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Fertility control
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Fertility control



contraceptive methods

contraceptive methods



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    Fertility control Fertility control Presentation Transcript

    • Fertility Control
      Reynel Dan L. Galicinao
    • Basic principles
    • 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
    • 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
      • expressed as pregnancies per 100 woman-years
    • Natural methods
    • 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
      • Cervical mucus method - increase in mucus at time of ovulation; clear and stringy
      • Basal body temperature - drops immediately before ovulation and rises 24-72 hours after ovulation
      • Symptothermal method - combines cervical mucus method and basal body temperature
    • Advantages
      • No health hazards
      • Inexpensive
      • May be religiously acceptable
      • Increased knowledge of cycles
      • 20% failure rate
      • Requires consistent record-keeping
      • 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
    • Advantages
      • No cost
      • No health hazards
      • Always available
      • Failure rate of 19%; preejaculatory fluid may contain sperm
      • 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
    • Advantages
      • No health hazards
      • No cost
      • Unreliable
      • 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
    • 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
    • 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
    • Advantages
      • Failure rate is low with proper use (3%)
      • Prevention of sexually transmitted diseases (STD)
      • Inexpensive
      • No health hazard
      • Decreased sensitivity
      • Interruption of sexual act
      • Sensitivity to latex may be a problem
      • Failure rate with typical use is 12%
    • Advantages
      • May help premature ejaculation by decreasing sensitivity
      • Increases male involvement in contraception
      • 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
    • Advantages
      • Failure rate with perfect use is 6%; 18% with typical use
      • Protection against STDs and possibly cervical neoplasia
      • Occasional toxic shock or allergic reactions
      • May experience pelvic discomfort
      • Possible increase in urinary tract infections
      • 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
    • spermicides
    • Advantages
      • Failure rate similar to diaphragm
      • May decrease risk of STDs
      • Risk of toxic shock, cervicitis, and PID
      • Requires frequent follow-up
      • Must be properly cleaned with soap and water, dried, and stored
    • Nonoxynol-9 or octoxynol-9
      Available in a variety of forms:
      • Foam
      • Jelly
      • Cream
      • Suppository
      • Tablet
      Place next to cervix before intercourse
      Better if used with a barrier method
    • Advantages
      • Available in a variety of forms
      • Sold over-the-counter
      • Less effective if not used with barrier method; generally, 21% failure rate
      • Some patients are allergic
      • Increases risk of UTI
      • Frequent use may cause genital lesions, increasing risk of HIV transmission
    • Intrauterine devices
    • 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
    • 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)
    • hormones
    • 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)
    • Advantages
      • As low as 0.1% failure rate
      • Decreased risk of endometriosis, ovarian and endometrial cancer, benign breast disease
      • Possible decreased risk of PID
      • Serious adverse reactions include:
      • Thrombophlebitis
      • Pulmonary embolism
      • Myocardial infarction
      • Cerebral embolism
      • especially for those who smoke cigarettes or are overweight.
    • Advantages
      • Aid in menstrual disorders
      • Improves acne
      • Questionable risk of breast, cervical cancer
      • May experience:
      • Nausea
      • Vomiting
      • Headache
      • Weight gain
      • 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.
    • Advantages
      • As low as 0.5% failure rate
      • Avoids estrogen-related adverse effects and possibly cardiovascular risks
      • May offer protection against PID
      • Safe in breast-feeding
      • May cause:
      • Irregular menses
      • Spotting
      • 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
    • Advantages
      • Same as oral hormones but administered weekly
      • Avoids first pass metabolism through liver
      • Same as oral hormones
      • 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
    • Advantages
      • Same as oral contraceptives except is administered monthly
      • Avoids first-pass metabolism through the liver
      • Same as oral contraceptives
      • Requires vaginal insertion and retrieval
    • Postcoital Contraception (Morning-after Pill)
      May be:
      • Combined estrogen and progestin
      • High-dose estrogen
      • Progestin
      Must be started within 24-72 hours after intercourse
    • Advantages
      • Very effective
      • May be religiously opposed
      • Can cause nausea
      • May cause birth defects
    • Progesterone Implant
      Progesterone release system made up of five silastic rods
      Implanted in subcutaneous fat of upper arm.
    • Advantages
      • Long-term
      • Convenient
      • Only 0.9% failure rate
      • May cause:
      • Irregular bleeding
      • Spotting
      • Amenorrhea
      • Acne
      • Headaches
      • May be difficult to remove
      • High initial expense
    • Progesterone injection (Depo-Provera)
      I.M. injection of long-acting progesterone
      Initial injection within first 5 days of menses, then every 3 months
    • 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
    • Combination Hormonal Injection
      Estrogen and progesterone in long-acting injection form
      Initial injection within 5 days of menses, then every 28-30 days
    • Advantages
      • Convenient
      • Low failure rate
      • Regular menses
      • Requires monthly follow-up
      • Some adverse reactions as oral contraceptives
    • Progesterone antagonist
    • 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
    • Advantages
      • Causes abortion in 95% of users up to 5 weeks after conception
      • May be religiously opposed
      • May cause:
      • Nausea
      • Bleeding
      • incomplete abortion
    • Tubal sterilization
    • 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
      • burn section of tube with or without excision
      • low reversal rate
      • the tube is tied in midsection and section removed
      • may be reversed
    • Fimbriectomy
      • the fimbriated end removed and end tied
      • 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
      • may be reversed
    • Complications
      Failure to successfully block the tubes
      Pregnancy or tubal pregnancy
      Uterine perforation
      Damage to bowel, bladder, or aorta
    • 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
    • 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
    • Advantages
      • Low incidence of complications
      • Short recovery
      • Leaves small or no scar
      • Quickly performed
      • Permanent
      • Reversal difficult and expensive
      • Sterilization procedures technically difficult
    • Advantages
      • Requires surgeon, operating room, trained assistants, medications, surgical equipment
      • Expensive at the time performed
      • If failure, high probability of ectopic pregnancy
      • No protection against STDs, including HIV
    • vasectomy
    • 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.
    • Advantages
      • Highly effective
      • Relieves the female of the contraceptive burden
      • Inexpensive in the long run
      • Permanent
      • Expensive in the short term
      • Serious long-term effects suggested (although currently unproved)
      • 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
      • Very safe
      • Quickly performed
      • Regret in 5%–10% of patients
      • No protection against STDs, including HIV
      • Not effective until sperm remaining in the reproductive system are ejaculated
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      THANK YOU!Have a nice day : )
      - RDG