The document discusses family planning and contraceptive use in India. It provides statistics on contraceptive knowledge, use, and methods. The total fertility rate is described. Barriers to meeting contraceptive needs include knowledge gaps, fear of side effects, and limited access to and quality of family planning services. Several contraceptive methods are summarized, including condoms, oral contraceptives, IUDs, and the lactational amenorrhea method.
Signs and Symptoms, Investigations-UPT and USG helps to diagnose pregnancy. A midwife can diagnose pregnancy by physical examination of signs and symptoms.
Normal labour and physiology of normal labourJasleen Kaur
This topic will make easy to understand normal labour and physiology behind normal labour to all medical students..Hopefully it would be beneficial to all dear students..
Signs and Symptoms, Investigations-UPT and USG helps to diagnose pregnancy. A midwife can diagnose pregnancy by physical examination of signs and symptoms.
Normal labour and physiology of normal labourJasleen Kaur
This topic will make easy to understand normal labour and physiology behind normal labour to all medical students..Hopefully it would be beneficial to all dear students..
“Clinicians should proactively talk to their patients of reproductive age about ECPs and offer advance prescriptions for ECPs during routine gynecologic office visits….”
This interesting ppt deals with pharmacological aspects of Gynecology highlighting various aspects of it...it'll be very useful for the beginners in Gynecology...
Introduction about postnatal care
Define postnatal care
Aims & objectives postnatal care
Important conditions we should enquire in postnatal care
Schedule of postnatal care
Postnatal exercise
Advice given to the mother during discharge postnatal care
Advice regarding family planning and sterilization during puerperium
“Clinicians should proactively talk to their patients of reproductive age about ECPs and offer advance prescriptions for ECPs during routine gynecologic office visits….”
This interesting ppt deals with pharmacological aspects of Gynecology highlighting various aspects of it...it'll be very useful for the beginners in Gynecology...
Introduction about postnatal care
Define postnatal care
Aims & objectives postnatal care
Important conditions we should enquire in postnatal care
Schedule of postnatal care
Postnatal exercise
Advice given to the mother during discharge postnatal care
Advice regarding family planning and sterilization during puerperium
Methods of randomisation in clinical trialsAmy Mehaboob
Randomization is the process by which allocation of subjects to treatment groups is done by chance, without the ability to predict who is in what group. A randomized clinical trial is a clinical trial in which participants are randomly assigned to separate groups that compare different treatments.
Randomized trials are gold standard of study designs because the potential for bias (selection into treatment groups) is avoided.
This document includes the purpose, types, advantages and disadvantages of each type of randomisation.
Antisperm antibody, presentation task in Infertility class. Our study program is Andrology, Medical Faculty, Airlangga University.
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Andrologi FK UNAIR: http://spesialis1.andrologi.fk.unair.ac.id/
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Presentation to the Animal Welfare Advisory Committee of London, Ontario on December 16, 2008. Summarizes the related paper that looks specifically into the non-lethal methods that have been proposed to deal with white-tailed deer.
National Family Planning methods - different types of methods temporary as well as permanent used to prevent pregnancy #Barrier methods #Oral pills #Mirena #Cu T #Female sterilization methods #Tubal Ligation #NSV
Family planning methods and modern contraceptives by Dr. Sonam AggarwalDr. Sonam Aggarwal
Family planning is a way of thinking and living that is adopted voluntarily, upon the basis of knowledge, attitude and responsible decision by individuals and couples in order to promote the health and welfare of family group and thus contribute effectively to the social development of country.
For other topics: click on the link https://www.slideshare.net/SonamAggarwal7/cytokine-syndrome-in-covid-19
This presentation is about contraception and birth control. It contains information about the type of contraceptive methods, how they are used and how effective they are.
Making Healthy Choices Your Contraceptive OptionsMs.docxsmile790243
Making Healthy Choices:
Your Contraceptive Options
Ms. Jeanette Shanley
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If it’s underlined…..
It could be on the Final !
The average woman is capable of bearing children for 36 years. Yet for 27 of those years, most women are actively trying to prevent pregnancy. Here’s the latest on everything from the Pill to the female condom – and what works best when.
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Points To Remember:
What is it?
How does it work?
