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    Insel10ebrup Ppt Ch06 Insel10ebrup Ppt Ch06 Presentation Transcript

    • Contraception and Abortion Chapter 6
    • Principles of Contraception
      • Based on the physiology of reproduction
      • Types: Barrier, Hormonal, Natural Methods, and Surgical
      • Factors affecting choice
        • Advantages and disadvantages
      • Effectiveness
    • Oral contraceptives (OCs): “The Pill”
      • Estrogen and progesterone taken orally
      • Mimics the hormonal activity of the corpus luteum
      • Most common is the combination pill
      • Extended-cycle pill
      • “ Minipill”
      • Advantages
      • Disadvantages
      • Effectiveness
    • Contraceptive Skin Patch
      • Thin 1 3/4 inch square patch
      • Releases estrogen and progestin slowly into the bloodstream.
      • Prevention the same way as OCs
      • Worn for one week, replaced on the same day for 3 consecutive weeks. Fourth week no patch
      • Advantages
      • Disadvantages
      • Effectiveness
    • Vaginal Contraceptive Ring
      • The NuvaRing
      • Resembles the rim of a diaphragm and is molded with progestin and estrogen
      • 2 inch ring slowly releases the hormones
      • During fourth week, remove the ring and use a new ring after the fourth week.
      • Advantages
      • Disadvantages
      • Effectiveness
    • Contraceptive Implants
      • Norplant; Jadelle (Norplant II); Implanon (2006)
        • Hormonal method
        • 6 flexible matchstick capsules
        • Protection for 5 years
        • Progestin inhibits ovulation
        • Advantages
        • Disadvantages
        • Effectiveness
    • Injectable Contraceptive
      • Depo-Provera, Lunelle (2002 voluntary recall)
        • Hormonal treatment
        • Injectable progestin every 12 weeks
        • Advantages
        • Disadvantage
        • Side effects
          • period will subside - ovaries will not release egg
          • It may take 12 months before cycle will return
        • Effectiveness
    • Emergency Contraceptive
      • Postcoital Pill, Morning After Pill, Plan B (OTC)
        • Use a EPT kit
        • Most common is the two dose regimen
        • Prevents uterine implantation
        • Needs to be taken within 72 hours. Best used within 24 hours
        • Intrauterine Device
    • Intrauterine Device (IUD)
      • T-380A (ParaGard) 10 years of protection
        • Copper
      • Levonorgestral (Mirena) 5 years of protection
        • Release small amounts of progestin
      • Not exactly sure how it prevents pregnancy
      • Advantages
      • Disadvantages
      • Effectiveness
    •  
    • Male Condoms
      • Thin latex sheaths
      • Protection against STD’s
      • Advantages
      • Disadvantages
      • Effectiveness
        • Use with spermicide
    •  
    • Female Condom
      • Reality Brand
      • Polyurethane sheath with two flexible rings
      • Advantages
      • Disadvantage
      • Effectiveness
    •  
    • The Diaphragm with Spermicide
        • Dome shaped cup of thin rubber stretched over a collapsible metal ring.
        • Custom fit
        • Following intercourse
        • Advantages
        • Disadvantages
          • Toxic shock syndrome (TSS)
        • Effectiveness
        • Lea’s Shield
    •  
    • Cervical Cap
      • Small rubber or plastic cap
      • Must use foam kit
      • Advantages
      • Disadvantage
    • Vaginal Spermicide
      • How it works
      • Advantages
      • Disadvantages
      • Effectiveness
    •  
    • Abstinence, Fertility Awareness, and Withdrawal
      • Abstinence
        • Without intercourse or sexual activities
        • Benefits: more self respect and respect for others. Security that you are being pursued for sexual reasons. Less worry about STDs and Pregnancy.
    • The Fertility Awareness Method (FAM)
      • FAM
        • Calendar method
        • Temperature method
        • Mucus method
      • Withdrawal
      • Combining methods
    • The Fertility Awareness Method (FAM)
    • Male Sterilization: Vasectomy
      • Severing of the vasa deferentia
      • May return to work in 2 days
      • Semen tested in 12 weeks or 20 ejaculations
      • Reversal varies between 80% to 50%, depending on the report.
