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  1. 1. Contraceptive Devices Female Reproductive System Natural Methods Barrier Methods Hormonal Methods Surgical Methods Delivery Process Fetal Presentation Abortion
  2. 2. Side Sectional View of Female Reproductive System
  3. 3. Female External Genitalia BACK TO TOPICS
  4. 4. Contraceptive is a regimen of one or more actions, devices, or medications followed in order to deliberately prevent or reduce the likelihood of a woman becoming pregnant or giving birth. Methods and intentions typically termed birth control may be considered a pivotal ingredient to family planning. BACK TO TOPICS
  5. 5. Abstinence Refraining from sex with a partner Refraining from intercourse with a partner Celibacy: not engaging in solitary or partnered sexual expression Avoids risk of STDs
  6. 6. Cyclical charting (Natural family planning) Recording of monthly menstrual events to aid in inducing or preventing pregnancy Avoidance of sexual intercourse during fertile days.  Variety of techniques:
  7. 7. a. Calender method •First unsafe day is 18 days less than length of shortest cycle •Last unsafe day is 11 days less than length of longest cycle •Unsafe days may range from 8 days (day 10-17) to 12 Days (Day 8-20)
  8. 8. b. Basal body temperature •based on body temperature, immediately upon rising •not helpful for predicting date of ovulation
  9. 9. c. Cervical mucus method (Ovulation or Billings method) •based on changes in cervical mucus secretion •Spinnbarkbeit: special type of mucus that is clear, slippery, and stretchable •occurs a few days prior ovulation and peaks at ovulation •intercourse must be avoided from a few days before to several days after ovulation d. Symptom-thermal method •combines BBT and ovulation method •Fertile period ends 3 days after elevated temp or 4 days after peak mucus
  10. 10. Advantages •health •religious or ethical •low cost Disadvantages •high failure rate •constant vigilance •avoidance of sexual intercourse can be long and impractical
  11. 11. Withdrawal 1. Typical failure rate is 19% 2. Advantage •man assumes responsibility 3. Disadvantages •difficult for men to predict ejaculation •pre-ejaculatory fluid can carry sperm • BACK TO TOPICS
  12. 12. Cervical Cap
  13. 13. The cervical cap is a flexible rubber cup- like device that is filled with spermicide and self-inserted over the cervix prior to intercourse. The device is left in place several hours after intercourse. The cap is a prescribed device fitted by a health care professional and is more expensive than other barrier methods such as condoms. 1. small, thimble-shaped soft rubber device that fits over cervix; used with spermicide
  14. 14. 3.Advantages: •Can be inserted many hours before sex play. •Easy to carry around, comfortable. •Does not alter the menstrual cycle. •Does not affect future fertility. •May help you better know your body. 4.Disadvantages: •Does not protect against HIV/AIDS. •Some women cannot be fitted. •Can be difficult to insert or remove. •Can be dislodged during intercourse. •
  15. 15. Diaphragm
  16. 16. The diaphragm is a flexible rubber cup that is filled with spermicide and self-inserted over the cervix prior to intercourse. The device is left in place several hours after intercourse. The diaphragm is a prescribed device fitted by a health care professonal and is more expensive than other barrier methods such as condoms. 1. dome-shaped rubber device worn over cervix; proper use includes spermicide
  17. 17. 3. advantages: •6 hrs before intercourse through 24 hrs after •used with spermicide, it reduces risk of STDs •no hormones involved •reduces risk of pelvic inflammatory disease (PID) 4. disadvantages: •must be fitted by health professional •must remain in place at least 6 hrs
  18. 18. Female Condom
  19. 19. The female condom, like the male condom, is a barrier contraceptive made of latex or polyurethane. The condom has a ring on each end. The ring that is placed inside the vagina fits over the cervix, while the other ring, which is open, rests outside of the vagina and covers the vulva. The female condom is sold over-the- counter. 1. can be inserted 8 hrs before intercourse
  20. 20. 3. advantages •no side effects •available •moderate protection from STDs 4 disadvantages •some loss of sensitivity •requires motivation •not as affect in preventing STDs as male condom
  21. 21. Male Condom
