妇产科学课件：Family planning

1、Family planning,Summary,Family planning enables sexually active couples to prepare for their pregnancies, in order to optimize both fetal and maternal outcomes. Fertility control? Avoid unwilling pregnancy Unplanned pregnancies constitute major public health problems.,排 卵,受 精,着 床,卵泡发育,Contraception,

2、 Abortion,Chapter 1 Contraception,Methods of contraception,Intrauterine device, IUD Hormonal contraception Other contraceptive methods,IUD,Convenience, cost effectiveness and reversibility For women who are in stable, mutually monogamous relationships at low risk for sexually transmitted infections

3、(STIs) Most commonly used in China80%,History of IUD,Used in animals at first 1909, the first human IUD, designed by a German doctor named Richard Richter, was made of silk Aseptic techniquemodern IUD,Ancient IUDs,Categories of modern IUDs,IUDs wound with copper wire Different shapes Different surfa

4、ce areas of copper The levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena) Release levonorgestrel 20ug/d Suitable for women with heavy menses or dysmenorrheal,Modern IUDs,TCu-380,TCu375 母体乐,Mechanisms of contraception,Mechanisms of contraceptive action of IUDs,Kill the sperm or fertilized

5、 ovum by Mobilization of leukocytes in response to the presence of the foreign body Leukocytes may produce an environment hostile to the fertilized ovum Spermicidal activity with copper devices Prevent implantation by Disruption of endometrial maturation with the progesterone-releasing device Altera

6、tion of normal tubal action Disruption of normal oocyte maturation,Indications to the use of IUDs,Women of childbearing age with no contraindication who accept IUD Uterine cavities sound to 6cm-9cm Parous women in a mutually monogamous relationship who do not have a current or prior history of STDs

7、or salpingitis Women desiring a method of high efficacy that is free of daily or coitally related activity,Current pregnancy Acute cervical, uterine, or salpingeal infection Suspected gynecologic malignancy Polymenorrhea(月经频发), hypermenorrhea(月经过多), or undiagnosed abnormal vaginal bleeding Severe ce

8、rvical relaxation, laceration or stenosis, or severe uterine prolapse Congenital anomalies of the genital organs Uterine cavities sound to 9cm,Contraindications of IUDs,Contraindications of IUDs,Severe acute or chronic general diseases History of STDs Pelvic tuberculosis High risk of infection or bl

9、eeding after induced abortion or delivery Copper allergic history Prior ectopic pregnancy Multiple sexual partners,Time of IUD insertion,3-7 days after menstrual bleeding stops, without sexual intercourse 42 days after vaginal delivery when perineal wound heal well and the uterus involute to normal

10、size 6 months after c-section Mirena should be inserted on the third day of menstrual bleeding,Insertion of the round IUD,Insertion of the uterine-shaped IUD,Insertion of the LNG-IUD,Follow-up of IUD by ultrasound,Follow up the IUD 3 months, 6 months, 12 months after insertion and every year afterwa

11、rds,Indications to the IUD removal,Expiryoftheavailability of an IUD Menopause for 6 months or menstrual disorder during perimenopausal period No more need for contraception Asking for other contraceptive methods or sterilization Severe side effects or complications Pregnancy,Acute genital or pelvic

12、 infection Poor systemic conditions or acute stage of general diseases Time of IUD removal: 3-7 days after menstrual bleeding stops Any time when there is severe vaginal bleeding,Contraindications to the IUD removal,IUD removal,Side effects of IUDs,Menstrual disorders or abnormal vaginal bleeding Lo

13、wer abdominal or lumbosacral pain Increasedvaginalsecretions,Complications of IUDs,Pregnancy Expulsion Pelvic infection,Hormonal contraception,Invented by an American doctor named Gregory Goodwin Pincus in 1954 Categories: Oral hormonal contraceptives (OCs) Hormonal contraception by injection, impla

14、ntation or transdermal routes,Mechanisms of contraceptive action,Suppression of the LH surge prevent ovulation Thickening of the cervical mucus prevent sperm penetration Alter motility of the muscle of the uterus and oviducts Slowing of tubal transport Atrophy of the endometrium prevent implantation