How do you use it?
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What Method Do I Choose?How will it work?Will it be convenient for me?Does it offer protection against STDs and pregnancy?Where can I find it?How much will it cost?
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Barrier vs. Hormonal MethodsBarrier methods
Made out of a material such as latex to prevent the sperm from reaching the egg.
May help prevent STDs.Hormonal methods
Used only by a woman.
NO protection against STDs.
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I. Non-Prescription MethodsMethods that can be obtained in drug stores, grocery stores, clinics, and most major retail chains.Can be less expensive or FREE.No hormonal side effects.
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Male CondomMade out of latex or polyurethane.Lubricated or Non-Lubricated.Textures, flavors, and colors.
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Male Condom:Keep in a cool, dry place. DO NOT keep in your wallet or car.Check expiration date!!86-89% effective with typical use.So…How do you put on a condom?
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Advantages/DisadvantagesAdvantages:
Effective, safe, fairly inexpensive.
Helps protect against STDs.
May help intercourse last longer.Disadvantages:
Can be messy. Can break.
Requires a water-based lubricant.
Can be allergic to latex or polyurethane.
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Female CondomA soft polyurethane tube with 2 rings, fits inside the vagina and covers part of the outer lips.85% effective with typical use.How do I use a female condom?
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Advantages/DisadvantagesAdvantages:
Effective and safe.
Can be inserted 8 hrs. before sex.
Helps protect against STDs.
Lubricated.Disadvantages:
Can be messy. Can break.
Can be allergic to material.
CANNOT be used together with a male condom.
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SpermicidesA chemical designed to kill sperm.Cream, jelly, foam, film, or suppository.80% effective on its own, more effective if used with condom or diaphragm.How do I use a spermicide?
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Advantages/DisadvantagesAdvantages:
Somewhat effective, safe, and a good lubricant.
Inexpensive.Disadvantages:
Must be inserted before intercourse.
NO protection against STDs.
Must reapply with each sex act.
May require a waiting period (10 minutes).
May cause vaginal irritation.
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( Dental) DamA thin latex or polyurethane sheet used for oral sex.Can help reduce the risk of contracting an STD.How is a dam used?
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Advantages/DisadvantagesAdvantages:
Helps protect against STDs.
Inexpensive.
M ...
The rajasthan right to hearing bill, 2012Shambhu N
IT IS REVOLUTIONARY BILL PASSED BY SH. ASHOK GEHLOT C.M. , RAJASTHAN , WHO HAS EMPOWERED COMMON MAN TO HEAR BY AUTHORITY IN STIPULATED PERIOD.
THE RAJASTHAN STATE AGAIN BECOME FIRST IN PASSING THE BILL .
Citizens will get the chance for hearing their grievance near their residence
They will be heard at the gram panchayat, tehsil, sub-division or district level
For this, public hearing officers and appellate authorities have been formed
It is mandatory to hear the complaints and dispose them within a stipulated time
The complainant has the right to appeal up to two levels, if not satisfied
challenges in obstetric prescription
Beautiful Slide Show By Editor Dr. Ragini Agrawal And Dr. Tamkeen khan
Dr. Ragini Agrawal, Chairperson Food , Drug & medico surgical Equipment Committee 2009-2011
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?
CONTRACEPTION
1. Family planning :Current Contraceptive Scenario in India IMA DISTRICT LEVEL WORKSHOP ON CONTRACEPTIVE UPDATES & SAFE ABORTION TECHNIQUES
2. Contraceptive Updates Seminar, October 2005 Source: NFHS-3 (2005-06) Percentage use of contraception by married Women (15-49) – Total urban rural N
3. Knowledge among eligible population (%) Contraceptive method Ever use (%) Current use (%) Contraceptive Scenario in India Any method 99 55.1 48.2 For all modern methods 98.9 49.3 42.8 Combined Oral pills 79.5 8.4 2.1 IUDs 70.6 5.6 1.6 Condoms 71 7.9 3.1 Female sterilization 98.2 34.2 34.2 Male Sterilization 89.3 2 1.9 Natural methods 48.9 11.8 5
7. Not using contraception Pregnant or amenorrhoeic Not pregnant or amenorrhoeic Pregnancy intended Pregnancy mistimed Need for spacing Need for limiting Fecund In fecund Want later Want no more Want soon Need for spacing Need for limiting Total Unmet Need Pregnancy unwanted
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27. Female Condom in Place Inner ring Outer ring Plastic sheath with ring at both ends How to grasp female condom for insertion
57. Oral Contraceptives and Emergency Contraceptive Pills Contraceptive Updates Seminar, October 2005
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59. Combined Oral Contraceptive pills Contraceptive Updates Seminar, October 2005 Alteration of endometrium to make it unsuitable for implantation even if the ovum is fertilized. Mechanism of action: Changes in cervical mucous which make it hostile for sperms Inhibition of ovulation by suppressing FHS and LH
60. Effectiveness Contraceptive Updates Seminar, October 2005 Failure rate is 0.3% as commonly used and only 0.1% on correct and consistent use. 99.97% to 99.99%.