  22. 22. The male condom is a barrier contraceptive made of latex or polyurethane. The condom must be fitted over the erect penis. The condom is sold over-the-counter and when used properly is an inexpensive, effective barrier to pregnancy and sexually-transmitted disease. 1. contraceptive sheath worn over erect penis •
  23. 23. 2. advantages: •availability •protection of STD's •usually, no side effects •male responsibility 3. disadvantages •requires motivation and consistency •condom can slip off •penis must be withdrawn immediately after
  24. 24. Spermicides are chemical products inserted in a woman's vagina before sex that inactivate or kill sperm. 1. sperm=killing agents placed in vagina 2. various forms: foam, gel, suppositories 3. Most effective when used with another barrier method 4. Typical failure rate=21%, PUFR=6%
  25. 25. 5. advantages: •availability •no hormones •some protection from STDs •no known side effects 6. disadvantages •can irritate •increased risk of yeast infections •taste interferes with oral sex
  26. 26. Intrauterine Device
  27. 27. The intrauterine device shown uses copper as the active contraceptive, others use progesterone in a plastic device. IUDs are very effective at preventing pregnancy (less than 2% chance per year for the progesterone IUD, less than 1% chance per year for the copper IUD). IUDs come with increased risk of ectopic pregnancy and perforation of the uterus and do not protect against sexually transmitted disease. IUDs are prescribed and placed by
  28. 28. 1. contraceptive device placed within uterine 2. prevents passage of sperm to fallopian tube 3. used to be thought that IUD's prevent implantation of fertilized egg in uterus 4. Typical failure rate=0.8-2%, PUFR=.1-1.5%, depending on brand
  29. 29. 5. advantages •requires little attention •low cost after initial purchase •progestin- or progesterone-releasing IUD decrease menstrual flow 6. disadvantages •high initial cost •no protection against STDs •many possible problems: spontaneously expelled; ecotopic pregnancy, uterine wall perforation, BACK TO TOPICS
  30. 30. Hormone-Based Contraceptives
  31. 31.  Combination oral contraceptives (birth control pills) 1. contraceptive hormones taken daily by mouth 2. combination of low estrogen to inhibit ovulation and progesterone to thicken mucus, inhibit ovulation, and hamper implantation. 3. pills vary in whether hormone levels are constant or change during cycle
  32. 32. 5. advantages: •effective •easy •generally safe •decreases menstrual cramps, shortens period 6. disadvantages •must be taken daily •cost •effects from hormones •can decrease milk production •health problems for some women •no protection from STDs
  33. 33. Progestin-only Contraceptives
  34. 34.  Progestin-only contraceptives 1. use a synthetic progesterone only 2. prevents ovulation, inhibits sperm movement, and thins endometrium 3. Different kinds a. Norplant: placed beneath skin of arm •effective up to five years •surgery can cause pain or problems b. Depo-Provera: injected once every three months c. Minipill: prevents ovulation •must be taken every day •can cause a lack of periods BACK TO TOPICS
  35. 35. Tubal Ligation
  36. 36. Surgical sterilization which permanently prevents the transport of the egg to the uterus by means of sealing the fallopian tubes is called tubal ligation, commonly called "having one's tubes tied". This operation can be performed laparoscopically or in conjunction with a Cesarean section, after the baby is delivered. Tubal ligation is considered permanent but reversals can be done in many cases. 1. Interrupts fallopian tubes by sealing tubes
  37. 37. 4. advantages: •highly effective •permanent •increased enjoyment of sexual activities 5. Disadvantages •permanent •surgery •no protection from STDs' •if fails, higher risk of ectopic pregnancy
  38. 38. Vasectomy
  39. 39. Vasectomy is a simple, painless procedure that is very effective in preventing pregnancy. Men usually have no side effects from vasectomy, and no change in sexual performance or function. 1. cut an tie the vas deferens 2. Sperm still present up to 8 weeks after surbey 3. Typical failure rate= 0.15%; PUFR=0.1%
  40. 40. 4. advantages •highly effective •permanent •relatively safe 5, Disadvantages: •permanent •not immediate •no protection from STDs' •occasional regret BACK TO TOPICS
  41. 41. Delivery presentation describes the way the fetus is positioned to come down the birth canal for delivery. The presentation is defined by fetal attitude, the presenting part, and maternal and fetal landmarks.
