妇产科学课件：Family planning

1、Family planningSummaryFamily planning enables sexually active couples to prepare for their pregnancies, in order to optimize both fetal and maternal outcomes.Fertility control? Avoid unwilling pregnancyUnplanned pregnancies constitute major public health problems.Three categories of family planning排

2、 卵受 精着 床卵泡发育InterceptionContraceptionAbortionChapter 1 ContraceptionMethods of contraceptionIntrauterine device, IUDHormonal contraceptionOther contraceptive methodsIUDConvenience, cost effectiveness and reversibilityFor women who are in stable, mutually monogamous relationships at low risk for sexu

3、ally transmitted infections (STIs)Most commonly used in China80%History of IUDUsed in animals at first1909, the first human IUD, designed by a German doctor named Richard Richter, was made of silkAseptic techniquemodern IUDAncient IUDsCategories of modern IUDsIUDs wound with copper wireDifferent sha

4、pesDifferent surface areas of copperThe levonorgestrel-releasing intrauterine system (LNG-IUS, Mirena)Release levonorgestrel 20ug/dSuitable for women with heavy menses or dysmenorrhealModern IUDsTCu-380TCu375 母体乐Mechanisms of contraceptionMechanisms of contraceptive action of IUDsKill the sperm or f

5、ertilized ovum byMobilization of leukocytes in response to the presence of the foreign bodyLeukocytes may produce an environment hostile to the fertilized ovumSpermicidal activity with copper devicesPrevent implantation byDisruption of endometrial maturation with the progesterone-releasing deviceAlt

6、eration of normal tubal actionDisruption of normal oocyte maturationIndications to the use of IUDsWomen of childbearing age with no contraindication who accept IUDUterine cavities sound to 6cm-9cmParous women in a mutually monogamous relationship who do not have a current or prior history of STDs or

7、 salpingitisWomen desiring a method of high efficacy that is free of daily or coitally related activityCurrent pregnancyAcute cervical, uterine, or salpingeal infectionSuspected gynecologic malignancyPolymenorrhea(月经频发), hypermenorrhea(月经过多), or undiagnosed abnormal vaginal bleedingSevere cervical r

8、elaxation, laceration or stenosis, or severe uterine prolapseCongenital anomalies of the genital organsUterine cavities sound to 9cmContraindications of IUDsContraindications of IUDsSevere acute or chronic general diseasesHistory of STDsPelvic tuberculosisHigh risk of infection or bleeding after ind

9、uced abortion or deliveryCopper allergic history Prior ectopic pregnancyMultiple sexual partnersTime of IUD insertion3-7 days after menstrual bleeding stops, without sexual intercourse 42 days after vaginal delivery when perineal wound heal well and the uterus involute to normal size6 months after c

10、-sectionMirena should be inserted on the third day of menstrual bleedingInsertion of the round IUDInsertion of the uterine-shaped IUDInsertion of the LNG-IUDComplications of IUD insertionModerate discomfort or pain when the uterus is sounded or when the IUD is insertedBleedingInfectionPartial or com

11、plete perforation of the uterusSyncopal reactionsUterine crampsFollow-up of IUD by ultrasoundFollow up the IUD 3 months, 6 months, 12 months after insertion and every year afterwardsIndications to the IUD removalExpiryoftheavailability of an IUDMenopause for 6 months or menstrual disorder during per

12、imenopausal periodNo more need for contraceptionAsking for other contraceptive methods or sterilizationSevere side effects or complicationsPregnancyAcute genital or pelvic infectionPoor systemic conditions or acute stage of general diseasesTime of IUD removal:3-7 days after menstrual bleeding stops

13、Any time when there is severe vaginal bleedingContraindications to the IUD removalIUD removalSide effects of IUDsMenstrual disorders or abnormal vaginal bleedingLower abdominal or lumbosacral painIncreasedvaginalsecretionsComplications of IUDsPregnancyExpulsionPelvic infectionHealth benefits of IUDs

14、The LNG-IUS results in a 70% to 90% reduction in menstrual blood lossThe LNG-IUS can release dysmenorrhealHormonal contraceptionInvented by an American doctor named Gregory Goodwin Pincus in 1954Categories:Oral hormonal contraceptives (OCs)Hormonal contraception by injection, implantation or transde

15、rmal routesMechanisms of contraceptive actionSuppression of the LH surge prevent ovulation Thickening of the cervical mucus prevent sperm penetrationAlter motility of the muscle of the uterus and oviducts Slowing of tubal transportAtrophy of the endometrium prevent implantationSevere cardiovascular

16、diseasesAcute or chronic hepatitis or nephritisThrombotic diseasesEndocrine disordersMalignant tumor, precancerous lesion, mass of uterus or breastLactation periodOligomenorrhoea (月经稀少) or age 45Undiagnosed abnormal vaginal bleedingMental disordersContraindications of OCsUsage of OCsSynthetic steroi

17、ds similar to the estrogen and progestinCommonly used drugs:Marvelon (妈富隆)=炔雌醇30g+去氧孕烯0.15mgYasmin (优思明)=炔雌醇30g+屈螺酮3.0mgDiane-35 (达英-35)=炔雌醇35g+醋酸环丙孕酮2mgCombined regimen (21 tablets) is begunwith the onset of the menstrual cyclestop for 1 week and then start the next cycleAdvantages of OCsOvarian an

