15 family planning

11,765 views

Published on

Published in: Education, Health & Medicine
2 Comments
30 Likes
Statistics
Notes
  • The International Agency for Research on Cancer (IARC), the cancer research agency of WHO, in its press release of the 29th of July 2005, informed of the publication of Monograph 91 on the carcinogenicity of combined estrogen-progestogen oral contraceptives (COC) and combined estrogen-progestogen menopausal therapy (HRT), based on the conclusions of an international Working Group of 21 scientists from 8 countries. Please see
    http://www.who.int/reproductivehealth/publications/ageing/cocs_hrt_statement.pdf and
    http://www.iarc.fr/en/media-centre/pr/2005/pr167.html
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • If you like the above slide, chkout http://NurseReview.Org
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
No Downloads
Views
Total views
11,765
On SlideShare
0
From Embeds
0
Number of Embeds
29
Actions
Shares
0
Downloads
1,007
Comments
2
Likes
30
Embeds 0
No embeds

No notes for slide
  • The goal are complished by eg: oral contraceptives, implantable rods, long acting progensterone injection eg:condom diaphragm, foam, rhythm, implantable rods eg: intrautering devices, diethylstibestrol, postcoital oral contraceptive, and inducing menstruation or abortion Each approach may be used successfully,individually or in combination,to prevent pregnancy,and each method has its own unique advantages and disadvantages.
  • Medroxyprogesterone acetate (Depo-Provera)
  • detumescence
  • Levonorgestrel (Mirena) lifespan is 5 years Copper TCu380A (Paragard) lifespan is more than 10 years
  • Expulsion 排出
  • . It is thought that the human ovum can be fertilized no later than 24 to 48 hours after it is extruded from the ovary. Although motile sperm have been recovered from the uterus and the oviducts as long as 60 hours after coitus, their ability to fertilize the ovum probably lasts no longer than 24 to 48 hours. Pregnancy is unlikely to occur if a couple refrains from intercourse for 4 days before, and for 3 or 4 days after, ovulation (fertile period) Unprotected intercourse on the other days of the cycle (safe period) should not result in pregnancy. Ovultation usually occurs about 14days (12 to 16) before the onset of menstruation
  • refrains from 忍住,戒除,克制不要
  • Followed by a second dose 12 hours later
  • The right fallopian tube is grasped with the clip The clip is closed and the tube is crushed The clip is closed and locked across the tube
  • Libido 性欲
  • Cramp 痛性痉挛
  • 15 family planning

    1. 1. Family Planning Qiong Wang, Yanmin Luo OBGY Department of First Affiliated Hospital of Sun Yat-sen University
    2. 2. Question <ul><li>How many children are you prefer in your family? </li></ul>
    3. 3. Question <ul><li>How many children could one family support? </li></ul>How many peoples could our earth support?
    4. 4. Question <ul><li>How many children could one woman produce in her whole life? </li></ul>
    5. 5. ---Family Planning--- <ul><li>What shall we do then? </li></ul>
    6. 6. Definition <ul><li>Family planning is the planning of when to have children </li></ul><ul><li>(the moms’ age of their first birth and the interval between the children) </li></ul>How to implement the Family Planning?
