This document discusses various contraceptive methods including hormonal contraception, intrauterine devices, barrier methods, natural family planning, and sterilization. It provides details on the mechanisms of different hormonal methods like combined oral contraceptives, progestin-only pills, patches, injections, and vaginal rings. Benefits and risks of long-acting reversible contraceptives like implants and intrauterine devices are also outlined. Emergency contraception and natural family planning methods are briefly described. Contraindications and effectiveness of various contraceptive options are covered.
contraception is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
contraception is a very important topic for pg entrance.....so all about it has been discussed in detail as required for pg entrance....do make use of it...
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. IDEAL CONTRACEPTIVE
Inexpensive
Easy and simple to use with minimum side effects
Rapidly reversible
Readily available
Highly effective.?
Can be administered by non-healthcare personnel.
3. Contraceptive effectiveness
• Difficult to determine :
1. Perfect VS typical use (method failure and patient
failure)
2. Correct VS incorrect use
3. long term VS short term
4. Pearl index
• Method used for determination of pregnancy failure
rate:
Pregnancy rate = no. of pregnancies x100women/12
months of use
5. classifications
A. Natural Methods
• Periodic abstinence
• Withdrawal
• Lactational Amenorrhea Method
• Standard days method
• Calender rhythm method
B. Barrier Methods
C. Hormonal
D Intrauterine Devices
E.. Sterilization
11. POP: Suitable for -
• Older women,
• Heavy smokers,
• Hx/Predisposition to VTE,
• Pts with HTN,Valvular heart ds., DM, or Migraine,
• Breastfeeding women < 6mo postpartum (delay
until =/> 3w postpartum to avoid risk of heavy
bleeding).
12. Starting the POP
• No previous contraception= start on day 1,
• Changing from COC= start the day following last pill (
no pill-free period),
• After childbirth= start anytime > 3w,
• If weight > 70 kg= Consider Desogestrel or 2 tabs/d
of any other POP( unlicensed)
13. Mechanism of action
• Combined :
most effective method because they inhibit midcycle gonadotropin surge
and prevent ovulation
• Progestin only pills:
don’t mainly not inhibit ovulation
Both types act by -altering cervical mucus making it thick viscid and scanty
-alter endometrium so not fit for implantation
- alter ovarian responsiveness to gonadotropin stimulation
14. How to prevent ovulation?
• Interfere with the release of GnRH from
hypothalamus so it will suppress LH & FSH
• In high concentration they will inhibit pituitary gland
directly
• Progestin only pills don't inhibit ovulation mainly
because a lower dose of progestin is used in
preparations less than combine forms it is important
to be taken at the same time of the day to ensure that
blood level do not fall below the effective levels
15. Short-term side-effects
• OESTROGENIC EFFECTS • PROGESTOGENIC EFFECTS
• Breast tenderness (3.6%), • Depression(3.9%),
• Nausea ( 1.5%), • Premenstrual tension
• Dizziness • Dry Vagina
• Cyclical wt. gain • Sustained wt. gain
• Bloating • Decreased libido
• Vaginal discharge without • Lassitude
infection • Acne
• use a more progestogen- • Use a more oestrogen-dominant
dominant pill pill
16. • Estrogen cause pigmentation and high level of
estrogen may accelerate the development of
gallbladder disease in young female but not increase
the risk of acute cholelithiasis
• Progestin : because they are structural related to
testosterone they produce androgenic effects like
increase weight and acnes
18. NONCONTRACEPTIVE BENEFITS
• BENEFITS FROM ANTIESTROGENIC EFFECTS
OF PROGESTERON:
1-decrease menses blood loss & improve anemia
2- risk of adeno CA of uterus
3- estrogen receptors in breast so risk
begnin breast disease ?
• BENEFITS FROM INHIBITION OF OVULATION
(dysmenorrhea )
use as therapy of severe dysmenorrhea
• OTHER BENEFITS: risk (PID,Rhumatoid a, bone
loss)
20. Neoplastic effects
• Breast CA
• Endometrial CA : protection related to duration of use
• Ovarian CA : decrease risk duration related
• Liver adenoma and CA?
