Fertility control

4,393
-1

Published on

contraceptive methods

4 Comments
12 Likes
Statistics
Notes
No Downloads
Views
Total Views
4,393
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
0
Comments
4
Likes
12
Embeds 0
No embeds

No notes for slide

Fertility control

  1. 1. Fertility Control<br />Reynel Dan L. Galicinao<br />
  2. 2. Basic principles<br />
  3. 3. Contraception - prevention of fertility on a temporary basis<br />Sterilization - permanent prevention of fertility<br />Female and male sterilization procedures<br />Some procedures can be reversed but with possible complications and variable success rates<br />It is best to include both partners in any contraception decision<br />
  4. 4. Contraception effectiveness depends on motivation<br /><ul><li>A result of education, culture, religion, personal situation</li></ul>Nurses should be familiar with contraceptive methods and educate patients without moral judgment<br />Failure rate (pregnancy)<br /><ul><li>determined by experience of 100 women for 1 year
  5. 5. expressed as pregnancies per 100 woman-years</li></li></ul><li>CONTRACEPTIVE METHODS<br />
  6. 6. Natural methods<br />
  7. 7. Periodic Abstinence <br />Abstain from intercourse during fertile period of each cycle<br />Determine fertile period by: <br /><ul><li>Calendar method - ovulation occurs 14 days before next menstrual period</li></li></ul><li>
  8. 8. <ul><li>Cervical mucus method - increase in mucus at time of ovulation; clear and stringy
  9. 9. Basal body temperature - drops immediately before ovulation and rises 24-72 hours after ovulation
  10. 10. Symptothermal method - combines cervical mucus method and basal body temperature</li></li></ul><li>Advantages<br />Disadvantages<br /><ul><li>No health hazards
  11. 11. Inexpensive
  12. 12. May be religiously acceptable
  13. 13. Increased knowledge of cycles
  14. 14. 20% failure rate
  15. 15. Requires consistent record-keeping
  16. 16. Decrease in spontaneity</li></li></ul><li>Coitus Interruptus<br />Withdrawal of penis from vagina when ejaculation is imminent<br />Must withdraw before ejaculation so that ejaculation occurs away from female genitalia<br />
  17. 17. Advantages<br />Disadvantages<br /><ul><li>No cost
  18. 18. No health hazards
  19. 19. Always available
  20. 20. Failure rate of 19%; preejaculatory fluid may contain sperm
  21. 21. Interruption of sexual act</li></li></ul><li>Lactation<br />Breast-feeding has a contraceptive effect <br /><ul><li>due to prolactin's inhibition of luteinizing hormone, which maintains menstrual cycle</li></ul>Breast-feed on demand, around the clock, without formula supplementation<br />
  22. 22. Advantages<br />Disadvantages<br /><ul><li>No health hazards
  23. 23. No cost
  24. 24. Unreliable
  25. 25. Need to use other method such as spermicide or barrier, which has no effect on breast milk</li></li></ul><li>Barrier method<br />
  26. 26. NURSING ALERT <br />Warn patients who use condoms, diaphragms, and the cervical cap that latex sensitivity may be a problem<br />Watch for itching, swelling, generalized reactions<br />
  27. 27. Condom (male and female)<br />Latex or polyurethane or processed collagenous tissue sheaths<br />Placed over erect penis to prevent semen from entering vagina<br />Female condom is placed in the vagina<br />Place condom over erect penis<br />
  28. 28. Leave dead space at tip of condom (from which air has been expelled) <br /><ul><li>To allow room for ejaculate</li></ul>Use spermicide on exterior for added protection<br />Grasp ring around condom at withdrawal to avoid leaving condom in vagina<br />
  29. 29.
  30. 30. Advantages<br />Disadvantages<br /><ul><li>Failure rate is low with proper use (3%)
  31. 31. Prevention of sexually transmitted diseases (STD)
  32. 32. Inexpensive
  33. 33. No health hazard
  34. 34. Decreased sensitivity
  35. 35. Interruption of sexual act
  36. 36. Sensitivity to latex may be a problem
