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FAMILY PLANNING
INTRODUCTION
 Family planning is the term given for pre-
pregnancy planning and action to delay and
prevent a pregnancy through artificial and/or
natural method of contraception.
Family planning:
According to WHO family planning is defined as
way of thinking and living that is adopted
voluntarily,upon the basis of knowledge,attitudes
and responsible descision of individual and
couples,in order to promote the health and welfare
of family, group and thus contribute effectively to
the social development of country.
Objectives of family planning
-to avoid unwanted births
-to bring about wanted births
-to regulate the interval between pregnancies
-to control the time at which births occur in
relation to the ages of the parent
Objectives of family planning:
-to determine the number of children in the
family.
-to improve and promote health status of mother
and children as well as whole family.
-To decrease the maternal and child mortality and
morbidity rate.
Benefits of family planning
 Physical health – Mothers, babies and whole
family.
 Economic– less expenses and more saving
 Social– decrease unemployment and crimes
 Educational—easy to provide education for
children's
 Others– lifestyle/standard of living, food/
nutrition
Scope of family planning services
A WHO Expert Committee (1970) has stated
that family planning includes following scope.
(1) the proper spacing and limitation of births.
(2) Advice on sterility,
(3) education for parenthood.
(4) Sex education
(5) screening for pathological conditions related
to reproductive system (e.g., cervical cancer)
(6) Genetic counseling
(7) premarital consultation and examination
(8) carrying out pregnancy tests,
(9) marriage counseling
(10) The preparation of couples for the arrival of
first child
(11) providing services for unmarried mothers
contraceptive methods
 Is a preventive methods to help women avoid
unwanted pregnancies.
 include all temporary and permanent
measures to prevent pregnancy resulting from
coitus.
Contraceptive methods:
 The present approach in the family planning
progamme is to provide a choice i.e,to offer all
methods from which individual can choose
according to his needs and wishes to promote
family planning as a way of life.
TYPES OF FAMILY PLANNING
1. TEMPORAY METHOD
NATURAL METHOD [WITHDRAWAL, CALENDAR, CERVICAL
MUCUS, BBT, SYMPTOTHERMAL , LAM ]
BARRIER METHOD [PHYSICAL , CHEMICALAND COMBINED ]
IUCD
HORMONAL METHODS [PILLS, DEPO, IMPLANT]
TYPES OF FAMILY PLANNING
2. PERMANENT METHOD
MALE VASECTOMY
FEMALE—MINILAP, LAPAROSCOPY
NATURAL FAMILY PLANNING
Rhythm (Calendar) method
Basal Body Temperature (BBT)
Cervical Mucus Method
Symptothermal method
Coitus Interruptus
Lactation amenorrhea
 Basal body temperature
 BBT is raised at the time of ovulation.
 Temper measured in morning same time when
out of bed.
 Intercourse to be done on post ovulatery
infertile phase , 3 days after ovulation temper
raises and continuing upto beginning of
menstruation.
CONTRACEPTION/family planning community health n ursing.ppt
DISADVATAGES
 NOT reliable method: of birth control, especially
for women with irregular cycles.
 Other factors such as a lack of sleep can cause a
woman’s temperature to vary.
 Cervical mucus is a fluid produced by small
glands near the cervix
 This fluid changes throughout her cycle, from
watery and sticky, to cloudy and thick.
 Each of these types of mucus is related to the
hormonal shifts that naturally occur during
the menstrual cycle.
Cervical Mucus Method
 After menstruation of 1 or few days no mucus is
seen its call dry period. This period is safe for
intercourse.
Note:
 At the time of ovulation , cervical mucus becomes
watery resembling raw egg white , clear , smooth,
slippery and profuse.
 After ovulation , under the influence of
progesterone , the mucus thicken and become less
in quantity.
Fertile days;
 When any type of mucus is seen before
ovulation it is called fertile days.
 Peak days
 The last days of slippery and wet mucus is
called peak day. It indicate ovulation is just
to happen or had just happened.
 After the ovulation, the mucus tends to dry
up again. These are also safe days.
CONTRACEPTION/family planning community health n ursing.ppt
Symptothermal Method
 Combines the cervical mucus and BBT methods
Watches temp. daily and analyzes cervical mucus
daily.
 Couple must abstain from intercourse until 3 days
after rise in temp or 3rd day after peak of mucus
change.
 More effective than BBT or CM method alone
 Symptothermic method
 Combination of BBT and cervical mucus .
 COITUS INTERRUPTUS:
 This is the oldest method of voluntary
fertility control.
 It is cost free or appliance free.
 The male withdraws his penis from vagina
before ejaculation and thereby prevents
deposition of semen into the vagina.
 COITUS INTERRUPTUS:
 Some couples are able to practice this
method sucessfully while other find difficult
to manage.
 the slightest mistake on timing of withdrawl
lead to deposition of certain amount of
semen.
Effectiveness:70-80%
Appropriate for
 Men who wish to participate actively in
family planning.
 Couples with religious region for not using
any contraceptives.
 Couple needing temporary method
ADVANTAGES
 Effective method
 Always available
 No method related health risk
 RYTHM METHOD:
 Also called calendar method.
 This method may be used by women whose
menstrual cycles are always between 26
and 32 days in length .
 Monitor of length of at least 6 menstrual
cycle
 To calculate:
 Minus 18 from shortest cycle
 Minus 11 from longest cycle = represents her
fertile day.