    7. 7. Definition <ul><li>Use of birth control and other techniques to implement the planning of when to have children. </li></ul><ul><li>Other techniques commonly used </li></ul><ul><li>include sexuality education , prevention and management of sexually transmitted infections , pre-conception counseling and management , and infertility management </li></ul>
    8. 8. The Content of Family Planning <ul><li>Contraception </li></ul><ul><li>Sterilization </li></ul><ul><li>Rescued strategy of the failure of contraception </li></ul>
    9. 9. Contraception
    10. 10. Contraception <ul><li>How many kinds of contraception methods do you know? </li></ul><ul><li>(From film or books) </li></ul>
    11. 12. Base knowledge of fertilization
    12. 13. Base Knowledge of Fertilization
    13. 14. Basic conditions of pregnancy <ul><li>Sperm, oocyte </li></ul><ul><li>Fertilization </li></ul><ul><li>Implantation </li></ul>
    14. 15. <ul><li>Inhibiting the development and release of the egg </li></ul><ul><li>To prevent sperm and egg from uniting </li></ul><ul><ul><li>Imposing a mechanical, chemical, or temporal barrier between sperm and egg </li></ul></ul><ul><li>Altering the ability of the fertilized egg to implant and grow </li></ul>How contraceptives work
    15. 16. <ul><li>Hormonal contraception </li></ul><ul><li>Nonhormonal contraceptive methods </li></ul>Contraception Methods
    16. 17. Hormonal Contraception <ul><li>Oral contraception pills (OC) </li></ul><ul><li>Injectable hormonal contraceptives </li></ul><ul><li>Hormonal delivery system </li></ul><ul><li>Transdermal routes </li></ul>
    17. 18. Question <ul><li>What kinds of hormone has been used in hormone contraception? </li></ul><ul><li>How does the hormone work in the contraception? </li></ul>
    18. 19. Hormonal Contraception <ul><li>Hormonal contraception are female sex steroids </li></ul><ul><li>Synthetic estrogen and a synthetic progesterone (progestin), or a progestin only </li></ul>
    19. 20. Hormone and oocyte development
    20. 21. Hormone and oocyte development Pituitary FSH LH Hypothalamus GnRH Ovary E P T inhibin Uterus Prolactin inhibin factor PRL E FSH LH E inhibin P (-)
    21. 22. Mechanism of Hormonal Contraception <ul><li>Inhibit Ovulation (no eggs) </li></ul><ul><li>For Reproductive Organ </li></ul><ul><li>Cervical discharge (thicker) </li></ul><ul><li>Thinner the liner of endometrium </li></ul><ul><li>Oviduct movement (direction and speed) </li></ul>
    22. 23. Oral Contraception Pills (OC) <ul><li>Short-Acting </li></ul><ul><li>Long-Acting </li></ul><ul><li>Postcoital Contraception Pills (Emergency Contraception) </li></ul>
    23. 24. Oral Contraception Pills (OC) <ul><li>Monophasic pills </li></ul><ul><ul><li>Deliver the same amount of estrogen and progestin every day </li></ul></ul><ul><li>Biphasic pills </li></ul><ul><ul><li>Deliver the same amount of estrogen every day for the first 21 days of the cycle </li></ul></ul><ul><ul><li>During the first half of the cycle, the progestin/estrogen ratio is lower to allow the lining of the uterus (endometrium) to thicken as it normally does during the menstrual cycle </li></ul></ul><ul><ul><li>During the second half of the cycle, the progestin/estrogen ratio is higher to allow the normal shedding of the lining of the uterus to occur </li></ul></ul><ul><li>Triphasic pills </li></ul><ul><ul><li>Constant or changing estrogen concentrations and varying progestin concentrations throughout the cycle </li></ul></ul>
    24. 25. Oral Contraception Pills (OC)
    25. 26. Postcoital Contracetion Pills