  37. 37. Failure rate with typical use is 12%</li></li></ul><li>Advantages<br />Disadvantages<br /><ul><li>May help premature ejaculation by decreasing sensitivity
  38. 38. Increases male involvement in contraception
  39. 39. Female condoms are more expensive, made of polyurethan</li></li></ul><li>Diaphragm <br />Rubber cap shaped like a dome with a flexible rim<br />Check for holes<br />Place spermicide inside dome<br />Place diaphragm against and covering cervical opening, behind lower edge of pubic bone<br />Leave in place for at least 6 hours after intercourse<br />
  40. 40.
  41. 41. Advantages<br />Disadvantages<br /><ul><li>Failure rate with perfect use is 6%; 18% with typical use
  42. 42. Protection against STDs and possibly cervical neoplasia
  43. 43. Occasional toxic shock or allergic reactions
  44. 44. May experience pelvic discomfort
  45. 45. Possible increase in urinary tract infections
  46. 46. Must be properly cleaned with soap and water, dried and stored to preserve integrity of rubber</li></li></ul><li>Cervical Cap <br />Rubber cap, shaped like a cup with a tall dome and flexible rim<br />Place spermicide inside cap and place cap over cervical opening prior to intercourse<br />
  47. 47. spermicides<br />
  48. 48. Advantages<br />Disadvantages<br /><ul><li>Failure rate similar to diaphragm
  49. 49. May decrease risk of STDs
  50. 50. Risk of toxic shock, cervicitis, and PID
  51. 51. Requires frequent follow-up
  52. 52. Must be properly cleaned with soap and water, dried, and stored</li></li></ul><li>Nonoxynol-9 or octoxynol-9 <br />Available in a variety of forms: <br /><ul><li>Foam
  53. 53. Jelly
  54. 54. Cream
  55. 55. Suppository
  56. 56. Tablet</li></ul>Place next to cervix before intercourse<br />Better if used with a barrier method<br />
  57. 57. Advantages<br />Disadvantages<br /><ul><li>Available in a variety of forms
  58. 58. Sold over-the-counter
  59. 59. Less effective if not used with barrier method; generally, 21% failure rate
  60. 60. Some patients are allergic
  61. 61. Increases risk of UTI
  62. 62. Frequent use may cause genital lesions, increasing risk of HIV transmission</li></li></ul><li>Intrauterine devices<br />
  63. 63. IUD<br />Small device made of plastic with exposed copper or progesterone-release system<br />Acts to inhibit uterine wall implantation<br />Health care provider inserts device; slowly and usually at time of menses<br />Check intrauterine device string regularly (at least once per month) or after each intercourse when it is first inserted<br />
  64. 64.
  65. 65. Advantages<br />Disadvantages<br />Failure rate low, 2% or less<br />Convenient<br />Permits spontaneous intercourse <br />Replaced every 10 years, depending on manufacturer recommendations<br />Risk of PID and resultant tubal damage and infertility<br />May cause spotting, bleeding, or pain<br />Risk of spontaneous abortion<br />Risk of uterine rupture (rare)<br />
  66. 66. hormones<br />
  67. 67.
  68. 68. Combination Oral Contraceptives <br />Tablets containing estrogen to inhibit ovulation and progestin to make cervical mucus impenetrable to sperm<br />Lowest effective doses are used<br />Take for 21 days with 7 days off <br />Or 28 days (if 7 days of placebos are included)<br />
  69. 69. Advantages<br />Disadvantages<br /><ul><li>As low as 0.1% failure rate
  70. 70. Decreased risk of endometriosis, ovarian and endometrial cancer, benign breast disease
  71. 71. Possible decreased risk of PID
  72. 72. Serious adverse reactions include:
  73. 73. Thrombophlebitis
  74. 74. Pulmonary embolism
  75. 75. Myocardial infarction
  76. 76. Cerebral embolism
  77. 77. especially for those who smoke cigarettes or are overweight. </li></li></ul><li>Advantages<br />Disadvantages<br /><ul><li>Aid in menstrual disorders
  78. 78. Improves acne
  79. 79. Questionable risk of breast, cervical cancer
  80. 80. May experience:
  81. 81. Nausea
  82. 82. Vomiting
  83. 83. Headache
  84. 84. Weight gain
  85. 85. Must remember to take at same time daily</li></li></ul><li>Progestin-only oral contra ceptive (mini-pill) <br />Smaller doses of progestins than in combined oral contraceptives<br />Take daily.<br />
  86. 86. Advantages<br />Disadvantages<br /><ul><li>As low as 0.5% failure rate
  87. 87. Avoids estrogen-related adverse effects and possibly cardiovascular risks
  88. 88. May offer protection against PID
  89. 89. Safe in breast-feeding
  90. 90. May cause:
  91. 91. Irregular menses
  92. 92. Spotting
  93. 93. Amenorrhea</li></li></ul><li>Combination Transdermal Contraceptive Patch <br />Estrogen and progesterone are absorbed systemically<br />As efficacious as oral hormones<br />Apply weekly to buttocks, inner aspect of upper arms, or abdomen for 3 weeks, then off for 1 week for menses<br />
  94. 94. Advantages<br />Disadvantages<br /><ul><li>Same as oral hormones but administered weekly
  95. 95. Avoids first pass metabolism through liver
  96. 96. Same as oral hormones
  97. 97. May become loose or cause minor skin reaction</li></li></ul><li>Hormonal Vaginal Contraceptive <br />Vaginal ring containing estrogen and progesterone<br />As effective as oral contraceptive<br />Insert ring into vagina on day 5 of cycle<br />Remove after 3 weeks for 1 week for menses<br />
  98. 98. Advantages<br />Disadvantages<br /><ul><li>Same as oral contraceptives except is administered monthly
  99. 99. Avoids first-pass metabolism through the liver
  100. 100. Same as oral contraceptives
  101. 101. Requires vaginal insertion and retrieval</li></li></ul><li>Postcoital Contraception (Morning-after Pill) <br />May be:<br /><ul><li>Combined estrogen and progestin
  102. 102. High-dose estrogen
  103. 103. Progestin</li></ul>Must be started within 24-72 hours after intercourse<br />
  104. 104. Advantages<br />Disadvantages<br /><ul><li>Very effective
  105. 105. May be religiously opposed
  106. 106. Can cause nausea
  107. 107. May cause birth defects</li></li></ul><li>Progesterone Implant <br />Progesterone release system made up of five silastic rods<br />Implanted in subcutaneous fat of upper arm.<br />
  108. 108. Advantages<br />Disadvantages<br /><ul><li>Long-term
  109. 109. Convenient
  110. 110. Only 0.9% failure rate
  111. 111. May cause:
  112. 112. Irregular bleeding
  113. 113. Spotting
  114. 114. Amenorrhea
  115. 115. Acne
  116. 116. Headaches
  117. 117. May be difficult to remove
  118. 118. High initial expense</li></li></ul><li>Progesterone injection (Depo-Provera) <br />I.M. injection of long-acting progesterone<br />Initial injection within first 5 days of menses, then every 3 months<br />
  119. 119. Advantages<br />Disadvantages<br />Convenient<br />Only 0.3% failure rate<br />Requires every 3-month follow-up<br />May cause irregular bleeding, spotting, amenorrhea<br />Long-term effects still unknown<br />High discontinuation rate in adolescents due to adverse effects and missed appointments<br />
  120. 120. Combination Hormonal Injection <br />Estrogen and progesterone in long-acting injection form<br />Initial injection within 5 days of menses, then every 28-30 days<br />
  121. 121. Advantages<br />Disadvantages<br /><ul><li>Convenient
  122. 122. Low failure rate
  123. 123. Regular menses
  124. 124. Requires monthly follow-up
  125. 125. Some adverse reactions as oral contraceptives</li></li></ul><li>
  126. 126. Progesterone antagonist<br />
  127. 127. RU-486 (Mifepristone) <br />Drug that prevents implantation and leads to menses (medical abortion)<br />Given orally within 10 days of a missed period<br />May be combined with prostaglandin suppository<br />
  128. 128. Advantages<br />Disadvantages<br /><ul><li>Causes abortion in 95% of users up to 5 weeks after conception
  129. 129. May be religiously opposed
  130. 130. May cause:
  131. 131. Nausea