 Example: If she has 6 menstrual cycles ranging
from 25 to 29 days, fertile period would be from 7
th day (25-18) to the 18 th day (29-11). To avoid
pregnancy, avoid coitus/use contraceptive during
those days.
CONTRACEPTION/family planning community health n ursing.ppt
LACTATION AMENNORRHEA
 This is a temporary contraceptive method that
relies on exclusive breast feeding.
 It can be used from birth up to six months.
 Producing milk is called lactating and not having
a period is called amenorrhea, hence
this method of birth control is called lactation
amenorrhea (or LAM).

LACTATION AMENNORRHEA
Who can use LAM?
 A woman can use LAM if:
1. her menstrual period has not returned since
delivery
2. she is breastfeeding her baby on demand, both
day and night and not feeding other foods or
liquids regularly
3. her baby is less than six months old.
LAM IS NOT APPROPRIATE WHEN
1. her menstrual period has returned
2. she is breastfeeding her baby irregularly more than
six hr apart
3. her baby is more than six months old.
4. feeding other foods or liquids regularly
Point to remember while on LAM
 Brest feeding to be done on demand [ at least 8
time/day including 1 times each night]
 Interval of feeing should not exceed 4 hr during
day and 6 hr during night.
 When menstrual periods return use other
contraceptive method
TEMPORARY
METHOD
BARRIER METHOD
INTRAUTERINE
METHOD
HORMONAL METHOD
A)Barrier methods
 physical methods e.g. condom,
Diaphragm
 chemical methods e.g. Foam,
suppository, cream
 Combined method
Barrier methods:
 The aim of these methods is to prevent live
sperm from meeting the ovum.
 The main contraceptive advantage is the
absence of side effects associated with the
"pill" and IUD.
 The non- contraceptive advantages include
-some protection against sexually
transmitted diseases
-a reduction in the incidence of pelvic
inflammatory disease.
-reduction in the risk of cervical cancer.
 Barrier methods require a high degree of
motivation on the part of the user.
 They are only effective if they are used
consistently and carefully.
I. Condom
 Most commonly used barrier device by
males around the world.
 Effective,simple method of contraception
without side effect.
 In addtion of preventing pregnancy,it
prevents STI's in both males and females.
 The condom is fitted in erect penis before
intercourse.The air must be expelled from
the teat end to make room for the
ejaculate.
Condoms
Mechanism:
 Prevents the semen from being deposited in the
vagina.
Effectiveness: 98%
Precautions for use
 Use new condom in each sexual intercourse
 Keep extra supply in case of emergency
 Do not store in warm place
 If condom break ,replace immediately.
Advanatages:
 Easily available and easy to use
 Safe and inexpensive
 No side effects
 Light and disposable
 Also prevents from STD's
 No contraindication
Disadvantages:
 It may slip off and tear during coitus due
to incorrect use
 Interferes with sex sensation and lack of
pleassure
 Need new condom with each intercourse
 Disposal problem
NUR 352 GYNAECOLOGY NURSING 48
CONDOMS
Female condom
 The female condom is a pouch made of
polyurethane, which lines the vagina.
 An internal ring in the close end of the
pouch covers the cervix and an external
ring remains outside the vagina.
 It is prelubricated with silicon, and a
spermicide need not be used.
 It is an effective barrier to STDs infection.
However, high cost and acceptability are
major problems.
NUR 352 GYNAECOLOGY NURSING 51
FEMALE CONDOM
Female Condoms
ADVANTAGES:
 Prevents STDs including HIV/AIDS
 DISADVANTAGES:
 High motivation
 Only women who can use diaphragms can
use female condom
 Slippage occurs
 Expensive
II.Diaphragm:
 It is vaginal barrier method.
 It was invented by German physician in 1882.
It is also called Dutch cap.
 It is dome shaped made up of rubber or latex
material .
CONTRACEPTION/family planning community health n ursing.ppt
 It has a flexible rim made of spring or metal. It
is important that a woman be fitted with a
diaphragm of the proper size.
 It is held in position partly by the spring
tension and partly by the vaginal muscle tone.
 In correct position, covers the cervix.
 The diaphragm is inserted before sexual
intercourse and must remain in place for not less
than 6 hours after intercourse.
 A spermicide jelly is always used along with
diaphragm.
Effectiveness:90%
CONTRACEPTION/family planning community health n ursing.ppt
CONTRACEPTION/family planning community health n ursing.ppt
CONTRACEPTION/family planning community health n ursing.ppt
 ADVANTAGES:
 cheap
 No gross medical side effects
 Control of pregnancy in hands of woman
 Reasonably safe when properly used
 Prevent spread of STDs though less effective than
condom
Disadvantages:
 Trainned personnel is required for
insertion
 If diaphragm is left in vagina for extended
period it leads to toxic shock syndrome
 After delivery, it can be used only after
involution of the uterus is completed.
NUR 352 GYNAECOLOGY NURSING 64
DIAPHRAGM + SPERMICIDE
B)Chemical methods:
Before the advent of IUD's and oral
contraceptives,spermicides were widely used.
It comprises three categories
-Foams
-creams
-Vaginal suppositories, tablets or dissolvable
film
SPERMICIDES
Spermicides are surface active agents
which attach themselves to sperm
and cause sperm cell membrane to break and
decrease movement
kill sperms.