  42. 42. Fetal station This is the relationship between the presenting part, whether that be the head, shoulder, buttocks, or feet, and two parts of the maternal pelvis called the ischial spines. Normally the ischial spines are the narrowest part of the pelvis, and are a natural measuring point for the delivery progress. If the presenting part lies above the ischial spines, the station is reported as a negative number from 0 to -3 where each number is a centimeter. If the presenting part lies below the ischial spines, the station is reported as a positive number from 0 to 3 where
  43. 43. 0 Station
  44. 44. +1 Station
  45. 45. +2 Station
  46. 46. +3 Station
  47. 47. Fetal lie: This is the relationship between the head to tailbone axis of the fetus and the head to tailbone axis of the mother. If the two are parallel, then the fetus is said to be in a longitudinal lie. If the two are at 90-degree angles to each other, the fetus is said to be in a transverse lie. Nearly all (99.5%) fetuses are in a longitudinal lie.
  48. 48. Transverse Lie
  49. 49. Longitudinal Lie
  50. 50. Fetal attitude: The fetal attitude describes the relationship of the fetus' body parts to one another. The normal fetal attitude is commonly referred to as the fetal position: the head is tucked down to the chest, with arms and legs drawn in towards the center of the chest. Abnormal fetal attitudes may include a head that is extended back or other body parts extended or positioned behind the back. Abnormal fetal attitudes can increase the diameter of theBACK TO TOPICS
  51. 51. Cephalic (head first) presentation is considered normal, but a breech (feet or buttocks first) delivery can be very difficult, even dangerous for the mother and the
  52. 52. Types of Breech Presentation
  53. 53. If your baby is breech, his bottom is the part of his body closest to the birth canal. No one is sure what causes a breech presentation, but it happens in 3% to 5% of single-baby deliveries. There are three types of breech presentation: complete, incomplete, and frank. Complete breech is when both of the baby's knees are bent and his feet and bottom are closest to the birth canal. Incomplete breech is when one of the baby's knees is bent and his foot and bottom are closest to the birth canal. BACK TO TOPICS
  54. 54. An abortion is the removal or expulsion of an embryo or fetus from the uterus, resulting in or caused by its death. This can occur spontaneously as a miscarriage, or be artificially induced by chemical, surgical or other means. Abortion (from the Latin word aboriri, "to perish") may be briefly defined as "the loss of a fetal life."
  55. 55. • Abortion • Loss of pregnancy before viability of fetus; may be • spontaneous, therapeutic or elective (clients may use • term “miscarriage” for spontaneous abortion.) •
  56. 56. • Types: • a. Threatened abortion –cervix closed –some bleeding and contractions –fetus is not expelled • b. Inevitable –cervix open –heavier bleeding and stronger contractions –loss of fetus usually not avoidable
  57. 57. Incomplete 1. expulsion of fetus is incomplete 2. membranes or placenta retained Complete 1. all products of conception expelled Missed 1. fetus dies in uterus, but is not expelled
  58. 58. • . Habitual – three pregnancy in a row culminating in • spontaneous abortion – may indicate need for investigation into underlying causes
  59. 59. • Assessment findings: • Vaginal bleeding (observing carefully for accurate • determination of amount, saving all perineal pads). • Contractions; pelvic cramping, backache • Lowered hemoglobin if blood loss significant • Passage of fetus/tissue •
  60. 60. • Nursing interventions: • Save all tissue passed (Histopathology examination). • Keep client at rest and teach reason for bed rest. • Increased fluids PO or IV as ordered. • Prepare client for surgical intervention (D & C or suction evacuation) if needed
  61. 61. • Provide discharge teaching about limited activities • and coitus after bleeding ceases. • Observe reaction of mothers and others, provide • emotional support and give opportunity to express • feelings of grief and loss. • Administer Rhogam if mother is Rh negative. •
  62. 62. Two Types of Abortion: Spontaneous abortions Is generally referred to as miscarriages, occur when an embryo or fetus is lost due to natural causes before the 20th week of gestation Induced abortion A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the fetus, in addition to the legality, regional availability, and doctor- patient preference for specific procedures.
  63. 63. Types of Induced Abortion: Surgical Abortion In the first twelve weeks, suction-aspiration or vacuum abortion is the most common method. Medical Abortion Effective in the first trimester of pregnancy, medical (sometimes called chemical abortion) Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost)
  64. 64. Medical Abortion