• Pituitary adenoma : mask symptoms produced by
prolactinoma amenorrhea and galactorrhea
• colorectal CA: protection
• Liver cyst and adenoma
21. Contraindications
• Absolutes
• Histoy of vascular disease (thromboembolism)
• Systemic diseases (affect vascular system) SLE , DM
with retinopathy or nephropathy
• Undiagnosed uterine bleeding
• Increase serum TGs
• Heart failure rare because incidence of heart diseases
are mostly after menopause
• Smoking in female more than 35y
23. VAGINAL RING
• Steroids absorbed though vaginal epithelium directly
into circulation
• Contain ethniyl estradiol and etonogestreland
• Place in vagina for 21 days and remove 7 days to
allow withdrawal bleedings
24.
25. TRANSDERMAL PATCH
• It releases norelgestromin & ethinyl estradiol
• Weekly applied, for 3 weeks, and the last week of the
cycle is a patch-free week
• Normal activities can be done while using the patch
27. • Sub dermal implants:
• Need trained personal for insertion and
removal.
• Out patients procedure.
• 99.5% effectiveness rate.
• Requires no user motivation so compliance
not problem.
• Amennorhoea is common
28. • Subdermal implantation for continuous release
• Effective for up to 3 years
• Rapid return of fertility
• Problems
• Menstrual irregularity
• Weight gain
• Surgical implantation & removal
31. IUD
-IUD is the world's most widely used method of
reversible birth control
3 TYPES:
1- Inert ( no longer recommended because of
painful and heavy periods).
2-Copper Releasing (paragard).
3-Progesterone Releasing (IUS):
A-Progestasert (progesterone T) 1976 - 2001.
B-Mirena (levonorgestrel).
32. Intrauterine Contraception Devices:
1. Most commonly used reversible
- Method of Contraception
worldwide
- effective > 97%.
- The newer devices have failure
rate < 0.5%
33. 2. Copper bearing IUCD
- Consist of a plastic frame with copper wire
around the stem.
- Surface of the copper determine the
effectiveness and active life of the device.
- Most IUCD licensed for use over 5-10 years
and because of gradual absoption of
copper, these IUCD renewed after 3-5 years.
Copper Salt give some protection against bacterial
infection.
34. Mechanism of Action:
- All IUCD cause a foreign body reaction in the
endometrium with increased prostaglandin
production and Leucocyte infeltration. This reaction
enhanced by copper which effect endometrial
enzymes and oestrogen uptake and also inhibit
sperm transport.
- Alteration of uterine and tubal fluid impairs the
viability of the gametes.
- The progesterone IUCD (LNG.IUS) cause endometrial
suppression and change in the cervical mucus and
utro tubal fluid impair sperm migration.
35. Clinical uses
• Long-term contraception
• Women with contraindications to COC
• Emergency contraceptive (1:1000 )
• menorrhagia , endometriosis, chronic
pelvic pain, dysmenorrhea , anemia.
37. EMERGENCY CONTRACEPTION
• After intercourse and before implantation
• Indication: failure of condoms
• Unprotected intercourse
• Within 72 hours after unprotected intercourse
• Levonorgestrel Combined
Prescription
• Single dose, the earlier the better
• Prevented 75% of unplanned pregnancies
• IUD Emergency Contraception
• Within 5 days after unprotected intercourse
• Copper IUD
41. Barrier methods of contraception
Two types :
1. Physical barrier methods, such as
condoms, diaphragm, and cervical caps, that prevent
pregnancy by blocking the entry of sperm into the
upper genital tract;
2. Chemical barrier methods (spermicides) that kill
or inactivate sperm on contact. ( less effective , used
in combination , no STDs protection )
42. Barrier methods of contraception
• easily available, reversible, and have fewer side
effects than hormonal methods.
• effective and acceptable if used consistently and
correctly.