Vaginal foam
Vaginal foam
Vaginal suppositories
CONTRACEPTION/family planning community health n ursing.ppt
CONTRACEPTION/family planning community health n ursing.ppt
CONTRACEPTION/family planning community health n ursing.ppt
 Kamal chakki is the example of spermicidal
vaginal suppository which is available in
Nepal .
Selection of Spermicide
 Foam affective immediately after insertion.
 Foam are recommended if spermicide is only
contraceptive method to be used.
 Vaginal tablets and suppositories are also
convenient but require waiting 10-15 minutes
after insertion before intercourse.
General information
 Spermicide should be used before each act of
intercourse.
 There is 10-15 minute waiting interval after insertion of
vaginal tablets, suppositories or films.
 Important to use recommendation of manufacturer.
 Apply extra spermicide if intercourse does not take
place between 1-2 hour
APPROPRIATE FOR
 Women who prefer not to use hormonal
method or is contraindicated (e.g. smoker over
age 35 )
 Women who should not use IUD.
 Women who are breastfeeding and need
contraceptive.
 Women wanting protection from STD and whose
partner is not willing to use condom.
 Couple needing temporary method and awaiting
another method.
 Couple needing a back up method.
 Couple who have intercourse frequently.
BENEFITS
 Effective immediately ( foams and creams)
 Do not affect breastfeeding
 Can be used as backup to other method
 No method related health risk
BENEFITS
 No systemic side effects
 Easy to use
 Increase wetness (lubrication) during intercourse
 No prescription or medical assessment necessary.
DISADVANTAGES:
 High failure rate
 Repeated after each sex
 They must be introduced into those regions of
vagina where sperms are likely to be deposited
 They may cause burning sensation or irritation
 High motivation required
 Waiting time is there
INTRA-UTERINE DEVICES
 The first version of the modern IUCD was
developed in 1909 by a German gynaecologist
and sex researcher named Ernst Grafenberg.
 It was a ring-shaped device made of silver wire
and silkworm gut.
 It was not widely used since until 1920s.
INTRA-UTERINE DEVICES:
 Plastic became popular in 1950s and became
very useful in the development of new form of
IUCD.
Types:
 -Non-medicated:First generation IUDs
 -Copper IUD : Second generation IUDs
 -Hormonal :Third generation IUDs
 The IUCD currently available in Nepal
is the copper T 380 A is shaped like a T
and has copper on the stem and the
arms, with a total exposed copper area of
380 square mm.
 It has white string at the base, which
extends through the cervix so that IUCD
can be removed.
 It can be left in place for 12 years.
CONTRACEPTION/family planning community health n ursing.ppt
Mechanism of action of IUDs:
Medicated IUDs:
 The sterile foreign-body reaction in the uterine
cavity causes both cellular [ Keeping the lining
of the uterus thin and biochemical changes
[Keeping the mucus in the cervix thick and
impenetrable to sperm ]that may be toxic to
sperm.
 By altering the biochemical composition of
cervical mucus, affect sperm motility and
survival.
 The copper acts as a natural spermicide within
the uterus which produces contraceptive
actions.
CONTRACEPTION/family planning community health n ursing.ppt
Advantages of copper devices:
-Effectiveness is about 99%
-lower incidence of side-effects i.e pain,bleeding
-easier to fit in nulliparaous women
-better tolerated by nullipara
-increased contraceptive effectiveness
-low expulsion rate
-effective as post-coital contraceptive,if inserted
within 3-5 days of unprotected intercourse.
Third Generation IUDs:
 The most commonly used hormonal device is
progestasert ,which is a T-shaped device filled
with 38 mg of progesterone.
 The hormone is released slowly in the uterus at
the rate of 65 mcg daily.
 Another hormonal device LNG-20 (Mirena) is
a T-shaped IUD releasing 20 mcg of
levonorgestrel.
Mechanism of action of Third generation
IUDs:
 It increases the viscocity of the cervical mucus
and thereby prevent sperm from entering the
cervix and fallopian tube..
 They also maintain high levels of
progesterone , thereby sustaining an
endometrial unfavorable to implantation.
.
 This causes a foreign-body inflammatory
response leading to biochemical and cellular
changes in the endometrial tissue and uterine
fluid.
 This action adds to progesterone's ability to
interfere with sperm migration, fertilization and
implantation.
 Effectiveness:90%
Mechanism of action of :LNG-20 IUD
 Causes cervical mucus to thicken
 Inhibit sperm motility and function
 Inhibition of implantation
Ideal IUDs candidate:
 Has been at least one child
 Has no ho of Pelvic disease
 Has normal menstrual periods
 Is willing to check IUD tail
 Has access to follow up and treatment as
needed
 Is in monogamous relationship.
Timing
 Anytime during the menstruation cycle within
10 days of beginning of menses.
 Immediate postpartum insertion: 1st week after
delivery
 Post-partum within 6-8 weeks . If using LAM
then after 6 months.
 Post abortion ( immediately or within 7 days ).
Instructions:
 Regularly check the tail or thread.
 If fails to locate thread , consult health worker
 Visit clinic if she experiences any side effects
such fever , pelvic pain and heavy bleeding.
 If menses is missed visit doctor.
 Check IUD periodically may expulse during
menstruation.
Special concern for return visit
 P : Period late, abortion spotting or bleeding.
 A : Abdominal pain, pain with intercourse, severe
cramping.
 I : Infection exposure [gonorrhoea], abnormal
discharge.
Special concern for return visit
 N : Not feeling well, fever, chills along with
lower abdominal pain.
