Family Planning上海交通大学医学院精品妇科.ppt

单击此处编辑母版标题样式 Family Planning DI WEN M.D., Ph.D. Professor & Chairman Department Of Obstetrics & Gynecology Renji Hospital Affiliated to SJTU School of Medicine Birth Control, Pregnancy, and Childbirth: Managing Your Fertility Hormonal methods Oral contraceptives Pills Depo-Provera Ortho-Evra Nuva ring Lunelle and Norplant (currently off the market) Methods of Fertility Management Surgical methods of sterilization Female Tubal ligation Male Vasectomy Methods of Fertility Management Other methods of contraception IUDs Progestasert ParaGuard Withdrawal Emergency contraceptive pills Emergency minipills Abstinence and “Outercourse” Methods of Fertility Management Effectiveness Compliance and desire to avoid pregnancy Frequency of intercourse Patients age Cost of method Side effects Patients perceptions and misperceptions Patients concomitant drug use Patients health status and habits Contraceptive Variables Prevents ovulation. FSH secretion is depressed LH peak is abolished. Urinary androgen excretion is much increased. Changes in cervical mucus make sperm penetration less likely. Oral Contraception Formulations Monophasics Biphasics Triphasics Mechanism of action Suppress ovulation Alter cervical mucus and endometrium OC Formulations & Mechanism of Action No significant increased risk among current or former users Small increased risk of breast cancer diagnosis Link to earlier diagnosis of breast cancer OC Health Risks-breast Cancer Numerous studies have linked OC use and cervical neoplasia Findings are difficult to interpret OC Health Risks-cervical Cancer Nonfatal venous thromboembolism Similar low risk of VTE associated with all low- dose OCs Myocardial infarction No increase in risk Further studies may prove OCs protective Stroke No increase in risk OC Health Risks Reduced risk of ovarian and endometrial cancer Menstrual benefits Improvement in benign breast conditions and ovarian cysts Improvement in acne Reduced incidence and severity of PID Protection against ectopic pregnancy Maintenance of bone density OC Noncontraceptive Benefits Thrombophlebitis or thromboembolic disorders Past history of DVT or thromboembolic disorders Cerebral vascular disease or coronary artery disease Known or suspected carcinoma of the breast Carcinoma of the endometrium Undiagnosed abnormal genital bleeding Jaundice Hepatic adenomas or carcinomas Known or suspected pregnancy Smoker over age 35 OC Contraindications Nausea Breast tenderness Menstrual changes Weight gain Headache OC Side Effects Formulation: Contains norethindrone or nogestrel 28 days of active hormones Candidates: Women who cannot or will not take estrogen Postpartum and lactating women Progestin-Only Pills Currently available: Injectable DMPA (Depo- Provera) Copper IUD (Paragard) Progestin IUD (Mirena) Long-Acting Contraceptives DMPA Injections Menstrual changes Delayed return of fertility Alopecia Reduced libido Weight gain? Depression? DMPA Side Effects Loss of bone mineral density? Lowered HDL level Protection against endometrial cancer, no impact on risk of other types of cancer Reduces PMS symptoms, iron- deficiency anemia, risks of PID, ectopic pregnancy DMPA Health Risks & Benefits Levonorgestrel Implants Side effects & risks Irregular bleeding Amenorrhea Headache Hair loss Weight gain Functional ovarian cysts Benefits Improvement of dysmenorrhea Improvement of PMS Implant Side Effects, Health Risks & Benefits Inert Copper bearing Progestogen releasing Intra Uterine Devices IUDs Risks: Perforation of the uterus (rare) Infection (antibiotic prophylaxis not needed) Expulsion rates: Copper T (Paragard) = 6% Progesterone-releasing IUDs = 38% IUD Insertion Risks Copper T: increased menstrual bleeding and dysmenorrhea Mirena: irregular bleeding and spotting before eventual amenorrhea IUD Insertion Side Effects Multiple sexual partners Pregnancy Abnormalities of the uterus PID Postpartum endometritis or septic abortion Uterine or cervical malignancy Undiagnosed genital bleeding Vaginitis or cervicitis Increased susceptibility to infection Previously inserted IUD still in place IUD: Major Contraindications Increased menstrual loss. Infection Pregnancy Expulsion Translocation Complications of IUDS Condoms Male latex, polyurethane, animal skin Female polyurethane Diaphragms Cervical cap Spermicides Barrier Contraceptives Male Condoms How to Use a Condom Figure 6.1 The Female Condom Brand Name: Reality The Diaphragm The Cervical Cap Spermicides Creams Films Foams Jellies Pessaries Sponges (All of these are mainly Nonoxynol based.) Spermicides Also called periodic abstinence or fertility awareness Calendar (“rhythm”) method Cervical mucus (ovulation or billings) method Basal body temperature method Symptothermal method Natural Family Planning 24 hours are allowed for ovum survival 3 days are allowed fro the sperms Coitus must be avoided from the 9th to the 15th day Rhythm Method(“safe Period”) Figure 6.4 The Fertility Cycle Billings Method Identify the peri-ovulatory phase by noting the vaginal sensations associated with changes in cervical mucus. High doses of combined OCs High doses of progestin-only pills Emergency contraceptive pills prevent pregnancy by inhibiting or delaying ovulation. They may also alter the endometrium, making it inhospitable to the implantation of ova. They may alter sperm or ovum transport. IUD The mechanism of action of the IUD as emergency contraception remains undefined. Emergency Contraception NEW METHODS: OrthoEvra “The Patch” Surgical Methods 1.Laparoscopic sterilisation Rings,Clips-Bipolar diathermy,Laser 2.Tubal ligation Artificial Abortion Definition: An abortion that is brought about intentionally(family planning et al.), Also called an induced or therapeutic abortion The termination of a pregnancy befor the 24th week. Abortion of Methods Vacuum aspiration 1st trimest Dilation and Evacuation (D&E) 2nd trimester Dilation and Curettage (D&C) 2nd trimester4) Figure 6.7 Amniocentesis Abortion of Methods Prostaglandin or induction abortions 2nd trimester Hysterotomy removal of the fetus surgically Intact dilation and extraction (D&X) late term abortion Mifepristone (RU-486) induces abortion by blocking progesterone used with Misoprost