Facts about Pakistan• One birth every 7 seconds• 3 mothers die in childbirth every hour• 12 million children under 5 years are malnourished• 50% of population are lacking safe drinking water.• 60% lack safe sanitary facilities• One doctor per 2008 persons• One nurse per 6500 persons• One hospital bed per 1506 persons• Unemployment, law and order problems and social
unrest increasing.
Population Profile
• 3.2 million 1947
• 128 million 1995
• 235 million By year 2015
• Population below poverty line 33.1%
Surgical Contraception
Female Sterilization• Laparoscopic• Minilap• Vaginal tubectomy
Male sterilization• vasectomy
Non surgical Tubal Occlusion
• Quinacrine pellets
• Tetracycline methyl cyanoacrylate
• Oviduct plugs
Barrier methods of C.C
Male condom• Advantages
• Simple
• Responsibility on male
• Protects against the transfer of venereal diseases
Male condom
Disadvantages
• Expensive
• Less satisfying sex
• Allergic reactions
Failure rate - 6-18 per HWY
Diaphram
• Functions1. Retainer of the spermicide2. To keep sperms away from alkaline
receptive cervical mucus3. Prevent the cervical mucus reaching the
vagina4. Prevents the aspiration of the sperms into
the cx & the uterus
Diaphram
Advantages– Safe,cheap,easy– Orgasm Does not influence the
orgasm of either partner.
DisadvantageLess effective in case of prolapse and retroversion
Failure Rate
2-15/100 women years
Intrauterine Devices
• Multiload Cu 250 and 375. These come preloaded and doesn't require to be loaded in the inserter.
Contraceptive prevalence rate (CPR)
Iran 23%
Bangladesh 40%
Indonesia 48%
Malaysia 51%
Turkey 72%
Pakistan 12%
CONTRACEPTION
Contraception Saves Lives
Contraception means prevention of conception by any method with out abstinence from sexual intercourse.
MOTIVATION
Counselling
Is the process of helping clients to make informed and voluntary decisions about choice of contraception.
Methods of Contraception • Physiological methods
– Rhythm method– Incomplete method
• Chemical methods
• Barrier methods
• Intrauterine contraceptive devices
• Hormones
• Sterilization
• Early abortion
Natural Family Planning
Abstaining from sexual intercourse during fertile phase of menstrual cycle.
Fertility Cycle
Phase I: Relatively infertile phase
(approx first 7 days)
Phase II: Fertile phase
(approx 8 to 16th day)
Phase III: Absolutely infertile phase
(approx 17th to 28th day)
Rhythm Method
• Advantage
• No expensive involved
• No side effects
• Disadvantage
• Planning of coitus
• Dependence on regularity of the cycle
• Suitable for educated,intelligent & cooperative women
Advantage Safe,easy,cheap
Orgasm doest not interfer with the orgasm of either partner.
Disadvantage
Less effective in case of prolaspe and retroversion
Failure Rate 2 – 15 /100 women years.
Intrauterine C.C device• Copper 250 and 375• Multiload
• Hormone releasing IUCDs
Progestasert
Levonorgesrel (Mirena)
levonova
Preloaded doesn't require to be loaded in the inserter.
Method
Pass uterine sound to measure the length of uterine cavity
Introduce the multiload with the inserter until it touches the fundus
Then withdraw the inserter.
Mode of action
• Immobilize the sperm and prevent it from fertlizing the ovum.
• Inflammatory reaction in the Endometrium prevents embedding of fertilzed ovum.
• Hormonal Effects.
Contradictions
Complications
Hormonal Contracption
• COC pills
• Progesterone only pill
• Long acting pill
• Intectables
• Vaginal rings
• implants
Contraindications oral contraception
• Absolute – Cholestatic jaundice of pregnancy– Porphyria– Pruritis of pregnancy– Herpes gestationalis – Cancer of breast.
Contraindications oral contraception
• Relative– Thromboembolism– Blood dyscrasias– Diabetes– Obesity– Chorea– Migraine– Varicose veins– Asthma– Depressive psychosis– Elective surgery
SEQUENTIAL PILL
• Two types of pill
• First 14 containj only oestrogen
• And last seven a combination of oestrogen and progestrogen
PROGESTRONE ONLY PILL
• Mini pell
• 28 or 35 packet
- femules - 500ug 28
- Moridey - 250ug 28
- Microval- 30ug 35
ADVANTAGES - POP
• Do not treduce breast milk
• Suitable for women with contraindication of oestrogens
• Minimal side effects
• No risk of circulatory or malignant disease
LONG ACTING PILLS
• Once a month
• Quinestrel + Levonorgestrel
INJECTABLES
• DEPOPROVERA (DMPA)– 150mg every 12 wks
• NORIGEST (NET-EN)• 200 mg ever 08 wks
• CYCLOPROVERA• Once a month
ADVANTAGES INJECTABLES
• Highly effective
• Easy to deliver
• Use independent of sexual intercourse
• Do not reduce breast milk
• May reduce anaemia
• Less dysmenorrhoea & PMT
DISADVANTAGES INJECTABLES
• Requires regulkar visits to the clinica for injections
• Not retrievable• Return to fertility is delayed for months• Menstrual irregularities• Galactorrhoea• Mild androgenic affects• Enuresis
VAGINAL RINGS
• Shell type
• Core type
• Contain Oestrogen + Progesterone or only Progesterone
• Rings changed every 03 months
CONTRACEPTIVE IMPLANTS
• NON – Biodegradable– Norplant – 1 - 5 yrs– Norplant – 2- 3 yrs– Implnon - 3yrs
• Biodegradable• Capronor - one year
POST COITAL CONTRACEPTION
• Immediate insertion of copper- T
• The YUZPE method– 2 tabs of COC at once and 02 tabs after 12
hours
• Ethinyl Oestradiol- 2.5 mg bd * 05 days
• Conjugated equine oestrogens- 10 mg tds * 05 days
MECHANISM OF ACTION POST COITAL CONTRACEPTION
• Block implantation
• Uterine fluid / genital tract mucus rendered hostile to sperm or blastocyst
RISK OF PREGNANCY POST COITAL CONTRACEPTION
• 20 %
• 30 % on the day of maximum risk
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