 S : string missing
Follow up
 Objectives of follow up :
 To provide motivation and support
 Presence of IUD confirm
 Diagnose and treat complication and side
effects
Side Effects and Complications:
 -Bleeding
 -Pelvic infection
 -pain
 -Uterine perforation
 -ectopic pregnancy
 -expulsion
Contraindication:
Absolute:
 -suspected pregnancy
 -PID
 -vaginal bleeding of unknown aetiology
 -cancer of cervix
 -previous ectopic pregnancy
Relative:
 -Anaemia
 -history of PID since last pregnancy
 -fibroid uterine .
 -unmotivated persons
Indication of Removal of IUDs:
 Persistent regular or irregular uterine bleeding
and severe cramp like pain in lower abdomen
 Increasing evidence of salphingitis
 Perforation of uterus
 Downward displacement of device into cervical
canal
 Pregnancy occuring with device in situ
 Patient desirous of baby
 Missing thread
Advantages:
 Simple to use ,requires no hospitalization
 Insertion takes only few minutes
 Once inserted stays in place as long as
required
 Contraceptive effect is reversible by removal
of IUD
 Highest continuation rate
Disadvantage
 -Bleeding
 -pain
 -Pelvic infection
 -Uterine perforation
 -ectopic pregnancy
 -expulsion
 Need trained person and need to go to
health facility.
CONTRACEPTION/family planning community health n ursing.ppt
Hormonal Contraceptives:
When properly used,it is the most effective
spacing methods of contraception.
Classification:
I.Oral Pills
-Combined pill
-Minipill [progesterone only pill]
II.Depot formulatios
-injectables
-subcutaneous implants
 Combined pill-
It is the most effective reversible method of
contraception.
 It is combination of estrogen and progesterone.
 The primary mechanism of action of hormonal
contraceptives is that they suppress the secretion
of gonadotropins (follicle stimulating
hormone, FSH and luteinizing hormone, LH).
 Combined pill-
 This inhibition also prevents the LH surge that
is necessary to trigger ovulation
 The combine pill nowadays contain low dose of
estrogen and progesterone.
 In Nepal the most common COCs are low dose
pill in 28 days package.
 Lo- femenal is available at all Nepal government
facilities.
 It contain norgesteral 0.3 mg ( progestin) and
ethinyl /estrogen 0.03 mg in each pill.
 The last 7 brown pills contains ferrous sulphate.
 They are found in market in the name of
sunaulogulaf and Nilocan .
 The pill is given orally for 21 consecutive
days begining on the 5th day of the
menstrual cycle,followed by a break of 7
days during which period menstruation
occurs.
 The bleeding which occurs is not like
normal menstruation ,but is as episode of
uterine bleeding from an incompletely
formed endometrium caused by
withdrawl of hormones.Therefore it is
called withdrawl bleeding.
 The pill should be taken everyday at a fixed
time, preferably before going to bed at night.
 If the user forgets to take a pill, she should take
it as soon as she remembers, and that she should
take the next day's pill at the usual time.
Mechanism of action:
 The mechanism of action of the combined
oral pill is to prevent the release of the ovum
from the ovary.
 This is achieved by blocking the pituitary
secretion of gonadotropins that is necessary
for ovulation to occur.
 It makes the cervical mucus thick and scanty
and thereby inhibit sperm penetration.
 It also inhibit tubal motility and delay the
transport of the sperm and of the ovum to
the uterine cavity.
Timing of usage
 Within 5 days of menses but backup method to be
used for next 7 days.
 Within 4 week postpartum
 Within 7 days post abortion
 If using LAM, after 6 months
 Within 5 days after first trimester abortion but
backup method to be used for next 7 days.
Effectiveness
 1oo% effective with perfect use
 With typical use out of 100, 5 may become
pregnant.
ADVANTAGES
 Highly effective
 Easy to use and don’t interrupt sexual activity
 Risk of PID is halved.
 Decrease risk of ovarian and uterine cancer (
suppression of ovulation decrease recurrent
ovarian injury)
 Menstrual periods are regular and painless.
ADVANTAGES
 Decrease menstrual blood loss (50%), so reduce
risk of anemia.
 Protection against ovarian cyst.
 Easily available for free of cost in health facilities.
DISADVANTAGES
 Failure rate is high if not taken regularly
 Most common side effect are
 headache,
 breast tenderness,
 feeling of being sick,
 change in body weight ,
 may also cause blood clots ,
 change in libido,
 depression and
 brown patches on the skin etc
 Minor side effects often clear up after 2-3 month
of use.
 Quantity of breast milk may be decreased.
Contraindicated
 Past history or presence of
thromboembolism
 Cancer of breast and genitals
 undiagnosed vaginal bleeding
 Severe migraine headache
 Pregnancy
 Heavy smoker ( more than 40 cigratee/day]
Contraindicated
 CVS disease
 Age above 40 years
 Smokers
 amenorrhea
Minipill [Progesterone only pill]
 Commonly referred to minipill.
 It contains only progesterone which is given
in small doses throughout the cycle.
Mechanism of action:
 It works mainly by making cervical mucus
thick and viscous,thereby prevents sperm
penetration.
 Endometrium becomes atrophic and
implantation is impaired.
Advantages:
 No estrogen related side effect
 Amount of progestin is lesser as compared to
combined pill.
 Easy to take.
 Nursing mother can take minipill after the
baby is six months.
Disadvantages:
 Menstrual irregularity is the most common
problem
 Irregular bleeding and spotting can be
observed.