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63. Side effects Contraceptive Updates Seminar, October 2005 Breakthrough bleeding-common with low dose progesterone pills due to low or absent estrogen. Nausea, vomiting, decreased appetite; usually pass off after 2-3 months of use Oligo and ammenorrhoea due to lack of proliferation of endometrium of cycle. Common among women who had menstrual problems before starting oral contraceptive pills.
64. Side effects Contraceptive Updates Seminar, October 2005 Vaginal discharge due to congestion and hypertrophy of cervical epithelium. Breast changes- oedema, heaviness and tenderness. Chloasma Weight gain in some cases due to estrogen and progesterone . Acne and oily skin.
65. ELIGIBILITY CRITERIA: (For low dose combined contraceptive pills) Contraceptive Updates Seminar, October 2005 Most women can use Combined Oral Contraceptives. Are of any age, including adolescents and over 40 (except women 35 years or older and who smoke) Smoke cigarettes but are under age 35 Have just had abortion or miscarriage
66. ELIGIBILITY CRITERIA: (For low dose combined contraceptive pills) Contraceptive Updates Seminar, October 2005 Heavy, painful menstrual periods or iron deficiency anemia (condition may improve) Benign breast disease Diabetes without vascular, kidney, eye or nerve disease Irregular menstrual periods Mild headaches Malaria Varicose veins
68. Who cannot use COCs? Contraceptive Updates Seminar, October 2005 Fully Breastfeeding within 6 month postpartum; If partially BF she can start after six weeks Are age 35+ and smoke more than 15 cigarettes per day Have multiple risk factors for arterial cardiovascular disease Have hypertension with systolic BP 140-159 and diastolic 90-99 and those having vascular disease. Have clear history of deep vein thrombosis (DVT), pulmonary thrombosis or current DVT or pulmonary thrombosis. Have known thrombogenic mutations. Have current history of ischemic heart disease or known hyperlipidaemias
69. Who cannot use COCs? Contraceptive Updates Seminar, October 2005 Women who have Migraine with aura Current breast cancer Diabetes with neuropathy, retinopathy, nephropathy and other vascular disease Acute hepatitis or severe cirrhosis of liver or benign or malignant liver tumours Complicated pulmonary hypertension, risk of atrial fibrillation, history of subacute bacterial endocarditis
70. Important Contraceptive Updates Seminar, October 2005 Women having the above health conditions should be encouraged to use other more appropriate contraceptives than COCs.