18、d 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 endometriosisDisadvantages of OCsThe risk of thromboembolic diseasePulmonary embolismCerebral th

19、rombosisGreater risk of developing coronary thrombosisconfined to older users who smoke one or more packs of cigarettes per dayDisadvantages of OCsBreast cancer? No risk or unclear Cervical intraepithelial neoplasia slightly higher riskOther infrequent problemsHypertensionCholelithiasis(胆石症)Benign l

20、iver tumorsSide effects of OCsBreakthrough spotting and bleeding resolve after 1 to 3 months of useMissed menstrual periods or amenorrheaNauseaHeadachesWeight gainOther contraceptive methodsMale condomFemale condomNatural family planning, NFPVaginal spermicidesMale condomDefinition:The latex rubber

21、or animal intestine condom serves as a cover for the penis during coitus and prevents the deposition of semen in the vagina.Male condomFailure rates: 2%-15% in the first year of useUsed in conjunction with contraceptive vaginal jelly or foam can reduce the chances for condom failure due to mechanica

22、l or technical deficienciesAdvantages of condomProvides highly effective and inexpensive contraceptionProvides protection against sexually transmitted diseases (STDs)Some condoms contain a spermicide, which may offer further protection against failureFemale condom(vaginal pouch)阴道隔膜宫颈帽Natural family

23、 planning methodWomen are fertile for only a few days of the menstrual cycleThe fertile period is from the time of ovulation to 2-3 days thereafterCouples avoid intercourse during the at-risk days, or use another method (usually condom) during the womans fertile days.Natural family planning methodA

24、variety of methods are used to calculate a womans fertile days each cycle.Calendar methodBasal body temperatureCervical mucus changesFertility monitors月经的周期型变化卵巢周期子宫内膜阴道涂片宫颈粘液结晶基础体温月经周期17142128 天4 6 8 10 12 14 16 18 20 22 24 26 28 天基 础 体 温（双相型）阴道鳞状上皮组织学与细胞学对照模式图内底层外底层中层（小）中层（大）表层表层浅棘层深棘层生发层宫颈粘液的周期性变

25、化羊齿状结晶椭圆体Natural family planning methodNot reliable and safe enoughNot recommended!Postcoital or emergency contraceptionTwo hormonal products are available for EC:High-dose levonorgestrelHighdose combined estrogen/progestin pillsStarting as soon as possible after exposureRecommended to be started wi

26、thin the first 72 hoursMorning after IUD (Copper) insertion within 120 hours Chapter 2 SterilizationFemale SterilizationAchieve sterilization by occluding the uterine tubesA permanent method of contraceptionRequiring an intraperitoneal(腹膜内的) incision and general anesthesiaLigation of the oviducts is

27、 usually performedthrough a colpotomy incisionthrough an abdominal incisionby laparoscopyComplications of female sterilizationIntraperitoneal hematocele or hematomaInfectionInjury of ureter, bladder or rectumPostbilateral tubal ligation syndrome:PainMenstrual disturbances (prospective controlled stu

28、dies show no statistical significant difference)Failure of sterilizationEctopic pregnancyTechniqueUchida method of sterilizationPomeroy type of tubal ligationChoose the technique most comfortable for the physicianChapter 3 Induced abortionDefinitionsAbortion is the interruption (spontaneous or induc

29、ed) of an established pregnancy before 20 weeks gestational ageMiscarriage is used by the lay public to describe the spontaneous loss“Elective” or “therapeutic” abortion are terms used to describe induced pregnancy termination.Induced abortionDefinition:deliberate termination of pregnancy in a manne

30、r that ensures that the embryo or fetus will not surviveMethods (for the first trimester):Suction curettageDilatation and evacuationMedical abortionSuction curettageSafest and most effective method to terminate pregnancies of 10 weeks duration or lessAdvantages:Empties the uterus more rapidly, minim

31、izes blood lossReduces the likelihood of perforation of the uterusSuction method for induced abortionComplicationsInfection 1%Excessive bleeding 2%Uterine perforation 1%Syncopal reactionsRetained tissueLeakagesuckMajor complicaitons 0.2%0.6%persistent feverhemorrhage requiring transfusionunintended

32、major surgeryUterine perforationDilatation and evacuationFor inducing midtrimester abortion (pregnancies of 10-14 weeks duration)A modification of suction curettageSerial placement of cervical dilatation sticks is used to effectly dilatate cervical canal with less likelihood of injuryLarger suction

33、cannulas and specially designed forceps are used to extract tissueComplicationsHemorrhage (usually due to atony or laceration)Perforation Infection Retained tissueAmniotic fluid embolismLate complicationsUterine cavity or cervical adhesionChronic pelvic inflammatory diseaseMenstrual disordersSecondary infertilityMifepristoneEffects first-trimester abortion 49 daysA synthetic drug developed by French pharmacologists, which acts at least partially as an antiprogestational agent.Given orally in conjunction with a prostagland