 Failure rate is high
 Increase risk of ectopic pregnancy
Method of using oral contraceptive
 Should start within 5 day of menstrual cycle.
 Started lately after 5 days should use back up
method for 7 days as it start its action only after 7
days.
 For women who had abortion can use on the same
day.
Method of using oral contraceptive
 Post partum not breasting can use after third
week.
 Some medication interfere with pills
effectiveness.e.g anti convulsant (carbamezapine)
, ATT(refampicin) , antifungal agent. So use
back of method or change contraceptive.
Advice to client for missing to take pill
 If miss taking pill on one day, take as soon as use
remember and take next pill at the regular time.
 If you miss talking a pill on two or more days,
take pill as soon as you remember. Take a pill
each day until you finish the pack and use
another backup contraceptive method.
Advice to client for consultation
Stop to take pill immediately and see health personnel
if you have:
 Sudden severe chest pain
 Sudden breathlessness
 Severe pain in the calf of one leg
 Fits, unusual dizziness or fainting.
 severe depression
Possible side effects
 Spotting or bleeding
 Jaundice [may elevate liver enzymes]
 Mastalgia[Breast pain]
 Amenorrhea
 High blood pressure.
II.Depot preparation:
a)DMPA(Depot-Medroxyprogesterone
acetate):
 Progesterone only injectables.
 Brand name is Depo-Provera
 Commonly called ‘Depo’
 Called ‘Sangini’ in Nepal
 The standard dose is 150 mg every 3
months I.M.
Mechanism:
a)Inhibition of ovulation-by suppresing
midcycle LH peak
b)cervical mucus becomes thick thereby
prevents sperm penetration
c)endometrium is atrophic thus pervents
implantation.
INDICATION OF DMPA
 Having increased risk of CVD.
 Other method using daily use are not suitable.
 Estrogen related complication occur.
 Amenorrhoea is acceptable or desirable.
 Contact wit service provider on regular basis is
difficult.
Administration
 The initial injection of DMPA should be given
during the first 7 days of the menstrual period.
 Within 4 weeks of postpartum
 Within 7 days of post abortion
 If using LAM after 6 months
 If partially breast feeding after 6 weeks
 Are given by deep intramuscular injection into
the gluteus maximus.
Advantages:
 Highly effective
 No back up method needed
 Loose less blood and less menstrual
cramping.
 Decrease chance of anaemia and PID.
 Reversible
 No estrogen related side effects.
 Can be used safely during lactation.
 Rapidly effective within 72 hours.
DISADVANTAGE
 may lead to very irregular period
 weight gain in some case
 must return clinic every 3 month
CLIENT INSTRUCTION
 Instruct for return visit every 3 months
 Can be given 2 week before and 2 weeks
after.
 If heavy vaginal bleeding , lower abdominal
pain, severe headache and depression return
to clinic.
 Explain about possible side effect
SIDE EFFECTS
 Spotting or bleeding
 Jaundice
 Mastalgia
 Amenorrhea
 High blood pressure
Subdermal implants [JADELLE]
 The Newer Norplant R-2 comprise of
progestin levenorgesterol into 2 small silicon
capsule.
 The device contain 75 mg of levenorgesterol in
each 2 silicon rubber capsule.
 Each rod is 2.5 mm in diameter and 43 mm in
length
 The silastic capsules or rods are implanted under
the skin of the forearm or upper arm.
Effective contraception is provided for 5 years.
Mechanism:
a)Inhibition of ovulation-by suppresing
midcycle LH peak
b)cervical mucus becomes thick thereby
prevents sperm penetration
c)endometrium is atrophic thus pervents
implantation.
Administration
 May be given anytime during menstrual cycle if
it is certain that she is not pregnant.
 should be given during the first 7 days of the
menstrual period.
 Within 4 weeks of postpartum
 Within 7 days of post abortion
Administration
 If using LAM after 6 months
 If partially breast feeding after 6 weeks
Indication
 Want long term spacing that is 5 years
Advantages:
 Highly effective 99.7 percent
 No back up method needed
 Reversible
 Can be used safely after childbirth and
during lactation.
 Long term protection 5 years
 Can be removed anytime
 Immediate return of fertility after removal
 Protect against uterine cancer
DISADVANTAGE
 may lead to very irregular period
 Need small surgical procedure and medical
person
 Does not protect from STD/AIDS
 Cannot discontinue by own wish
CONTRAINDICATED
 suspected pregnancy
 Liver disease
 Breast cancer
 Uterine bleeding
Use with caution
 Irregular bleeding
 High blood pressure
 High cholesterol
 Headache
 Drug( refampicin , antiepileptic)gall bladder
disease
Client’s instruction
 Insertion area to be clean dry with pressure
dressing in place for 2 days and band aid for
5 days
 No staining the area for few days
 If sign of infection such as inflammation ,
pain and fever return to clinic
 Follow up after 7 days for check up of
insertion site
IMMEDIATE CONSULTATION IN CASE
OF
 Heavier periods than normal
 Prolong and missed periods
 Severe abdominal pains
 Severe headache
 Blurred vision
II.Terminal methods:
a)Male sterillisation:
 Also called voluntary sterillisation where by
reproductive function of male is permanently
destroyed.
 It is also called as vasectomy.
 Now a days Non-scalpel vasectomy is more
preferred rather than traditional one.