    26. 27. Question <ul><li>Why we use ethinyl estradiol combined with Progestins ? </li></ul><ul><li>Estradiol only? </li></ul><ul><li>Progestins only? </li></ul>
    27. 28. Injectable Hormonal Contraceptives
    28. 29. Hormonal delivery system Subdermal Implants (Patches)
    29. 30. Hormonal delivery system Vaginal rings
    30. 31. Side Effect and Treatment <ul><li>Morning sickness </li></ul><ul><li>Slight-- no treatment </li></ul><ul><li>Heavy-- change to other agents </li></ul><ul><li>Virginal bleeding </li></ul><ul><li>Add ethinyl estradiol 0.005mg-0.01mg each day (1 or 2 tables) </li></ul>
    31. 32. Side Effect and Treatment <ul><li>Amenorrhea </li></ul><ul><li>Recover after stop the agents </li></ul><ul><li>Oligomenorrhea </li></ul><ul><li>Slight-- no treatment </li></ul><ul><li>Heavy-- change to other agents </li></ul>
    32. 33. Side Effect and Treatment <ul><li>Weight gain </li></ul><ul><li>Pigmentation </li></ul><ul><li>Headachereast painappetite gain ashinching </li></ul>
    33. 34. Long-term Safety of Hormonal Contraception <ul><li>Venous Thrombosis, cerebral vascular accident, heart stroke </li></ul><ul><li>High estrodiol link to </li></ul><ul><li>Low dose estrodiol is safety </li></ul>
    34. 35. Long-term Safety of Hormonal Contraception <ul><li>Reproductive Cancer </li></ul><ul><li>Endometrium cancer </li></ul><ul><li>Ovary cancer </li></ul><ul><li>Cervical cancer controversial </li></ul><ul><li>Breast cancer controverial </li></ul>
    35. 36. Long-term Safety of Hormonal Contraception <ul><li>Fertility regain </li></ul><ul><ul><li>80% women recover their menses after 3 month with long-effect agent </li></ul></ul><ul><ul><li>90% women recover their menses after 3 month with short-effect agent </li></ul></ul><ul><ul><li>80% women recover their menses after 1 month with short-effect agent </li></ul></ul>
    36. 37. Long-term Safety of Hormonal Contraception <ul><li>Metabolic Effect </li></ul><ul><li>Glucose metabolism </li></ul><ul><ul><li>Progestin exhibit insulin antagonism, but fasting blood glucose normal </li></ul></ul>
    37. 38. Long-term Safety of Hormonal Contraception <ul><li>Metabolic Effect </li></ul><ul><li>Lipid metabolism </li></ul><ul><ul><li>Estrogen depress LDL and elevate HDL </li></ul></ul><ul><ul><li>Triglyceride and Cholesterol are elevate with long-term hormonal contraception </li></ul></ul>
    38. 39. Long-term Safety of Hormonal Contraception <ul><li>Metabolic Effect </li></ul><ul><li>Protein metabolism </li></ul><ul><ul><li>A few women could be total protein elevate, albumin decrease, globulin elevate </li></ul></ul>
    39. 40. <ul><li>Hormonal contraception </li></ul><ul><li>Nonhormonal contraceptive methods </li></ul>Contraception Methods
    40. 41. Nonhormonal contraceptive methods <ul><li>Barrier contraception </li></ul><ul><ul><li>Male condoms </li></ul></ul><ul><ul><li>Vaginal diaphragm (contraceptive diaphragm) </li></ul></ul><ul><li>Intrauterine Devices, IUD </li></ul><ul><li>Physiologic contraception </li></ul><ul><li>Others </li></ul>
    41. 42. Nonhormonal Contraceptive Methods (condom) <ul><li>Condoms made of animal intestine were used by aristocracy of Europe in the 1700s </li></ul><ul><li>Latex rubber </li></ul>
    42. 43. Nonhormonal Contraceptive Methods (condom) <ul><li>Contraceptive sheath worn over erect penis </li></ul><ul><li>Typical failure rate=16% </li></ul><ul><li>Advantages: </li></ul><ul><ul><li>Protection of STD's </li></ul></ul><ul><ul><li>Usually, no side effects </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Condom can slip off </li></ul></ul><ul><ul><li>Penis must be withdrawn immediately after ejaculation </li></ul></ul>