71. When can a woman start COCs? Contraceptive Updates Seminar, October 2005 During a menstrual cycle Amenorrhoea Between 2 menstrual cycles Breastfeeding Switching to another hormonal method Switching from non-hormonal method After miscarriage or abortion Switching from IUD (including hormonal)
72. Key steps for providing COCs Contraceptive Updates Seminar, October 2005 Give pills, 3 months supply if possible. Running out of pills is one of the major reasons for unintended pregnancy. Explain how to use If possible give condoms or spermicide to use: Until she can start taking the pills If she starts packet of pills late, misses pills in row or stops taking pills for any other reason If there is possibility of transmission of STIs/HIV Show her how to use condoms and spermicide. Invite the client to come back any time if she has any questions, problems or wants another method Plan for return visit
73. Pills missed? Contraceptive Updates Seminar, October 2005 WHAT TO DO IF YOU MISS ONE OR MORE PILLS Every time you miss one or more active pills (days 1-21): In these special cases, ALSO follow these special rules If you miss nay of the 7 inactive pills (in a 28–pill pack only) 1. Take a pill as soon as you remember 1. Take the next pill at the usual time 3. Keep taking active pills as usual, one each day Source: Johns Hopkins University Bloomberg School of Health, Population information program Started pack 2 or more days late? Missed 2–4 pills of first 7 pills days 1–7 Missed 5 or more active pills in a row days 1–7 Missed 2–4 pills of last 7 active pills days 15–21 Avoid sex or another method for 7 days Finish all active pills in the pack. Do not take last 7 (inactive) pills in 28–pill pack. Do not wait 7 days to start next 21– pill pack. Start a new pack. 1. Throw away missed pills 2. Keep taking one pill each day 3. Start new pack as usual
74. What to do at follow up visit Contraceptive Updates Seminar, October 2005 Ask if client has any questions or anything to discuss. Ask client about her experience with the method. Give her any information she needs and invite her to return any time for help. If she has problems that cannot be resolved, help her choose another method. Plan for next visit before she will need more pills.
75. Emergency Contraceptive Pills (ECPs) Contraceptive Updates Seminar, October 2005 Emergency contraception: Is method of contraception used before missing a period to prevent pregnancy. It is also called “morning after” or post-coital contraception.
76. Indications for using emergency contraception Contraceptive Updates Seminar, October 2005 A woman who had unprotected sex, and wants to prevent pregnancy. For example: She did not expect to have sex and was not using any contraception Sex was forced Condom broke or slipped She ran out of contraceptives, or was irregular in taking pills and did not use condoms or spermicide. She is late for a contraceptive injection.
77. What pills can be used as ECPs? Contraceptive Updates Seminar, October 2005 Progestin-only dedicated products: Levonorgesterol pills are generally used GOI emergency contraceptive pills also available through public systems Several commercial preparations available in market
78. Contraceptive Updates Seminar, October 2005 Levonorgesterol alone EC pills- A dedicated product 0.75 mg of tablets Levonorgestel available in India. The current recommendation: 1 pill of LNG 0.75 mg to be taken as soon as possible after unprotected coitus (within 72 hours) followed by another pill 12 hours later. Depending on the composition 1 pill of 1.5mg in a single dose can be taken.
79. GOI Guidelines Contraceptive Updates Seminar, October 2005 The Government of India guidelines for Emergency Contraception recommend use of Levonorgestrel (progestogen only) LNG as a “dedicated product” for effective emergency contraception. The Drug Controller of India has approved only Levonorgestrel for use as ECP.
80. How effective are ECPs? Contraceptive Updates Seminar, October 2005 Pregnancy rate 8%, if women have sex once in the second or third week of the menstrual cycle without using contraception. Pregnancy rate 2% if women use combined oral contraceptives for emergency contraception Pregnancy rate 1% if women use progestin-only ECPs
81. How do ECPs work? Contraceptive Updates Seminar, October 2005 Probable mechanisms are: Inhibition or delay of ovulation Thickening of cervical mucous Direct inhibition of fertilization Histological and biochemical alteration in endometrium leading to impaired endometrial receptivity to implantation of the fertilized egg Alteration in transport of egg, sperm and embryo Interference with corpus luteum function and luteolysis
82. Medical eligibility criteria for Emergency Oral Contraception Contraceptive Updates Seminar, October 2005 Any woman can use emergency oral contraception if she is not already pregnant within the stipulated time period.
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84. Advice on common problems Contraceptive Updates Seminar, October 2005 Nausea: Eat something soon after taking the pills to reduce nausea.Take anti-emetic half an hour before taking emergency contraceptive pills and every 4-6 hours thereafter. Vomiting: If the woman vomits within 2 hours of taking the pills, she may take another dose. Otherwise she should not take any extra pills. Extra pills will not make the method more effective, and they may increase nausea. Her next monthly period may start a few days earlier or later than expected. Reassure her that this is not a bad sign.