• Protect against STD
43. Natural Methods:
1.) Calendar Method (Safe period)
- relies upon the fact that there are certain days during
the menstrual cycle when conception can occur
following ovulation, the ovum is viable within
reproductive tract for a maximum of 24 hrs.
- The life spam of sperm is longer 3 days.
- During 28 day menstrual cycle, ovulation occur around
day 14. This means that coitus must be avoided from
8th to 17th day.
- Failure rate is high so many couples find it difficult to
adher to this method.
44. 2.) Ovulation method (The billing’s method)
- Ovulation prediction can be enhaced by several
complementary methods including *Basal body
temperature (BBT) rise in progesterone following
ovulates – rise temp. BBT 0.2-0.4 C, until the onset of
menstruation .
* Cervical mucus – several days before ovulation
mucus appearance of raw egg white, clear, slippery
and stretchy (spinnbarkeit). The final day of fertile
mucus is considered to be the day when ovulation is
most likely to occur and abstinence must be
maintained from first day of fertile mucus until 3 days
after the peak day. The end of the fertile period is
characterized by appearance of (infertile mucus)
which is scanty and viscous.
45. *Failure rate of natural method mucus and BBT and
Calendar method 2.8 %.
3-personal fertility monitors: small devices able to
detect urine concentration of oestrone and LH
indicate start and end of fertile period.
- Failure rate 6.2%.
- Disadvantage – provide no protection from STD .
46. How to use Standard Days
Method
Every morning move
the rubber ring to the
next bead.
THE RED BEAD
is day 1 of cycle. Always move the ring in
On the first day of your the direction of the
period, move the rubber arrow.
ring onto the red bead. WHITE BEAD
Each bead DAYS
Mark a calendar to help
represents a day are days when
remember.
of your you CAN get
menstrual cycle pregnant.
BROWN BEAD Use a condom or
DAYS do NOT have
are days when sex on these
pregnancy days to prevent
is unlikely. pregnancy.
You can have sex on these days.
No condom needed. Are you ready to
When your next period choose this
starts, move the ring to the red method?
bead again. Skip over any
47. What to remember
• Move the rubber ring one bead forward every
day
• Always use condoms or avoid sex on
fertile “white bead” days
Come back if:
• You get your period early Dark brown
(it starts before you put the ring on bead
the dark brown bead)
• You get your period late Last brown
bead
(it does NOT start by the day after
you put the ring on the last brown
bead)
• You have unprotected sex Anything else I can
repeat or explain?
on a fertile “white bead” day Any other
questions?
48. Male condoms
• It is one of the most popular mechanical barriers.
Among all of the barrier methods, the condom
provides the most effective protection of the genital
tract from STDs. Its usage has increass because of the
concern regarding the acquisition of HIV and STDs.
49. Male condoms
• Increasing the efficacy :
• reservoir tip
• The addition of spermicidal
lubricant to the condom. (water-based not oil-based)
• the addition of an intravaginal spermicidal agent
50. Female condoms
• It contains 2 flexible rings. The ring at the closed end
of the sheath serves as an insertion mechanism and
internal anchor that is placed inside the vaginal canal.
The other ring forms the external patent edge of the
device and remains outside of the canal after
insertion.
51. Female condoms
- Mechanism of action :
• Prevents passage of sperm
and infections into the vagina
( protection against STDs )
• Can be inserted up to 8 hours
prior to intercourse; can remain in
place up to 8 hours
52. Female condoms
- Efficacy
• Pregnancy rates for the female condom range
between 5 and 21 per 100 women per year.
(higher than male condoms)
• To increase efficacy Simultaneous use of both the
female and male condom is not recommended
• Re-use is not recommended .
53. Diaphragm
• The diaphragm is a shallow latex cup
with a spring mechanism in its rim to hold it
in place in the vagina
• It is inserted before intercourse so that the
posterior rim fits into the posterior fornix and
the anterior rim is placed behind the pubic bone.
• Spermicidal cream is applied to the inside of the
dome, which fits against the vaginal wall.
