Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
INTRODUCTION OF
CONTRACEPTIVE IMPLANTS
Prepared By: Dr.Kiak
Obstetrics & Gynecology Division
Date: 2014 - 04 - 18
Sub-derm...
CONTENT
 Brief Introduction
 What is It
 Component/Structure
 Release Rate of Levonorgestrel
 Pre-clinical Evaluation...
Brief Introduction
 Implants are approved in more than 60 developed and
developing countries and are currently being used...
Countries using Implant
Burundi
Ethiopia
Ghana
Malawi
Mali
China
Indonesia
Kenya In Progress (n=20)
Under Review (n=10)
Ne...
Levonorgestrel subdermal implants provide effective long
term contraception.
Implants are a good choice of contraceptive...
Long-Acting & Permanent Methods
 The advantages that implants and other methods such as
the IUD offer over other contrace...
Components
 Implants is a set of two flexible cylindrical implants
consisting of a dimethylsiloxane/ methylvinylsiloxane
...
Medical adhesive
43mm thin-walled silicon tubing
levonorgestrel & Siloxane copolyme
12.5mm
Components
Session IV A, Slide ...
Structure
 The sole active ingredient in the rods is levonorgestrel (-)-13-
ethyl-17-hydroxy-18,19-dinor-17α-pregn-4-en-2...
Release Rate of Levonogestrel
 Diffusion of Levonogestrel from the rods produces a continuous
low dose of the progestin a...
Pre Clinical Evaluation
Levonorgestrel implant is a totally synthetic &
Biologically active Progestin- does not contain
e...
Mechanism Of Actions
At least 3 mechanism are active in preventing pregnancy
1. Ovulation inhibition- by suppressing of
go...
Efficacy/Fertility
It is convenient, safe, and over 99% effective
Prevents against pregnancy for up to 5 years, can be
r...
Subjective Symptoms
The cost is K1040-K2080 and around K200-K400
for removal
Headache
Nausea
Breast pain & Mood change...
Timing of Insertion
Should be inserted on day 1-5 during menstrual cycle
Immediately or on week after 1st/2nd trimester
...
Implant Insertion Technique
Session IV A, Slide #2
One-Rod Implant Insertion:
Required Equipment
• An examination table
• ...
Session IV A, Slide #4
Implanon Insertion: Step 1
• Have the client lie on
her back with the arm
that she doesn’t
normally...
Session IV A, Slide #6
Implanon Insertion: Step 3
• Mark the insertion site
with a marker.
• Make 2 marks:
– First, mark t...
Session IV A, Slide #7
Implanon Insertion: Step 4
• Clean the client’s upper
arm with antiseptic
solution. Frame the
inser...
Session IV A, Slide #8
Implanon Insertion: Step 5
• Remove the needle
shield.
• Stretch the skin around
the insertion site...
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture...
Session IV A, Slide #16
Implanon Insertion: Step 13
• Verify the presence of the implant by
palpating the site.
• Apply a ...
Sino-implant (II) Jadelle Implanon
Manufacturer Shanghai Dahua
Pharmaceutical
Bayer HealthCare Schering Plough /
Organon
F...
Monthly Stat for Implants
 There were total of 102 implants done for the first half of April
2014, MGH 70, Ialibu 28 & MT...
Summary
 Contraceptive implant system provides effective,long-
acting, reversible contraception for women.
 Two thin, fl...
You cannot have maternal health without reproductive health. And
reproductive health includes contraception and family pla...
Upcoming SlideShare
Loading in …5
×

Implants.ppt3

Jadella Implant is a form family planning which comes in two silicon rods,implan subdermal Over the years it release progestin to prevent ovulation thus prevent pregnancy