    43. 44. Insertion of a vaginal diaphragm to cover the cervix and anterior vaginal wall Nonhormonal Contraceptive Methods (Vaginal diaphragm)
    44. 45. Nonhormonal contraceptive methods <ul><li>Barrier contraception </li></ul><ul><li>Intrauterine Devices, IUD </li></ul><ul><li>Physiologic contraception </li></ul><ul><li>Others </li></ul>
    45. 46. Nonhormonal Contraceptive Methods (Intrauterine Devices, IUD)
    46. 47. Nonhormonal Contraceptive Methods (Intrauterine Devices, IUD)
    47. 48. Mechanism of IUD <ul><li>Cause unsterilized inflammation (exotic) LC MC </li></ul><ul><li>(kill spermembryo) </li></ul><ul><li>IUD's prevent implantation of fertilized egg in uterus </li></ul><ul><ul><li>ER in the gland cells of endometium has been changed </li></ul></ul>
    48. 49. <ul><li>IUD with copper </li></ul><ul><li>continuously release small amount of the metal (greater inflammation/cell metabolism/gland cell atrophic) </li></ul><ul><li>IUD with progesterone </li></ul><ul><li>continuously release small amount of progesterone (endometrium change to secretary phase earlier) </li></ul>Mechanism of IUD
    49. 50. Contraindications of IUD <ul><li>May be got pregnancy </li></ul><ul><li>Pelvic inflammation </li></ul><ul><li>Undiagnosed genital bleeding </li></ul><ul><li>Uterine anomalies (Separate uterus) </li></ul><ul><li>Large fibroids </li></ul><ul><li>Chronic immune suppression </li></ul><ul><li>Copper allergy and Wilson’s disease </li></ul>
    50. 51. IUD insertion <ul><li>When: </li></ul><ul><ul><li>3-7 days after menses </li></ul></ul><ul><ul><li>42 days after postpartum, uterus in normal size </li></ul></ul><ul><ul><li>Induced abortion after early pregnancy </li></ul></ul><ul><li>Notice: </li></ul><ul><ul><li>Taken patient’s history and physical examination </li></ul></ul><ul><ul><li>Patient should avoid intercourse or use other contraception methods in the first cycle of IUD insert </li></ul></ul>
    51. 52. Side effect of IUD <ul><li>Bleeding </li></ul><ul><li>Low abdominal pain </li></ul><ul><li>Discharge </li></ul><ul><li>Fall off (expulsion) </li></ul><ul><li>Get down from the funds </li></ul><ul><li>Perforation </li></ul>
    52. 53. Complications- Pelvic infection <ul><li>There is a small increase in the risk of acute pelvic inflammatory disease in IUD users, but this is largely confined to the first 3 weeks after insertion </li></ul><ul><li>If it dose occur, antibiotic therapy is commenced </li></ul><ul><li>If the infection is severe, the device should be remove </li></ul>
    53. 54. Complications- Expulsion <ul><li>Most expulsion occur in the first few months after their insertion, most frequently during menstruation </li></ul><ul><li>The incidence of expulsion varies with the stiffness, size, and shape of the device </li></ul><ul><li>The patient should examine herself periodically, and routinely after her menses </li></ul>
    54. 55. Complications- Perforation <ul><li>About 0.1~1% of devices perforate the uterus </li></ul><ul><li>Partial perforation may occurs at the time of insertion and later migration completes the perforation </li></ul><ul><li>Perforation can be found by careful inspection, ultrasound or X-ray </li></ul><ul><li>It is advisable to remove all extrauterine IUD by either laparoscopy or laparotomy </li></ul>
    55. 56. Complications- Pregnancy <ul><li>Pregnancy rates vary according to the type of the device used,0.3%~6% </li></ul><ul><li>The risk of failure of the IUD diminishes with each year after insertion </li></ul><ul><li>If pregnancy does occur, need to remove the IUD and terminate the pregnancy </li></ul>