CONTRACEPTION/family planning community health n ursing.ppt
 The Non-scalpel vasectomy
(NSV), originally developed in
China in 1974 by Dr. Li
Shungian
 It is an innovative approach to
exposing the vas deferens using
2 specialized surgical
instruments( extracutaneous
forcep and sharp pointed curved
mosquito hemostat).
 The vas clamp is used to grasp the
vas and small puncture is made in
the scrotum with the sharp tipped
forceps
 the vas is lifted out for occlusion. No
stitches are required
 As compared to traditional incision
technique, NSV resulted in less
bleeding, hematoma, infection, and
pain, and a shorter operative time
Guideline for sterilization Preoperative
a. The age of the husband should not ordinarily be
less than 25 years nor should it be over 50
years
b. The age of the wife should not be less than 20 or
more than 45 years
c. The motivated couple must have 2 living
children at time of operation
d. If the couple has 3 or more living children , the
lower limit of age of the husband or wife may
be relaxed.
e. The client should sign the consent to undergo
sterilization operation without outside pressure ,
should know the operation is irreversible and also
the spouse has not been sterilized earlier.
f. Accurate medical history and physical
examination
g. Client should take bath and clean clothes before
surgery
h. Ask to bring clean scrotal support clothes
i. Shaving of pubic hair
j. No anesthesia is used so can go ho afetr taking 3
min rest.
k.Scrotal support, operative site to be kept clean
and dry and rest for 2 days.
l. 3-5 day refrain form sexual intercourse.
m.Use other methods for 3 month.
NUR 352 GYNAECOLOGY NURSING 164
VASECTOMY
Effectiveness:99%
Advantages:
 simple and safe.
 No stitches
 Less discomfort
 Faster procedure
 Faster recovery
 complication is few
 Reversible is possible
Disadvantage
 Delay effectiveness ( require 3 months or 20
ejaculation)
 Does not protect STD/AIDS
 Difficult to reverse
 Risk and side effect of minor surgery
Contraindication
 Large vericocelel[enlargement of pampiniform
plexus in scrotum]
 Hydrocele [ fluid-filled sac surrounding a
testicle that causes swelling in the scrotum.
 Scar tissue
 Inguinal hernia
 Previous scrotal surgery
 Intra mass
Complication:
Immediate:
 Swelling and wound pain
 Blood clots
 Infection
 spontaneous recannalisation:
 Most epithelial cell will recannalise after
damage.
-Autoimmune response:
 Blocking of vas caused reabsorption of sperm
 lead to development of antibodies against
sperm in blood.
-Psychological
Client may complain of
 Reduction of sexual vigour(strength)
 Impotence (inability to develop or maintain an
erection of the penis )
 Headache etc.
Post-operative advice
1. The patient should be told that he is not sterile
immediately after the operation; at least 30
ejaculations may be necessary before the
seminal examination is negative.
2. To use contraceptives until aspermia has been
established.
3. To avoid taking bath for at least 2 days after
the operation.
4. To wear a T-bandage or scrotal support
(langot) for 15 days and to keep the site clean
and dry.
5. To avoid cycling or lifting heavy weights for 15
days. There is, however no need for complete
bed rest.
6. To have the stitches removed on the 5th day
after the operation.
Female sterlization
 It is a voluntary sterillisation method where
by reproductive function of female is
permanently destroyed.
 Most common procedure is minilaparotomy.
CONTRACEPTION/family planning community health n ursing.ppt
 It is a much simpler procedure requiring a
smaller lower abdominal incision of only 2-3
inch conducted under local anesthesia.
 Fallopian tube are located , cut out and tyed.
 After that abdominal opening is closed.
 Client can be discharged 3-4 hr of operation
Tubal Ligation
NUR 352 GYNAECOLOGY NURSING 176
TIMING OF PROCEDURE
 Anytime during menstrual cycle, if client is
not pregnant.
 48 hr after delivery
 6-8 weeks postpartum
ADVANTAGE
 Highly effective
 Permanent method
 Does not interfere sexual intercourse
 Can be performed in OPD basis
 Can be done 48 hr after delivery.
DISADVANTAGE
 Expensive than vasectomy
 Not reversible
 No protection for STD/HIV
 Risk and side effect of minor surgery
CONTRAINDICATION
 Pregnancy
 Respiratory problem
 PID/UTI
 Mass in pelvis
 Heart disease
 Severe anaemia
 Allergic
 Fibroid and abdominal surgery
 It is also found to be a suitable procedure at
the primary health centre level and in mass
campaigns.
 It has the advantage over other methods
with regard to safety, efficiency and ease in
dealing with complications.
 Minilap operation is suitable for postpartum
tubal sterilization
Laparoscopy
 Female sterilization through abdominal approach
with a specialized instrument called "laparoscope“
is called laparoscopy.
 A tiny incision is made and a thin, long
instrument (called a laparoscope) that contains a
small lens and lighting system to magnify and
illuminate the structures inside the lower abdomen
is inserted.
CONTRACEPTION/family planning community health n ursing.ppt
Laparoscopy
 Once the tubes are accessible, the rings (or clips)
are applied to occlude the tubes
CONTRACEPTION/family planning community health n ursing.ppt
ADVANTAGE
 Operation require 15 min
 Only small scar
 Immediate effective
 Effective permanent method
 Can be done on OPD basis
 No interference in sexual activity
CONTRAINDICATION
 SAME AS MINILAP
COMPLICATION
 Fever
 Wound infection
 Injury to other organ e.g. hematoma, injury to
abdominal organ.