85. Specific reasons to return to the healthcare provider Contraceptive Updates Seminar, October 2005 Advise her to return or see another health care provider if her next period is quite different from usual for her, especially if: There is unusually light bleeding (possibly pregnancy) Bleeding does not start within 4 weeks (Possible pregnancy) Unusually painful (possibly ectopic pregnancy). But emergency oral contraception does not cause ectopic pregnancy. If there are symptoms of sexually transmitted diseases.
86. Some facts about ECPs Contraceptive Updates Seminar, October 2005 Will not disrupt an established pregnancy Offer no protection against STIs. Do not provide continuing protection from pregnancy. No medical conditions rule out ECPs.
87. Providing ECPs: Key steps Contraceptive Updates Seminar, October 2005 Help the client feel at ease. Ask when unprotected sex took place. Give the woman pills. Explain how to take them. She can take first dose at once.
88. Providing ECPs: Key steps Contraceptive Updates Seminar, October 2005 Explain and discuss important points about ECPs. Discuss her ongoing need for contraception Tell her that if she vomits within 2 hours of taking pills, she may take another dose.
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132. In India DMPA currently approved and available in 106 countries and NET-EN in over 60 countries. Some social marketing organizations also provide ICs Approved by Drug Controller of India and commercially available.
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145. WHO Eligibility Criteria Source : WHO 2004. Category Description When clinical judgment is available When clinical judgment is limited 1 No restriction for use Use the method under any circumstances Use the method 2 Benefits generally outweigh risks Generally use the method 3 Risks generally outweigh benefits Use of method not usually recommended, unless other methods are not available/acceptable Do not use the method 4 Unacceptable health risk Method not to be used
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149. REMEMBER! Counseling does not terminate when the client accepts a method or undergoes the procedure, its process completes when the acceptor returns to the service centre/provider for follow up and goes back home with satisfaction.
169. Swab the cervix with antiseptic. Gently introduce the loaded inserter assembly through the cervical canal until the flange comes in contact with the cervix.
170. Hold the plunger stationary and withdraw the insertion tube so as to release the arms of the T.
171. Gently push the insertion tube upwards, towards the top of the uterus until a slight resistance is felt. This ensures that the T is closer to the fundus.
182. REFER to a centre with experienced staff and equipment in case of Endometriosis Fixed uterus due to previous surgery or infection Hernia (umbilical or abdominal wall) Postpartum uterine rupture or perforation Post-abortion uterine perforation
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184. Requirements of a safe procedure Client assessment Counseling Laboratory tests Informed consent Anesthesia Infection prevention Instructions to accompanying persons
185. Counseling: Ensure Informed Choice A FRIENDLY COUNSELLOR: LISTENS to the concerns of the women GIVES clear & practical information HELPS her to make informed choice to avoid later regret Source: Family Planning: A Global Handbook for Providers, WHO, 2007
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189. Five common causes of female sterilization failure Surgical “occlusion” of a structure other than the fallopian tube (most often, the round ligament) An undetected luteal-phase pregnancy that was present at the time of sterilization Incomplete or inadequate occlusion of the fallopian tube Misplacement of the mechanical device Development of tuboperitonoal fistula.