  132. 132. Bleeding
  133. 133. incomplete abortion</li></li></ul><li>STERILIZATION PROCEDURES<br />
  134. 134. Tubal sterilization<br />
  135. 135. Approaches<br />Abdominal is most frequently used: may be postpartum laparotomy, minilaparotomy, or laparoscopy<br />Laparoscopy with electrocoagulation is frequently performed<br />It is a safe and effective procedure<br />Vaginal incision in posterior vagina (colpotomy) with the uterine tube pulled through it<br /><ul><li>Higher rate of complications/infection</li></li></ul><li>Techniques<br />Vary by surgeon preference<br />Electrocoagulation<br /><ul><li>most common
  136. 136. burn section of tube with or without excision
  137. 137. low reversal rate</li></ul>Pomeroy<br /><ul><li>the tube is tied in midsection and section removed
  138. 138. may be reversed</li></li></ul><li>Fimbriectomy<br /><ul><li>the fimbriated end removed and end tied
  139. 139. Irreversible</li></ul>Cornual resection<br /><ul><li>removal of the section of tube nearest uterus and suture cornual opening closed</li></ul>Silastic bands<br /><ul><li>plastic or metal clips to occlude tube
  140. 140. may be reversed</li></li></ul><li>
  141. 141. Complications<br />Failure to successfully block the tubes<br />Pregnancy or tubal pregnancy<br />Hemorrhage<br />Infection<br />Uterine perforation<br />Damage to bowel, bladder, or aorta<br />
  142. 142. Nursing Interventions<br />Assess motivation for sterilization and level of knowledge about the procedure<br />Counsel as necessary<br />Teach patient there is no effect on hormones and menstruation will continue<br />Teach patient there should not be any adverse effect on sexual response<br />
  143. 143. Other birth control methods are discontinued immediately before the procedure<br />Prepare the patient to expect some abdominal soreness for several days<br />Instruct her to report any bleeding, increasing pain, or fever<br />Sexual intercourse and strenuous activity should be avoided for 2 weeks<br />
  144. 144. Advantages<br />Disadvantages<br /><ul><li>Low incidence of complications
  145. 145. Short recovery
  146. 146. Leaves small or no scar
  147. 147. Quickly performed
  148. 148. Permanent
  149. 149. Reversal difficult and expensive
  150. 150. Sterilization procedures technically difficult </li></li></ul><li>Advantages<br />Disadvantages<br /><ul><li>Requires surgeon, operating room, trained assistants, medications, surgical equipment
  151. 151. Expensive at the time performed
  152. 152. If failure, high probability of ectopic pregnancy
  153. 153. No protection against STDs, including HIV </li></li></ul><li>vasectomy<br />
  154. 154. Vasectomy<br />Male sterilization<br />Ligation and transection of part of the vas deferens, with or without removal of a segment of the vas deferens<br />The spermatozoa, which are manufactured in the testes, cannot travel up the vas deferens after this surgery.<br />
  155. 155.
  156. 156. Advantages<br />Disadvantages<br /><ul><li>Highly effective
  157. 157. Relieves the female of the contraceptive burden
  158. 158. Inexpensive in the long run
  159. 159. Permanent
  160. 160. Expensive in the short term
  161. 161. Serious long-term effects suggested (although currently unproved)
  162. 162. Permanent (although reversal is possible, it is expensive and requires a highly technical and major surgery, and its results cannot be guaranteed) </li></li></ul><li>Advantages<br />Disadvantages<br /><ul><li>Highly acceptable procedure to most clients
  163. 163. Very safe
  164. 164. Quickly performed
  165. 165. Regret in 5%–10% of patients
  166. 166. No protection against STDs, including HIV
  167. 167. Not effective until sperm remaining in the reproductive system are ejaculated </li></li></ul><li>http://nurseRD.blogspot.com<br />www.authorstream.com/reynel89/Nursing<br />www.slideshare.net/reynel89/slideshows<br />THANK YOU!Have a nice day : )<br />- RDG<br />

×