Contraception and lactation

1. Contraception
Temporary
Natural
Barrier method
O C pills
IUCDs
Injectables
Implants
Permanent
Female sterilisation
Male sterilisation
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2. Barrier methods
Diaphragm,
Cervical cap,
Female condom
Spermicides – Nonoxynol 9
Male condom
Advantages
Prevent STDs
Failure rate is more. 2
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3. IUCDs
Unmedicated IUDs
Lippe's Loop
Copper IUDs
Cu T 200, Cu 7, Multiload Cu T 250,
Cu T 380 – 8yrs.
Hormone relasing IUDs
Progestasert -38 mg of progesterone
65 micro gms / day.
Levonova - 60 mg of levonorgestrel
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4. Patient selection for IUD
- Low risk for STD
- Multiparas
- Monogamous relationship
- Desirous of long term reversible
contraception
- Does not want permanent contraception
- Previous mishap with OC pills or
Barrier contraception.
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5. Contraindications for IUDs
- Suspected pregnancy
-PID, Lower genital tract infection
- Fibroids, Menorrhagia, Dysmenorrhoea
- Severe anaemia
- Uncontrolled DM
- Heart disease
- Previous Ectopic
- Scar on the uterus – Relative
- Unmarried or Nullipara.
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6. Technic of insertion
Mechanism of action
Complications
- Immediate
- Early - Expulsion, Perforation, Spotting
Infection ( Actinomycosis )
Dysmenorrhoea
- PID, Pregnancy, Ectopic, Perforation,
Menorrhagia, Dysmenorrhoea.
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7. Advantages
- Coital independent
- No need for repeated insertion frequently
- Highly effective
- No systemic side effects
- Fertility returns
Non contraceptive use
- Asherman's syndrome and uterine septum.
After resection
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8. Suppression of spermatogenesis
- MPA 250 mg i/m with 200 mg
Nor ethesterone wkly
- GnRh – continuous
- Testosterone Enanthate 200 mg wkly
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9. Suppression of Ovulation
Combined OC pills
Triphasic pilla
Mini pills
Benifits of OC pills
Controll fertility effectively
Scanty periods – good for menorrhagia and
dysmenorrhoea
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10. Benifits – contd
Prevents anaemia
Decrease benign breast disease, Functional
Ovarian cyst , Ovarian and uterine
Malingnancy.
Protect against rheumatoid arthritis
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11. Side effects
Spotting, Scanty periods or amenorrhoea
Infections of genital tract – fungal
Causes – Ca breast (?), Pituitary adenoma
Suppression of lactation
Change in libido
CHO intolerance – CI in DM
Lipid metabolism
Rifambicin - decreases absorption
Thromboembolism
Head ache, dipression, migraine, irritability
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12. Contraindications
Heart disease
Hypertension
Thromboembolism
Myocardial ischemia, sickle cell anaemia
C/C Liver disease
Ca breast, Thyroid disease
Gross obesity
Lactating woman
Women on Rifambcin
Before surgery
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13. Triphasic pills
EE and LNG – different amounts
No adverse effect on CHO and lipids
Mini pill ( POP )
Nor ethiseterone , Nor gestrel or LNG
For lactating women
Contra indications
Malignancy, Previous ectopic, Ovarian
cyst, AUB, Liver disease, arterial
disease
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14. Depot injections
DMPA – 25 – 50 mg with 5mg oestradiol
Monthly – i/m
Subdermal implants
Norplant 1 – 6 silastic capsules
36 mg LNG , for 5 yrs,
50 micro gm / day
Norplant 2 – Two rods , 70 mg LNG.
For 5 yrs , 50 micro gm / day
Remove after 5 yrs.
Biodegradable capsules under trial
Disadvantage – Break through bleeding
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15. Silastic Vaginal Ring ( SVR )
Progerterone 20 micro gm / day
Centchroman ( saheli )
Synthetic non- steroidal
30 mg / day - 1stday, twice wkly for 12 wks
Wkly aftrewards
CI – liver disease, PCOD,cervical
dysplasia
Advantages
Return of fertility
No teratogenic effects
No carcinogenic effect 15
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16. Post coital contraception
EE img / day for 5 days – Within 72hrs
Two tabs of COC with high doses of
hormones
LNG 600 mg / day for 5 days – trial
RU 486 ( Mifipristonr )
Fertilisation not prevented.
Necrosis of endometrium – abortion
25 mg twice/day for 4 days
Pg – last day , complete abortion
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17. THANK YOU
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18. LACTATION
Lactogenisis
Suckling – Ant. Pituitary – Prolactin – milk
Secreting cells – milk production
Dopamine inhibits Pr secretion
Bromocriptine – dopamine agonist
Milk ejection – Neuroendocrine reflex, by
External stimuli
Oxytocin – contraction of
myoepithelial cells
Rooming
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19. First feeding
Within ½ hr after normal delivery
4 hrs after cs.
Exclusive breast feeding
Cholostrum
Demand feeding
Tcchnic of feeding
Requirement
100 ml / kg / 24hrs - 1st wk
150 ml ,, by 19th day
Diet for mother – balenced
500 kcals extra – 2700 kcals
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20. Advantages of breast feeding
Hygienic , convenient, no cost.
Ideal composition for easy digestion
Anti infective properties
Anti allergic properties,less chance for
Developing eczema
Mental growth and IQ better
Bonding between mother and baby
Maternal benefits
Uterine involution
Protection against pregnancy
Acceleration of wt. Loss in the
pureperium
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21. Problems of breast feeding
Insufficient
Retracted nipple
Cracked nipple
Breast engorgement
Preterm baby
wt. Less than 1500 gms require
Supplement.
Less than 34wks – may not suck- EBM
Not replace BF 21
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22. Expressed Breast Milk ( EBM )
6 hrs in room temp
24 hrs in refrigeration
3 months in freezer.
Do not boil EBM
Give immediately after warming
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23. Supression of lactation
Indication
Breast Ca for Tt.
Mother on anticancer drugs,or teratogenic
drugs
Mother on i /v drug abuse
HIV positive mother
Active pul.tuberculosis
Puerperal psychosis
Perinatal death
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24. Drugs
Dopamine antagonist
Bromocriptine, Cabergolin
Pyridoxin
Non – pharmacological
Tight bandaging of breasts
Jasmine flower – through olfactory –
hypothalamic – hypophysis
pathway
Inhibit prolactin
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25. Baby Friendly Hospital Initiative ( BFHI )
To support breast feeding
Guidelines
- Each hospital – written policy about BF
- Training for all msdical/ paramedical staff
- Tteach pregnant women about BF
- First feedin – time
- No supplement to the baby unless indicated
- Rooming the baby
- Feeding on demand
- Avoid pacifier or bottle
- Facility for medical help, if needed
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26. THANK YOU
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