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Fertility control


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contraceptive methods

contraceptive methods

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