Family Planning上海交通大学医学院妇科课件

FamilyPlanning

DIWEN

M.D.,Ph.D.Professor&ChairmanDepartmentOfObstetrics&GynecologyRenjiHospitalAffiliatedtoSJTUSchoolofMedicineBirthControl,Pregnancy,

andChildbirth:

ManagingYourFertility

HormonalmethodsOralcontraceptivesPillsDepo-ProveraOrtho-EvraNuvaringLunelleandNorplant(currentlyoffthemarket)MethodsofFertilityManagement

SurgicalmethodsofsterilizationFemaleTuballigationMaleVasectomy

MethodsofFertilityManagementOthermethodsofcontraceptionIUDsProgestasertParaGuardWithdrawalEmergencycontraceptivepillsEmergencyminipillsAbstinenceand“Outercourse〞

MethodsofFertilityManagementEffectivenessComplianceanddesiretoavoidpregnancyFrequencyofintercoursePatient’sageCostofmethodSideeffectsPatient’sperceptionsandmisperceptionsPatient’sconcomitantdrugusePatient’shealthstatusandhabitsContraceptiveVariablesPreventsovulation.FSHsecretionisdepressedLHpeakisabolished.Urinaryandrogenexcretionismuchincreased.Changesincervicalmucusmakespermpenetrationlesslikely.OralContraceptionFormulationsMonophasicsBiphasicsTriphasicsMechanismofactionSuppressovulationAltercervicalmucusandendometrium

OCFormulations&MechanismofActionNosignificantincreasedriskamongcurrentorformerusersSmallincreasedriskofbreastcancerdiagnosisLinktoearlierdiagnosisofbreastcancer

OCHealthRisks-breastCancerNumerousstudieshavelinkedOCuseandcervicalneoplasiaFindingsaredifficulttointerpret

OCHealthRisks-cervicalCancerNonfatalvenousthromboembolismSimilarlowriskofVTEassociatedwithalllow-doseOCsMyocardialinfarctionNoincreaseinriskFurtherstudiesmayproveOCsprotectiveStrokeNoincreaseinrisk

OCHealthRisksReducedriskofovarianandendometrialcancerMenstrualbenefitsImprovementinbenignbreastconditionsandovariancystsImprovementinacneReducedincidenceandseverityofPIDProtectionagainstectopicpregnancyMaintenanceofbonedensity

OCNoncontraceptiveBenefitsThrombophlebitisorthromboembolicdisordersPasthistoryofDVTorthromboembolicdisordersCerebralvasculardiseaseorcoronaryarterydiseaseKnownorsuspectedcarcinomaofthebreastCarcinomaoftheendometriumUndiagnosedabnormalgenitalbleedingJaundiceHepaticadenomasorcarcinomasKnownorsuspectedpregnancySmokeroverage35

OCContraindicationsNauseaBreasttendernessMenstrualchangesWeightgainHeadache

OCSideEffectsFormulation:Containsnorethindroneornogestrel28daysofactivehormonesCandidates:WomenwhocannotorwillnottakeestrogenPostpartumandlactatingwomenProgestin-OnlyPillsCurrentlyavailable:InjectableDMPA(Depo-Provera)CopperIUD(Paragard)ProgestinIUD(Mirena)

Long-ActingContraceptives

DMPAInjectionsMenstrualchangesDelayedreturnoffertilityAlopeciaReducedlibidoWeightgain?Depression?

DMPASideEffectsLossofbonemineraldensity?LoweredHDLlevelProtectionagainstendometrialcancer,noimpactonriskofothertypesofcancerReducesPMSsymptoms,iron-deficiencyanemia,risksofPID,ectopicpregnancyDMPAHealthRisks&Benefits

LevonorgestrelImplantsSideeffects&risksIrregularbleedingAmenorrheaHeadacheHairlossWeightgainFunctionalovariancystsBenefitsImprovementofdysmenorrheaImprovementofPMSImplantSideEffects,

HealthRisks&BenefitsInertCopperbearingProgestogenreleasing

IntraUterineDevices

IUDsRisks:Perforationoftheuterus(rare)Infection(antibioticprophylaxisnotneeded)Expulsionrates:CopperT(Paragard)=6%Progesterone-releasingIUDs=3~8%

IUDInsertionRisksCopperT:increasedmenstrualbleedinganddysmenorrheaMirena:irregularbleedingandspottingbeforeeventualamenorrhea

IUDInsertionSideEffectsMultiplesexualpartnersPregnancyAbnormalitiesoftheuterusPIDPostpartumendometritisorsepticabortionUterineorcervicalmalignancyUndiagnosedgenitalbleedingVaginitisorcervicitisIncreasedsusceptibilitytoinfectionPreviouslyinsertedIUDstillinplace

IUD:MajorContraindications

Increasedmenstrualloss.InfectionPregnancyExpulsionTranslocation

ComplicationsofIUDSCondomsMalelatex,polyurethane,animalskinFemalepolyurethaneDiaphragmsCervicalcapSpermicides

BarrierContraceptives

MaleCondomsHowtoUseaCondomFigure6.1TheFemaleCondom

BrandName:Reality

TheDiaphragm

TheCervicalCapSpermicides

CreamsFilmsFoamsJelliesPessariesSponges(AllofthesearemainlyNonoxynolbased.)

SpermicidesAlsocalledperiodicabstinenceorfertilityawarenessCalendar(“rhythm〞)methodCervicalmucus(ovulationorbillings)methodBasalbodytemperaturemethodSymptothermalmethod

NaturalFamilyPlanning24hoursareallowedforovumsurvival3daysareallowedfrothespermsCoitusmustbeavoidedfromthe9thtothe15thdayRhythmMethod(“safePeriod〞)Figure6.4TheFertilityCycleBillings’Method

Identifytheperi-ovulatoryphasebynotingthevaginalsensationsassociatedwithchangesincervicalmucus.HighdosesofcombinedOCsHighdosesofprogestin-onlypillsEmergencycontraceptivepillspreventpregnancybyinhibitingordelayingovulation.Theymayalsoaltertheendometrium,makingitinhospitabletotheimplantationofova.Theymayalterspermorovumtransport.IUDThemechanismofactionoftheIUDasemergencycontraceptionremainsundefined.

EmergencyContraceptionNEWMETHODS:OrthoEvra“ThePatch〞SurgicalMethods

1.Laparoscopicsterilisation

Rings,Clips-Bipolardiathermy,Laser2.Tuballigation

ArtificialAbortionDefinition:Anabortionthatisbroughtaboutintentionally(familyplanningetal.),AlsocalledaninducedortherapeuticabortionTheterminationofapregnancybeforthe24thweek.

AbortionofMethodsVacuumaspiration–1sttrimestDilationandEvacuation(D&E)–2ndtrimesterDilationandCurettage(D&C)–2ndtrimester4)Figure6.7

Amniocentesis

AbortionofMethods

Prostaglandinorinductionabortions–2ndtrimesterHysterotomy–removalofthefetussurgicallyIntactdilationandextraction(D&X)–latetermabortionMifepristone(RU-486)–inducesabortionbyblockingprogesteroneusedwithMisoprostil(aprostaglandin)

Complications*Incompleteuterineevacuation*Uterineperforationand/ordamagetoabdominalviscera.*Sepsis.*Haemorrhage.*Rhesusisoimmunisati