnormalities
The ideal IUD candidateWHO HAS AT LEAST ONE CHILD
HAS NO H/O PELVIC DISEASE
HAS NORMAL MENSTRUAL PERIOD
IS WILLLING TO CHECK IUD TAIL
HAS ACCESS TO FOLLOW UP AND TREATMENT
IS IN A MONOGAMOUS RELATIONSHIP
THANK U