      • Complication rate
      • Effectiveness
    •  
    • Female Sterilization
      • Tubal sterilization (laparoscopy) is most common
      • Essure system (2002)
        • Sprng-like metallic implants causing scarring blocking the Fallopian tubes
      • Hysterectomy
      • Surgical cases
      • Complication rate
      • Reversibility
    •  
    • Which Contraceptive Method is Right for You?
      • Appropriate method of birth control
        • Individual health risks
        • Implications of unplanned pregnancy
        • Risks of STDs
        • Convenience and comfort level
        • Type of relationship
        • Ease and Cost
        • Religious or other philosophical beliefs
    • The Abortion Issue
      • The history of abortion in the U.S.
        • Mid-1800’s: Prior to 20 weeks was legal
        • 1900’s: Physicians joined with other groups - stating untrained people were performing them. All states made abortion illegal
    • Current Legal Status
      • 1973: Roe versus Wade
        • Supreme Court ruled :
          • Pregnancy divided into 3 trimesters
            • 1st trimester - up to women & doctor
            • 2nd trimester - state may regulate
            • 3rd trimester - state may regulate and bar all abortions that are not life threatening to mother
      • U.S. Congress and federal Medicaid funds
      • 17 states provide nonfederal public money
      • Current issues
        • 2000 Nebraska ban on partial birth
        • 2006 Supreme Court reconsideration of Partial Birth Abortion Ban Act
    • Moral Considerations
      • Pro-life : The fertilized egg is a human being from the moment of conception and therefore an abortion is murder.
        • Any women having sex knows pregnancy is possible - she has a moral obligation
        • Women unable or unwilling to raise the children should consider placing him/her up for adoption
        • Abortion has destructive effects on our traditional morals and values
    • Moral Considerations
      • Pro-Choice : There are distinct stages of fetal development and that preserving the fetus early in pregnancy is not the ultimate moral concern.
        • Women should have the right to make their own decisions
        • If not legal then unsafe and unregulated practices would occur
        • Women would be divided into those who could afford and those who could not.
        • Some physicians would be forced to break the law
    • Public Opinion
      • U.S. public opinion seems to change depending on the situation
      • Many approve legal abortion when health or welfare consequences could result
      • The issue in later pregnancy is when does the right of the fetus take precedence over the woman’s rights
    • Personal Considerations
      • Legal arguments
      • Moral arguments
      • Short and long term ramifications
    •  
    • Methods of Abortion
      • Two categories
        • Surgical - 98% of all abortions
        • Medical
      • Ends a pregnancy before birth takes place
        • Miscarriage/Spontaneous abortion - embryo or fetus dies in the uterus and is expelled by the body
        • Ending a pregnancy voluntarily - induced abortion
        • Approx. 88 % of all abortions are performed during the first trimester
        • Typically performed at a clinic, health center, or in a doctors office.
        • Women are usually able to return home an hour or so later
    • Suction Curettage
      • Vacuum aspiration
      • Early abortion; about 6 th to 12 th week
      • Used about 90% of all abortions
      • Vagina is washes with antiseptic, Anesthetic is injected into or near the cervix.
      • Cervix is gently and gradually stretched over a 24 hour period.
      • After dilation a tube connected to a suction machine gently empties the uterus
      • After suction a Curette (narrow metal loop) gently scrapes the walls of the uterus
      • After a few hours in recovery the woman can return home
    •  
    • Manual Vacuum Aspiration
      • MVA
        • Done within 4 or 5 weeks of last menstrual cycle
        • More effective and safer if performed at least 6 or 7 weeks
        • Gentle suction of a syringe
        • Cervix is dilated with meds.
        • Uterus is emptied with a handheld syringe
        • If a definitive gestational sac is not identified then women is tested for possible ectopic pregnancy
    • Complications of Abortion
      • Possible physical effects
        • Fever above 100º F.
        • Abdominal pain or tenderness
        • Swelling
        • Backache
        • Prolonged or Heavy bleeding
        • Foul smelling vaginal discharge
        • Vomiting
        • Fainting
        • Delay of 6 or more weeks in resuming menstruation
    • Possible Psychological Effects
      • Possible feels after having an abortion
        • Guilt
        • New strength in having made and carried out an important decision
        • Depression
        • Sense of loss
        • Negative feelings about sex
        • Relationship may end
        • Anger
        • Bitterness
    • Contraception and Abortion Chapter 6