    56. 57. Complications- Ectopic pregnancy <ul><li>Compared with women having unprotected intercourse, the incidence of pregnancy is lower in women with an IUD </li></ul><ul><li>However, should pregnancy occur, there is a higher risk (10%) of the pregnancy being extrauterine </li></ul><ul><li>Ectopic pregnancy should be exculded in any woman who conceives with IUD </li></ul>
    57. 58. Nonhormonal contraceptive methods <ul><li>Barrier contraception </li></ul><ul><li>Intrauterine Devices, IUD </li></ul><ul><li>Physiologic contraception </li></ul><ul><ul><li>Coitus interruptus (withdrawal) </li></ul></ul><ul><ul><li>Natural family planning </li></ul></ul><ul><li>Others </li></ul>
    58. 59. Coitus interruptus (withdrawal) <ul><li>The penis is withdrawn from the vagina just before ejaculation occurs </li></ul><ul><li>Failure reasons </li></ul><ul><ul><li>Live sperm leaks form the urethra before and during coitus </li></ul></ul><ul><ul><li>The withdrawal is delayed so that part of the semen is discharged within the vagina </li></ul></ul>
    59. 60. Natural family planning <ul><li>Also called rhythm </li></ul><ul><li>Avoiding coitus during the period of greatest fertility </li></ul>
    60. 61. Natural family planning <ul><li>Human ovum can be fertilized no later than 24 to 48 hours after ovulation </li></ul><ul><li>Although motile sperm have been recovered from the uterus and the oviducts as long as 60 hours after coitus, their ability to fertilize the ovum probably lasts no longer than 24 to 48 hours </li></ul>
    61. 62. Natural family planning <ul><li>Ovulation : </li></ul><ul><ul><li>14 days (12 to 16) before the onset of menstruation </li></ul></ul><ul><li>Fertile period: </li></ul><ul><ul><li>4 days before, and for 3 or 4 days after ovulation </li></ul></ul><ul><li>Safe period: </li></ul><ul><ul><li>on the other days of the cycle </li></ul></ul>
    62. 63. Natural family planning <ul><li>Pregnancy is unlikely to occur if a couple refrains from fertile period </li></ul><ul><li>Unprotected intercourse on safe period should not result in pregnancy </li></ul>
    63. 64. <ul><li>Hormonal contraception </li></ul><ul><li>Nonhormonal contraceptive methods </li></ul><ul><li>Postcoital contraception </li></ul><ul><ul><li>Hormonal </li></ul></ul><ul><ul><li>IUD </li></ul></ul>Contraception Methods
    64. 65. Postcoital contraception <ul><li>Emergency Contraception </li></ul><ul><li>Indication: </li></ul><ul><ul><li>After unprotected intercourse </li></ul></ul><ul><ul><li>Missed combined pill </li></ul></ul><ul><ul><li>Burst condom </li></ul></ul><ul><li>Contraindication: pregnancy </li></ul>
    65. 66. Postcoital contraception <ul><li>Should be taken in 3 days after unwilling intercourse </li></ul><ul><ul><li>the closer to coitus, the greater the effectiveness </li></ul></ul><ul><li>Medicine </li></ul><ul><ul><li>LNG Levo-norgestrel </li></ul></ul><ul><ul><li>Mifepristone </li></ul></ul><ul><ul><li>LNG+EE </li></ul></ul><ul><ul><li>Propargyl acetate or LNG </li></ul></ul>
    66. 67. Postcoital contraception <ul><li>It prevents 85% of expected pregnancies </li></ul><ul><li>Side effect: </li></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Bleeding </li></ul></ul>
    67. 68. Postcoital contraception <ul><li>A copper-bearing IUD can be inserted up to five days after unprotected intercourse </li></ul><ul><li>The failure to prevent pregnancy in 1 percent of cases </li></ul><ul><li>It has the advantage of providing ongoing contraception for suitable women </li></ul>