15、,Severe cardiovascular diseases Acute or chronic hepatitis or nephritis Thrombotic diseases Endocrine disorders Malignant tumor, precancerous lesion, mass of uterus or breast Lactation period Oligomenorrhoea (月经稀少) or age 45 Undiagnosed abnormal vaginal bleeding Mental disorders,Contraindications of

16、 OCs,Usage of OCs,Synthetic steroids similar to the estrogen and progestin Commonly used drugs: Marvelon (妈富隆)=炔雌醇30g+去氧孕烯0.15mg Yasmin (优思明)=炔雌醇30g+屈螺酮3.0mg Diane-35 (达英-35)=炔雌醇35g+醋酸环丙孕酮2mg Combined regimen (21 tablets) is begun with the onset of the menstrual cycle stop for 1 week and then start

17、the next cycle,Advantages of OCs,Ovarian and endometrial cancer Menorrhagia(月经过多) and dysmenorrhea(痛经) PID, endometriosis, benign breast changes, and ectopic pregnancy Iron-deficiency anemia and acne Improvements in hirsutism(多毛症) and symptomatic endometriosis,Disadvantages of OCs,The risk of thromb

18、oembolic disease Pulmonary embolism Cerebral thrombosis Greater risk of developing coronary thrombosis confined to older users who smoke one or more packs of cigarettes per day,Disadvantages of OCs,Breast cancer? No risk or unclear Cervical intraepithelial neoplasia slightly higher risk Other infreq

19、uent problems Hypertension Cholelithiasis(胆石症) Benign liver tumors,Side effects of OCs,Breakthrough spotting and bleeding resolve after 1 to 3 months of use Missed menstrual periods or amenorrhea Nausea Headaches Weight gain,Other contraceptive methods,Male condom Female condom Natural family planni

20、ng, NFP Vaginal spermicides Postcoital or emergency contraception,Chapter 2 Sterilization,Female Sterilization,Achieve sterilization by occluding the uterine tubes A permanent method of contraception Requiring an intraperitoneal(腹膜内的) incision and general anesthesia Ligation of the oviducts is usual

21、ly performed through a colpotomy incision through an abdominal incision by laparoscopy,Chapter 3 Induced abortion,Definitions,Abortion is the interruption (spontaneous or induced) of an established pregnancy before 20 weeks gestational age Miscarriage is used by the lay public to describe the sponta

22、neous loss “Elective” or “therapeutic” abortion are terms used to describe induced pregnancy termination.,Induced abortion,Definition: deliberate termination of pregnancy in a manner that ensures that the embryo or fetus will not survive Methods (for the first trimester): Suction curettage Dilatatio

23、n and evacuation Medical abortion,Suction curettage,Safest and most effective method to terminate pregnancies of 10 weeks duration or less Advantages: Empties the uterus more rapidly, minimizes blood loss Reduces the likelihood of perforation of the uterus,Suction method for induced abortion,Complic

24、ations,Infection 1% Excessive bleeding 2% Uterine perforation 1% Syncopal reactions Retained tissue Leakagesuck Major complicaitons 0.2%0.6% persistent fever hemorrhage requiring transfusion unintended major surgery,Uterine perforation,Dilatation and evacuation,For inducing midtrimester abortion (pr

25、egnancies of 10-14 weeks duration) A modification of suction curettage Serial placement of cervical dilatation sticks is used to effectly dilatate cervical canal with less likelihood of injury Larger suction cannulas and specially designed forceps are used to extract tissue,Complications,Hemorrhage

26、(usually due to atony or laceration) Perforation Infection Retained tissue Amniotic fluid embolism,Late complications,Uterine cavity or cervical adhesion Chronic pelvic inflammatory disease Menstrual disorders Secondary infertility,Mifepristone,Effects first-trimester abortion 49 days A synthetic dr

27、ug developed by French pharmacologists, which acts at least partially as an antiprogestational agent. Given orally in conjunction with a prostaglandin such as misoprostol,Complications,Failure to terminate a pregnancy Incomplete abortion Significant uterine cramping,Follow-up of patients after induced abortion,Take temperature several times daily and report fever or unusual ble