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Iud barrier 2 (2)
 

Iud barrier 2 (2)

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    Iud barrier 2 (2) Iud barrier 2 (2) Presentation Transcript

    • FAMILY PLANNING ‘ a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and responsible decision by individual and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country.’ -----WHO 1971
    • FAMILY PLANNING
      • OBJECTIVES::
      • To avoid unwanted birth
      • To bring about wanted birth
      • To regulate the interval between pregnancy
      • To control the time at which the birth occur in relation to the ages of the parents
      • To determine the number of children in the family
    • ELIGIBLE COUPLE:CURRENTLY MARRIED COUPLE WHEREIN THE WIFE IN THE REPRODUCTIVE AGE(15-45) TARGET COUPLE::COUPLES WHO HAVE HAD 2-3 LIVING CHILDREN. FP WAS LARGELY DIRECTED TO SUCH COUPLLES. TWO CHILD FAMILY NORM  NRR=1  COUPLE PROTECTION RATE=60%
    • Physician obligations are: First do no harm . ( primum non nocere, Hippocrates ) 400 B.C Assessing the balance between risk and benefit
    • Temporary methods Permanent methods
      • 1.Natural Methods
          • Periodic abstinence
          • Withdrawal
          • Lactational Amenorrhea Method
      • 2.Barrier methods
      • 3.Hormonal contraception
      • 4.Intra uterine contraceptive devices
      • 5.Emergency (Post coital ) contraception
      Temporary methods
    • Pearl index
      • Method used for determination of pregnancy failure rate:
      • Pregnancy rate = no. of pregnancies x100women/12 months of use
    • BARRIER METHODS
      • Condom male
      • female
      • Diaphragm
      • Sponge
      • Spermicides
      PHYSICAL METHOD CHEMICAL METHOD
    • Condoms Benefits No medical side-effects Inexpensive, easily accessed Protecting against STDs ( Latex ) HPV that can cause genital warts HSV that can cause genital herpes Hepatitis-B virus Lower risk for cervical dysplasia and cancer
    • Condoms Disadvantages Can interrupt sexual activity May sometimes tear or leak Failure rate 2-3----14 HWY Can cause an allergic reaction
    • INTRAUTERINE DEVICES (IUD)
      • 1) Non medicated(inert) or first generation IUD :: lippes loop
      • Large size  Good anti-fertility effect but higher removal rate due to pain and bleeding.
      • 2) Copper IUD ::( Second generation IUD)
      • T Cu 380 A(2002 NFPP) no.  SA(sq.mm) of
      • Nova T, T Cu 380 Ag Cu on the device.
      • ML-Cu-250, ML-Cu-375
      • Low side effect---low expulsion rate---great efficacy—better tolerated by nullipara-----------but still bleeding be the commonest S/E.
    • INTRAUTERINE DEVICES (IUD)
      • 3) Hormone releasing IUD::
      • Progestasert  38 mg of progesterone  release @ 65mcg daily.
      • LNG-20 (MIRENA)  release @ 20 mcg of levonorgestrel daily.
      • Low side effect---low expulsion rate---great efficacy—better tolerated by nullipara-----------and bleeding much less occurred than copper devices.
    • Mechanism of Action
      • Foreign body reaction  altering cellular and biochemical changes in the endometrium  impair the viability of gamete.
      • Cervical mucus is changed to obstruct passage of sperm through the cervix.
      • Prevent chances of fertilization rather than implantation
      • endometrial thinning which inhibits implantation of embryos
      • Inhibition of ovulation.(Probably)
      • Timing of insertion::::
      • During menstruation or within 10 days of beginning of menstrual period.
      • Immediate postpartum insertion  1 st wk after delivery  chances of perforation
      • Post puerperal insertion  6-8 wks after delivery.
      T-CU 380 A PROGESTASERT MIRENA FAILURE RATE 0.5-0.8 1.3-1.6 0.2 CHANGE AFTER (YRS) 10 1 7
    • ADVANTAGES
      • Long-term contraception
      • Virtually free of systemic S/E
      • Women with contraindications to COC
      • Emergency contraceptive.
      DISADVANTAGES
      • BLEEDING
      • PELVIC INFECTION
      • UTERINE PERFORATION
      • ECTOPIC PREGNANCY
      • EXPULSION
    • Absolute Contraindications
      • Pregnancy.
      • Post partum puerperal sepsis
      • Immediately post-septic abortion
      • -Undiagnosed abnormal vaginal bleeding.
      • -Suspected gynecological malignancy.
      • ( Cervical cancer, Endometrial cancer)
      • - Current STDs .
      • - Current PID.
    • Relative Contraindications
      • Anaemia
      • -Menorrhagia
      • -H/O PID in last pregnancy
      • -Purulent cervical discharge
      • -Anatomical abnormalities
    • The ideal IUD candidate
      • WHO HAS AT LEAST ONE CHILD
      • HAS NO H/O PELVIC DISEASE
      • HAS NORMAL MENSTRUAL PERIOD
      • IS WILLLING TO CHECK IUD TAIL
      • HAS ACCESS TO FOLLOW UP AND TREATMENT
      • IS IN A MONOGAMOUS RELATIONSHIP
    • THANK U