    68. 69. Postcoital contraception <ul><li>It should be considered as an emergency measure to be used rather than as a regular method of contraception </li></ul>
    69. 70. Percentage of failure in different contraception methods <ul><li>Spermicides 21% </li></ul><ul><li>Withdrawal 19% </li></ul><ul><li>Periodic abstinence 15% </li></ul><ul><li>Condom female 21% </li></ul><ul><li>Condom male 12% </li></ul><ul><li>Pills 3% </li></ul><ul><li>IUD 2% </li></ul><ul><li>Implant 0.3% </li></ul><ul><li>Patch 5% </li></ul><ul><li>Copper IUD 0.8% </li></ul><ul><li>Female sterilization 0.4% </li></ul><ul><li>Male sterilization 0.15% </li></ul>
    70. 71. The content of family planning <ul><li>Contraception </li></ul><ul><li>Sterilization </li></ul><ul><li>Operations methods (female/male ) </li></ul><ul><li>Rescued strategy of the failure of contraception </li></ul>
    71. 72. Sterili zation
    72. 73. Female sterilization <ul><li>Called tubal sterilization operation (tubal ligation) </li></ul>
    73. 74. Tubal clips
    74. 75. Male sterilization
    75. 76. Female sterilization <ul><li>Failure rate: 1/2000 </li></ul><ul><li>Permanence contraception </li></ul><ul><li>Have the risks of surgery </li></ul>
    76. 77. Contraindication of female tubal sterilization <ul><li>Pelvic inflammations </li></ul><ul><li>Skin (section site) inflammation </li></ul><ul><li>Fever (over 37.5 ℃ two times interval 4h during 24 h) </li></ul><ul><li>Severe disease couldn’t tolerance operation </li></ul><ul><li>Psychological disease </li></ul>
    77. 78. Complications <ul><li>Tubal recanalization </li></ul><ul><li>Pregnancy </li></ul><ul><li>Ectopic pregnancy </li></ul><ul><li>Menstrual irregularity </li></ul><ul><li>Loss of libido </li></ul><ul><li>Infection </li></ul><ul><li>Injury rectum or bladder </li></ul>
    78. 79. Family planning methods choice <ul><li>Newly wedded couple </li></ul><ul><ul><li>Male condom, female condom, spermicidal jelly </li></ul></ul><ul><ul><li>No IUD or oral hormonal contraceptives </li></ul></ul><ul><li>Couple with one child </li></ul><ul><ul><li>IUD, Male condom, oral hormonal contraceptives, Norplant, spermicidal jelly </li></ul></ul>
    79. 80. Family planning methods choice <ul><li>Couple with two or more children </li></ul><ul><ul><li>Sterilization </li></ul></ul><ul><li>Women during breastfeeding </li></ul><ul><ul><li>IUD, condom </li></ul></ul><ul><ul><li>No hormonal contraceptives </li></ul></ul><ul><li>Women in climacteric </li></ul><ul><ul><li>No hormonal contraceptives </li></ul></ul><ul><li>Condom for people with STDs or HIV </li></ul>
    80. 81. The content of family planning <ul><li>Contraception </li></ul><ul><li>Sterilization </li></ul><ul><li>Rescued strategy of the failure of contraception </li></ul>
    81. 82. Rescued strategy of the failure of contraception
    82. 83. Rescued strategy of the failure of contraception <ul><li>Induced abortion </li></ul><ul><li>In early pregnancy (first trimester) </li></ul><ul><li>In second trimester </li></ul><ul><li>Operation </li></ul><ul><li>Medicine </li></ul>
    83. 84. Induced abortion <ul><li>Vacuum curettage </li></ul><ul><li>Suction aspiration </li></ul><ul><li>Dilation and evacuation </li></ul><ul><li>&quot;Suction&quot; dilation and curettage </li></ul>
    84. 85. Induced abortion <ul><li>Vacuum curettage </li></ul><ul><li>6-10 weeks gestation age </li></ul>