 Intraoperative haemorrhage
 Nausea and vomiting
Preoperative preparation
 Complete medical history and physical
examination
 Fasting for 8 hr before surgery and do not take
any medication
 Inform consent
 Bath and clean before operation
 Empty bladder
 Jewellery and hair pin to be remove
 Change gown in OT
 Tab diazepam 5 mg 45 min before operation
Postoperative preparation
 Vital to be checked every 15 min until patient
become stable
 Rest 2-3 hr after operation
 Light snack and tea can be given
 Can bath after 5 days
 Keep clean and dry
 Postoperative analgesic medication for 5 days
 Follow up visit after 1 week
 Sexual relation after 1 week
 Any complication follow up visit

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CONTRACEPTION/family planning community health n ursing.ppt

  • 2. INTRODUCTION  Family planning is the term given for pre- pregnancy planning and action to delay and prevent a pregnancy through artificial and/or natural method of contraception.
  • 3. Family planning: According to WHO family planning is defined as way of thinking and living that is adopted voluntarily,upon the basis of knowledge,attitudes and responsible descision of individual and couples,in order to promote the health and welfare of family, group and thus contribute effectively to the social development of country.
  • 4. Objectives of family planning -to avoid unwanted births -to bring about wanted births -to regulate the interval between pregnancies -to control the time at which births occur in relation to the ages of the parent
  • 5. Objectives of family planning: -to determine the number of children in the family. -to improve and promote health status of mother and children as well as whole family. -To decrease the maternal and child mortality and morbidity rate.
  • 6. Benefits of family planning  Physical health – Mothers, babies and whole family.  Economic– less expenses and more saving  Social– decrease unemployment and crimes  Educational—easy to provide education for children's  Others– lifestyle/standard of living, food/ nutrition
  • 7. Scope of family planning services A WHO Expert Committee (1970) has stated that family planning includes following scope. (1) the proper spacing and limitation of births. (2) Advice on sterility, (3) education for parenthood. (4) Sex education
  • 8. (5) screening for pathological conditions related to reproductive system (e.g., cervical cancer) (6) Genetic counseling (7) premarital consultation and examination (8) carrying out pregnancy tests, (9) marriage counseling
  • 9. (10) The preparation of couples for the arrival of first child (11) providing services for unmarried mothers
  • 10. contraceptive methods  Is a preventive methods to help women avoid unwanted pregnancies.  include all temporary and permanent measures to prevent pregnancy resulting from coitus.
  • 11. Contraceptive methods:  The present approach in the family planning progamme is to provide a choice i.e,to offer all methods from which individual can choose according to his needs and wishes to promote family planning as a way of life.
  • 12. TYPES OF FAMILY PLANNING 1. TEMPORAY METHOD NATURAL METHOD [WITHDRAWAL, CALENDAR, CERVICAL MUCUS, BBT, SYMPTOTHERMAL , LAM ] BARRIER METHOD [PHYSICAL , CHEMICALAND COMBINED ] IUCD HORMONAL METHODS [PILLS, DEPO, IMPLANT]
  • 13. TYPES OF FAMILY PLANNING 2. PERMANENT METHOD MALE VASECTOMY FEMALE—MINILAP, LAPAROSCOPY
  • 14. NATURAL FAMILY PLANNING Rhythm (Calendar) method Basal Body Temperature (BBT) Cervical Mucus Method Symptothermal method Coitus Interruptus Lactation amenorrhea
  • 15.  Basal body temperature  BBT is raised at the time of ovulation.  Temper measured in morning same time when out of bed.  Intercourse to be done on post ovulatery infertile phase , 3 days after ovulation temper raises and continuing upto beginning of menstruation.
  • 17. DISADVATAGES  NOT reliable method: of birth control, especially for women with irregular cycles.  Other factors such as a lack of sleep can cause a woman’s temperature to vary.
  • 18.  Cervical mucus is a fluid produced by small glands near the cervix  This fluid changes throughout her cycle, from watery and sticky, to cloudy and thick.  Each of these types of mucus is related to the hormonal shifts that naturally occur during the menstrual cycle. Cervical Mucus Method
  • 19.  After menstruation of 1 or few days no mucus is seen its call dry period. This period is safe for intercourse. Note:  At the time of ovulation , cervical mucus becomes watery resembling raw egg white , clear , smooth, slippery and profuse.  After ovulation , under the influence of progesterone , the mucus thicken and become less in quantity.
  • 20. Fertile days;  When any type of mucus is seen before ovulation it is called fertile days.
  • 21.  Peak days  The last days of slippery and wet mucus is called peak day. It indicate ovulation is just to happen or had just happened.  After the ovulation, the mucus tends to dry up again. These are also safe days.
  • 23. Symptothermal Method  Combines the cervical mucus and BBT methods Watches temp. daily and analyzes cervical mucus daily.  Couple must abstain from intercourse until 3 days after rise in temp or 3rd day after peak of mucus change.  More effective than BBT or CM method alone
  • 24.  Symptothermic method  Combination of BBT and cervical mucus .
  • 25.  COITUS INTERRUPTUS:  This is the oldest method of voluntary fertility control.  It is cost free or appliance free.  The male withdraws his penis from vagina before ejaculation and thereby prevents deposition of semen into the vagina.