  • Be the first to comment

Implants.ppt3

  1. 1. INTRODUCTION OF CONTRACEPTIVE IMPLANTS Prepared By: Dr.Kiak Obstetrics & Gynecology Division Date: 2014 - 04 - 18 Sub-dermal Contraceptive Implant JADELLE LEVONORGESTREL
  2. 2. CONTENT  Brief Introduction  What is It  Component/Structure  Release Rate of Levonorgestrel  Pre-clinical Evaluation  Mechanism of Action  Efficacy/Fertility  Subjective Symptoms  Timing of Insertion  Implant Insertion Technique  Comparison - New Hormonal Implants  Monthly Stat for Implants -MGH  Summary
  3. 3. Brief Introduction  Implants are approved in more than 60 developed and developing countries and are currently being used by millions of women worldwide 1 . Owing to their high contraceptive efficacy (which begins almost immediately after insertion), low rate of complications and side-effects, possibility of long-term use following a single intervention and the rapid return of fertility after removal.  Contraceptive implants are good candidates for inclusion in the method mix offered by family planning programmes, especially in under-resourced setting 2 . 1. Ref: Contraceptive implants come of age. Progress in Reproductive Health Research 2003; No. 61. Geneva; World Health Organization (www.who.int/reproductive-health/hrp/progress/61/news61.htm (accessed 1 September 2008). 2. Boostra H, Duran V, Weaver K. Norplant and the boom or bust phenomenom. IPPF Medical Bulletin October 1999;33:3–4.
  4. 4. Countries using Implant Burundi Ethiopia Ghana Malawi Mali China Indonesia Kenya In Progress (n=20) Under Review (n=10) Nepal Pakistan Rwanda Tanzania Uganda Argentina Bangladesh Bolivia Brazil Burkina Faso Chile Colombia Dominican Republic Ecuador Fiji India Mexico Mozambique Nigeria Peru Russia South Africa Sudan Venezuela Zimbabwe REGISTERED (n=6) Sierra Leone Madagascar Zambia
  5. 5. Levonorgestrel subdermal implants provide effective long term contraception. Implants are a good choice of contraceptive method in women who desire effective contraception, but who are unable to, or prefer not to, comply with an oral regimen or injection. Implants maybe used to postpone 1st pregnancy Space pregnancy Provide long-term contraception when desired family size is reached What is it?
  6. 6. Long-Acting & Permanent Methods  The advantages that implants and other methods such as the IUD offer over other contraceptive methods is that they are not user-dependent in the way that condoms, injectables & combined oral contraceptives (COC) are 3 . Ref. 3.Russell J. Contraceptive failure in the United States. Contraception 2004;70:89–96.
  7. 7. Components  Implants is a set of two flexible cylindrical implants consisting of a dimethylsiloxane/ methylvinylsiloxane copolymer core enclosed in thin-walled silicone tubing. Each rod contains 75 mg of the progestin levonorgestrel. The core of each rod is a mixture, half of levonorgestrel, half of the elastomer. The rods are sealed with polydimethylsiloxane adhesive & sterilized. Each rod is approximately 2.5 mm in diameter & 43 mm in length 4 . Ref. 4. Harold Nash, and Sandra Waldman. Jadelle ィ Levonorgestrel Rod Implants:.A Summary of Scientific Data and Lessons Learned from Programmatic Experience Irving Sivin,
  8. 8. Medical adhesive 43mm thin-walled silicon tubing levonorgestrel & Siloxane copolyme 12.5mm Components Session IV A, Slide #3 Implanon Applicator
  9. 9. Structure  The sole active ingredient in the rods is levonorgestrel (-)-13- ethyl-17-hydroxy-18,19-dinor-17α-pregn-4-en-20-yn-3-one. It has a molecular weight of 312.45 and the structural formula.  Medical grade silicone rubber materials, including the type used in Jadelle, have been employed in various implantable devices for humans since 1950 4 .  Silicone rubber implant have be employed in various implantable device  Prosthetic devices  Heart valves  Drainage tubes QuickTime™ and a decompressor are needed to see this picture. Ref. 4. Harold Nash, and Sandra Waldman. Jadelle ィ Levonorgestrel Rod Implants:.A Summary of Scientific Data and Lessons Learned from Programmatic Experience Irving Sivin,
  10. 10. Release Rate of Levonogestrel  Diffusion of Levonogestrel from the rods produces a continuous low dose of the progestin and is is delivered directly into interstitial fluids from the subcutaneous implants  After placement of Jadelle rods,levonorgestrel concentrations reach a maximum level within 2-3 days after implant  Decline rapidly over the 1st month both due to a decrease in the rate of release & because of decreased circulating levels of sex hormone binding globulin (SHBG), a protein that binds levonorgestrel. Jadelle/Day Dosage/Rate Remarks 1 month 100g/day 12 months 40g/day 24 months 30g/day -stabilizing thereafter
  11. 11. Pre Clinical Evaluation Levonorgestrel implant is a totally synthetic & Biologically active Progestin- does not contain estrogen- a subdermal contraceptive implant A double silicon rods preload in a sterile disposable applicator to facilitate easy & rapid insertion Release of Levonorgestrel sufficient to prevent conception within 24hrs after implant Effective role for 5 years
  12. 12. Mechanism Of Actions At least 3 mechanism are active in preventing pregnancy 1. Ovulation inhibition- by suppressing of gonadotrophins (LH&FSH) secretion 2. Thickening of the cervical mucus -increase viscosity of the cervical mucus that preventing passage of sperm into the uterus 3. Decrease endometrial thickening during the use of implants.
  13. 13. Efficacy/Fertility It is convenient, safe, and over 99% effective Prevents against pregnancy for up to 5 years, can be removed @ anytime Return to fertility rapidly after removal. Another Jadelle implant can be inserted immediately after removal for protection against pregnancy  It is invisible Can be used without anything else