    85. 86. Induced abortion –Vacuum curettage <ul><li>Procedure-1 </li></ul><ul><li>outpatient procedure, takes less than 15 minutes </li></ul><ul><li>Suction is created with either an electric pump (electric vacuum aspiration or EVA) or a manual pump (manual vacuum aspiration or MVA </li></ul><ul><li>a local anesthetic to numb the cervix </li></ul><ul><li>instruments called &quot;dilators&quot; to open the cervix, or sometimes medically induce dilation with drugs </li></ul><ul><li>a sterile cannula is inserted into the uterus and attached via tubing to the pump. The pump creates a vacuum which empties uterine contents </li></ul>
    86. 87. Induced abortion –Vacuum curettage <ul><li>Procedure-2 </li></ul><ul><li>After a procedure for abortion or miscarriage treatment, the tissue removed from the uterus is examined for completeness </li></ul><ul><li>Expected contents include the embryo or fetus as well as the decidua, chorionic villi, amniotic fluid, amniotic membrane and other tissue </li></ul><ul><li>Post-treatment care includes brief observation in a recovery area and a follow-up appointment approximately two weeks later </li></ul>
    87. 88. Induced abortion –Vacuum curettage <ul><li>Complications during operation-1 </li></ul><ul><li>Perforation of uterus </li></ul><ul><li>Induced abortion syndrome (Vagus nerve excited) </li></ul><ul><ul><li>Bradycardia, low BP, pale, sweeting, dizziness, chest tightness, syncope or convulsion </li></ul></ul><ul><li>Partial tissue remaining </li></ul>
    88. 89. Induced abortion –Vacuum curettage <ul><li>Complications during operation-2 </li></ul><ul><li>Suction failure </li></ul><ul><li>Bleeding </li></ul><ul><li>Inflammation </li></ul><ul><li>Embolization </li></ul><ul><li>Cervix laceration </li></ul>
    89. 90. Induced abortion –Vacuum curettage <ul><li>Long-term Complications </li></ul><ul><li>Adhesion of cervix or uterus cavity (Asherman's syndrome) </li></ul><ul><li>Ectopic pregnancy, miscarriage, and abnormal placentation </li></ul><ul><li>Pelvic inflammation </li></ul><ul><li>Menstrual abnormalities </li></ul><ul><li>Infertility </li></ul>
    90. 91. Rescued strategy of the failure of contraception <ul><li>Induced abortion </li></ul><ul><li>In early pregnancy (first trimester) </li></ul><ul><li>In second trimester </li></ul><ul><li>Operation </li></ul><ul><li>Medicine </li></ul>
    91. 92. Medicine Induced Abortion <ul><li>Indications </li></ul><ul><ul><li>Less than 49 days gestation age </li></ul></ul><ul><ul><li>10-24 weeks gestation age (usually combined with curettage) </li></ul></ul><ul><li>Medicine </li></ul><ul><ul><li>RU-486 (mifepristone), analogue of progestin </li></ul></ul><ul><ul><li>Misoprostol, analogue of PGE1 </li></ul></ul>
    92. 93. Medicine Induced Abortion Complications <ul><li>Failure to terminate a pregnancy </li></ul><ul><li>Incomplete abortion </li></ul><ul><li>Significant uterine cramping </li></ul><ul><li>Nausea, vomiting </li></ul><ul><li>Uterus bleeding </li></ul><ul><li>Infection </li></ul>
    93. 94. Summary <ul><li>Contraception </li></ul><ul><ul><li>Hormonal or nonhormonal </li></ul></ul><ul><ul><li>Methods, mechanism, indication, side effects </li></ul></ul><ul><li>Sterilization </li></ul><ul><li>Rescued strategy of the failure of contraception </li></ul><ul><ul><li>Operation or medical </li></ul></ul><ul><ul><li>Technique, indication, complication </li></ul></ul>
    94. 95. Case <ul><li>A 20-year-old nulligravid patient wants to know what is “the best method of contraceptive.” </li></ul><ul><li>Her history reveals that her periods are regular with cramping. </li></ul><ul><li>She is currently taking no medications and knows of no allergies </li></ul>
    95. 96. Question: <ul><li>In listing possible options, all of the following might be appropriate except: A: Oral contraceptive B: Vaginal diaphragm C: IUD D: Rhythm E: Tubal ligation </li></ul>
    96. 97. 谢谢

    ×