54. Diaphragm
• It prevents pregnancy by acting as a barrier to the passage of
semen into the cervix
• provides effective contraception for 6 hours.
• After intercourse, the diaphragm must be left in place for at
least 6 hours.
• Effectiveness depends on the age of the user, continuity of
use, and the use of spermicide along with the diaphragm.
Failure rate is estimated to be 20% .
56. Diaphragm
• Disadvantages :
- Prolonged use increase the risk of UTI
- More than 24 hours use is not recommended
due to the possible risk of TSS.
- Might cause vaginal erosions if not placed properly .
- Requires a professional fitting (trained provider is needed) .
57. Cervical cap
• a cup-shaped latex device that fits over the base of the
cervix.
• The cap must be filled one third full with spermicide
prior to insertion
• Inserted 8 hours before coitus and can be left in place
for as long as 48 hours.
58. Cervical cap
• Acts as both mechanical barrier to sperm and as a chemical agent
with the use of spermicide .
• Pregnancy rates range between 4 and 36 per 100 women per year.
• Effectiveness depends on the parity of women due to the shape of
the cervical os.
• Disadvantages : cervical erosions and vaginal spotting , risk for TSS
, requires professional fitting and training for use , high failure rate
, and candidates must have a history of normal results of pap smears.
59.
60. Spermicides
• consist of a base combined with either nonoxynol-9
or octoxynol
• Surfactant that destroys the sperm cell membrane
• Forms available : vaginal
foams, suppositories, jellies, films, foaming
tablets, and creams.
61. Spermicides
• Failure rate is about 26% within the 1st year of use.
• Advantages : ease of application , available over the
counter , inexpensive and it augments the
contraceptive efficacy of the cervical cap and
diaphragm .
• Disadvantages : minimal protection against STDs
, risk of vaginal irritation and allergic reaction.
62. Sterilization
• Sterilization :female sterilization and male vasectomy are permenant
metod of contaception and highly effective
• They are generally chosen by relatively older couple who are sure
that they copleted their family.
• Also individual who carry a genetic disorder may choose to be
strlizer.
• 28% of reproductive age women undergo tubal ligation and 10% of
men undergo vasectomy.
• Sterilization methods include:
1- Vasectomy in males.
2- Tubal Ligation in females .
63. Tubal Ligation
• This involve mechanically blockage of
both fallopian tube to prevent the
sperm reaching and fertilizing the
oocyte
• sterilization performed by
laparoscopically(under GA) or through
a suprapubic “mini-laparotomy”
• Failure rate: 0.5%
64.
65. Tubal Ligation
Advantages:
• intended to be permanent
• highly effective
• safe
• quick recovery
• lack of significant long-term side effects
• cost effective
66. Tubal Ligation
Disadvantage:
• possibility of patient regret
• difficult to reverse
• future pregnancy could require assisted reproductive
technology (such as IVF)
• more expensive than vasectomy
67. Cont.
Complication:
A women may experienced anasthetic problem or may be
damage to intra-abdominal during the procedure.
NOTE:
ectopic pregnancy can be a late complications
and any sterilized women who misses her period and has
symptom of pregnancy should seek
medical advice.
68. Vasectomy
Mechanism of action:
Vasectomy involve division of the vas deferens on each
side to prevent the release of sperm during
ejaculation.
Easier than tubal ligation.
Usually done under local anesthesia.
• Failure rate: 0.1%.
69.
70. Vasectomy
Advantages:
• permanent
• highly effective
• safe
• quick recovery
• lack of significant long-term side effects
• cost effective; less expensive than tubal ligation
71. Vasectomy
Disadvantages:
• reversal is difficult, expensive, often unsuccessful
• not effective until all sperm cleared from the
reproductive tract (may take up to 12 w)
• no protection from STDs
72. Cont.
Complication of vasectomy:
Immediately bleeding, wound infection and hematoma
may occur.
At the cut of vas deferns small lump will apear as a
result of a local inflammation response this is called
sperm granuloma it needs surgica excision.