194. Medical Eligibility Most men who want vasectomy can have safe and effective procedures in routine settings. Most men can have vasectomy This includes men of any age who are HIV positive or at high risk of HIV or other STIs have sickle cell disease or hereditary anaemia; have no children
195. Medical Eligibility Active sexually transmitted infection If he has the following, DELAY vasectomy and refer for treatment Scrotal skin infection or mass in the scrotum Acute systemic infection or significant gastroenteritis Inflamed (swollen and tender) tip of penis, ducts or testicles
196. If he has any of the following, REFER him to a center with experienced staff and equipment that can handle potential problems: Hernia in the groin (can perform vasectomy at the same time as repairing hernia. If this is not possible, the hernia should be repaired first) Filariasis or elephantitis Undescended testicles - both sides Current-AIDS related illness Coagulation disorders
197. If he has any of the following, use CAUTION Large varicocoel or hydrocoele (swollen veins or membranes in the spermatic cord or testes, causing swollen scrotum) Previous scrotal surgery or injury Undescended testicles – one side only (vasectomy is performed on the normal side only. Then if any sperm remains in the semen after 3 months, the other side must be done, too) Diabetes
198. Having a vasectomy Counseling Requirement of safe procedure: Informed consent Infection prevention Client assessment Anaesthesia Instructions to client
225. COMPENSATION For Public (Govt.) facilities High Focus States Breakage of the Compensation package Acceptor Motivator Drugs and dressing Surgeon charges Anesthetist Staff nurse OT technician/helper Refreshment Camp management Total VAS. (ALL) TUB. (ALL) 1100 600 200 150 50 100 100 75 - 25 15 15 15 15 10 10 10 10 1500 1000
226. COMPENSATION B. For Private Facilities: High Focus States Type of operation Facility Motivator Total Vasectomy (ALL) Tubectomy (ALL) 1300 1350 200 150 1500 1500
227. Need of the HOUR Involvement Partnership Commitment IMPROVING AVAILABILITY & QUALITY of CONTRACEPTIVE SERVICES PUBLIC & PRIVATE
228. Orientation on safe abortion for private providers Dr. Dinesh Agarwal NPO(RH), UNFPA
234. Facilities required for site appro val MTP rules segregate sites which offer only 1 st trimester MTPs & sites that offer MTPs up to 20 weeks. For MTP up to 12 weeks For MTP up to 20 weeks Gynecological examination/ labor table Operation table Resuscitation & sterilization equipment Instrument for performing abdominal or gynecological surgery Drugs & parenteral fluid Anesthetic equipment Back up facilities for treatment of shock & facilities for transportation Resuscitation & sterilization equipment Drugs & parenteral fluids for emergency use notified by the government of India from time to time
266. MMA drug protocol Protocols for mifepristone & misoprostol administration Gestational Age Mifepristone on Day 1 Misoprostol on Day 3 Dose Route Recommended options Up to 49 days 200 mg orally (one 200 mg tablet) 400 μ g (two 200 μ g tablets) Oral/ vaginal Up to 63 days 200 mg orally (one 200 mg tablet) 800 μ g (four 200 μ g tablets) Sublingual/ vaginal
272. Methods S econd trimester pregnancy termination Induction method: Emcredyl Instillation Surgical Method: Dilatation & Evacuation (D&E) Medical method: Combination of mifepristone & misoprostol *This is currently not an approved method for 2 nd trimester MTP in India
273.
274.
Editor's Notes
The female condom has been available in Europe since 1992 and in 1993 the US FDA approved the female condom for marketing and distribution. The female condom is a strong, soft transparent polyurethane sheath inserted in the vagina before sexual intercourse, providing protection against both pregnancy and STIs. It is stronger than latex, odourless, causes no allergic reactions and unlike latex can be used with both oil based and water based lubricants. There are no serious side effects associated with the female condom and less than 10 percent of users report mild irritations. Laboratory studies indicate that the female condom is impermeable to STIs and HIV
These are some of the most important method-specific , i.e., intrinsic characteristics of the IUD, that make it an important method to be available for programs and service providers, and that make it a good potential choice for many women. Our challenge, of course, as change agents working for change agencies is to translate and transmit these method-specific facts and characteristics—and the important recent findings about their even greater safety than had previously been thought—into accurate perceptions and appropriate contraceptive behaviors in the programs and countries we assist. _______ First bullet: efficacy approaches FS, cheaper, easier to provide and reverse: In effect: “Reversible sterilization”—but in quotes because this is not ever how we’d promote it because of inevitable misconceptions and problems that would cause—but it certainly is “food for programmatic thought”
In the first year after the procedure: 0.5 pregnancies per 100 women. Within 10 years of the procedure: 1.8 pregnancies per 100 women Effectiveness depends partly on how the tubes are blocked, but all pregnancy rates are very low. Postpatum tubal ligation In the first year after the procedure—0.05 pregnancies per 100 women. Within 10 years after the procedure—0.75 pregnancies per 100 women.
Most women can have sterilization With proper counseling and informed consent, sterilization can be used in any circumstances by women who: Just gave birth (within 7 days) Are breastfeeding
Fixed uterus due to previous surgery or infection Endometriosis Hernia (umbilical or abdominal wall) Postpartum uterine rupture or perforation or postabortion uterine perforation