  14. 14. Subjective Symptoms The cost is K1040-K2080 and around K200-K400 for removal Headache Nausea Breast pain & Mood changes Others include- pain, itchiness, infection and expulsion on insertion site This does not protect you from STDs
  15. 15. Timing of Insertion Should be inserted on day 1-5 during menstrual cycle Immediately or on week after 1st/2nd trimester abortion In Postpartum women  Non BF women immediately or within 6 wks after labor  BF women should not use implants before 6 wks after labor.  However,studies have shown no significant effects on the growth or health of infants whose nursing mothers began using levonorgestrel implants immediately or 5-7 wks after childbirth. There is no experience to support the use of Jadelle earlier than six weeks after childbirth in lactating women
  16. 16. Implant Insertion Technique Session IV A, Slide #2 One-Rod Implant Insertion: Required Equipment • An examination table • Sterile surgical drapes (optional) and gloves • Antiseptic solution • Local anesthetic, needles, and syringe • Implanon applicator • Skin closure, sterile gauze, and compresses QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. Two rods implant Insertion Required Equipment
  17. 17. Session IV A, Slide #4 Implanon Insertion: Step 1 • Have the client lie on her back with the arm that she doesn’t normally use flexed at the elbow and externally rotated. • Implanon should be inserted sub-dermally just under the skin. QuickTime™ and a decompressor are needed to see this picture. Jadelle Insertion: Step 1
  18. 18. Session IV A, Slide #6 Implanon Insertion: Step 3 • Mark the insertion site with a marker. • Make 2 marks: – First, mark the spot where the rod will be inserted. – Second, mark a spot a few centimeters proximal to the first mark. This second mark will later serve as a direction guide during insertion. QuickTime™ and a decompressor are needed to see this picture. Jadelle Insertion: Step 2 3 Finger breath Medial Epicondyle
  19. 19. Session IV A, Slide #7 Implanon Insertion: Step 4 • Clean the client’s upper arm with antiseptic solution. Frame the insertion area with a drape that has an opening (optional). • Anesthetize the insertion area with anesthetic spray or by injecting 2 cc of 1% lidocaine just under the skin along the planned insertion tunnel). QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. Jadelle Insertion: Step 4-5 Injection 10cc of 1% Lidocaine just under the skin
  20. 20. Session IV A, Slide #8 Implanon Insertion: Step 5 • Remove the needle shield. • Stretch the skin around the insertion site with thumb and index finger. Session IV A, Slide #9 Implanon Insertion: Step 6 • Insert the tip of the needle, at about a 20 degree angle. QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. Jadelle Insertion: Step 6 Jadelle Insertion: Step 7
  21. 21. QuickTime™ and a decompressor are needed to see this picture. QuickTime™ and a decompressor are needed to see this picture. Session IV A, Slide #10 Implanon Insertion: Step 7 • Release the skin. • Lower the applicator to a horizontal position. Session IV A, Slide #11 Implanon Insertion: Step 8 • Lift the skin with the tip of the needle, keeping the needle in the subdermal connective tissue. • While lifting the skin, gently insert the entire needle. Keep the applicator parallel to the surface of the skin. Jadelle Insertion: Step 8 Jadelle Insertion: Step 9
  22. 22. Session IV A, Slide #16 Implanon Insertion: Step 13 • Verify the presence of the implant by palpating the site. • Apply a sterile gauze and wrap the arm with a pressure bandage. • Before the client is discharged, observe her for a few minutes for signs of bleeding from the insertion site. • Fill out the user card and give it to the client. • Review post-insertion instructions and other key messages. • Dispose of the applicator and syringe properly. QuickTime™ anda decompressor areneededto seethis picture. Jadelle Insertion: Step 10
  23. 23. Sino-implant (II) Jadelle Implanon Manufacturer Shanghai Dahua Pharmaceutical Bayer HealthCare Schering Plough / Organon Formulation 150 mg levonorgestrel In 2 rods 150 mg levonorgestrel In 2 rods 68 mg etonogestrel In 1 rod Mean Insertion & Removal time Insertion: 2 min Removal: 4.9 min Insertion: 2 min Removal: 4.9 min Insertion: 1.1 min Removal: 2.6 min Labeled duration of product use 4 years 5 years 3 years Trocars Disposable Autoclavable / Disposable Pre-loaded disposable Cost of implant (US$) K17.00 K55.00 K52.00 Cost per Year (if used for duration) K5.20 K12.40 K17.42 New hormonal implants Comparison of Sino-Implant, Jadelle, Implanon
  24. 24. Monthly Stat for Implants  There were total of 102 implants done for the first half of April 2014, MGH 70, Ialibu 28 & MTC 14 1 2 5 10 52 0 10 20 30 40 50 60 TOTAL NUMBER Extra-uterine Pregnany Purperal Sepsis Cearean Section Para >5 Para 1-4 INDICATIONS JADELLE IMPLANTS-MGH Remarks: Positive Response to Jadelle Implants
  25. 25. Summary  Contraceptive implant system provides effective,long- acting, reversible contraception for women.  Two thin, flexible rods made of silicone tubing and filled with levonorgestrel, a synthetic progestin, are inserted just under the skin of a woman’s upper,inner arm in a minor surgical procedure.  Protection from pregnancy is provided within 24 hours, when insertion is performed during the first week of a woman’s menstrual cycle.  The woman rapidly returns to her normal fertility when the implants are removed.  Sub-dermal implantable contraceptives are highly effective, easy to use and carry a low risk of side-effects. These features make them a good option for women in under-resourced settings.
  26. 26. You cannot have maternal health without reproductive health. And reproductive health includes contraception and family planning and access to legal, safe abortion. Hillary Clinton quotes

×