  • 26.  COITUS INTERRUPTUS:  Some couples are able to practice this method sucessfully while other find difficult to manage.  the slightest mistake on timing of withdrawl lead to deposition of certain amount of semen. Effectiveness:70-80%
  • 27. Appropriate for  Men who wish to participate actively in family planning.  Couples with religious region for not using any contraceptives.  Couple needing temporary method
  • 28. ADVANTAGES  Effective method  Always available  No method related health risk
  • 29.  RYTHM METHOD:  Also called calendar method.  This method may be used by women whose menstrual cycles are always between 26 and 32 days in length .  Monitor of length of at least 6 menstrual cycle
  • 30.  To calculate:  Minus 18 from shortest cycle  Minus 11 from longest cycle = represents her fertile day.  Example: If she has 6 menstrual cycles ranging from 25 to 29 days, fertile period would be from 7 th day (25-18) to the 18 th day (29-11). To avoid pregnancy, avoid coitus/use contraceptive during those days.
  • 32. LACTATION AMENNORRHEA  This is a temporary contraceptive method that relies on exclusive breast feeding.  It can be used from birth up to six months.  Producing milk is called lactating and not having a period is called amenorrhea, hence this method of birth control is called lactation amenorrhea (or LAM). 
  • 34. Who can use LAM?  A woman can use LAM if: 1. her menstrual period has not returned since delivery 2. she is breastfeeding her baby on demand, both day and night and not feeding other foods or liquids regularly 3. her baby is less than six months old.
  • 35. LAM IS NOT APPROPRIATE WHEN 1. her menstrual period has returned 2. she is breastfeeding her baby irregularly more than six hr apart 3. her baby is more than six months old. 4. feeding other foods or liquids regularly
  • 36. Point to remember while on LAM  Brest feeding to be done on demand [ at least 8 time/day including 1 times each night]  Interval of feeing should not exceed 4 hr during day and 6 hr during night.  When menstrual periods return use other contraceptive method
  • 38. A)Barrier methods  physical methods e.g. condom, Diaphragm  chemical methods e.g. Foam, suppository, cream  Combined method
  • 39. Barrier methods:  The aim of these methods is to prevent live sperm from meeting the ovum.  The main contraceptive advantage is the absence of side effects associated with the "pill" and IUD.
  • 40.  The non- contraceptive advantages include -some protection against sexually transmitted diseases -a reduction in the incidence of pelvic inflammatory disease. -reduction in the risk of cervical cancer.
  • 41.  Barrier methods require a high degree of motivation on the part of the user.  They are only effective if they are used consistently and carefully.
  • 42. I. Condom  Most commonly used barrier device by males around the world.  Effective,simple method of contraception without side effect.
  • 43.  In addtion of preventing pregnancy,it prevents STI's in both males and females.  The condom is fitted in erect penis before intercourse.The air must be expelled from the teat end to make room for the ejaculate.
  • 45. Mechanism:  Prevents the semen from being deposited in the vagina. Effectiveness: 98% Precautions for use  Use new condom in each sexual intercourse  Keep extra supply in case of emergency  Do not store in warm place  If condom break ,replace immediately.
  • 46. Advanatages:  Easily available and easy to use  Safe and inexpensive  No side effects  Light and disposable  Also prevents from STD's  No contraindication
  • 47. Disadvantages:  It may slip off and tear during coitus due to incorrect use  Interferes with sex sensation and lack of pleassure  Need new condom with each intercourse  Disposal problem
  • 48. NUR 352 GYNAECOLOGY NURSING 48 CONDOMS
  • 49. Female condom  The female condom is a pouch made of polyurethane, which lines the vagina.  An internal ring in the close end of the pouch covers the cervix and an external ring remains outside the vagina.
  • 50.  It is prelubricated with silicon, and a spermicide need not be used.  It is an effective barrier to STDs infection. However, high cost and acceptability are major problems.
  • 51. NUR 352 GYNAECOLOGY NURSING 51 FEMALE CONDOM
  • 53. ADVANTAGES:  Prevents STDs including HIV/AIDS
  • 54.  DISADVANTAGES:  High motivation  Only women who can use diaphragms can use female condom  Slippage occurs  Expensive
  • 55. II.Diaphragm:  It is vaginal barrier method.  It was invented by German physician in 1882. It is also called Dutch cap.  It is dome shaped made up of rubber or latex material .
  • 57.  It has a flexible rim made of spring or metal. It is important that a woman be fitted with a diaphragm of the proper size.  It is held in position partly by the spring tension and partly by the vaginal muscle tone.
  • 58.  In correct position, covers the cervix.  The diaphragm is inserted before sexual intercourse and must remain in place for not less than 6 hours after intercourse.  A spermicide jelly is always used along with diaphragm. Effectiveness:90%
  • 62.  ADVANTAGES:  cheap  No gross medical side effects  Control of pregnancy in hands of woman  Reasonably safe when properly used  Prevent spread of STDs though less effective than condom
  • 63. Disadvantages:  Trainned personnel is required for insertion  If diaphragm is left in vagina for extended period it leads to toxic shock syndrome  After delivery, it can be used only after involution of the uterus is completed.
  • 64. NUR 352 GYNAECOLOGY NURSING 64 DIAPHRAGM + SPERMICIDE
  • 65. B)Chemical methods: Before the advent of IUD's and oral contraceptives,spermicides were widely used. It comprises three categories -Foams -creams -Vaginal suppositories, tablets or dissolvable film
  • 67. Spermicides are surface active agents which attach themselves to sperm and cause sperm cell membrane to break and decrease movement kill sperms.
  • 74.  Kamal chakki is the example of spermicidal vaginal suppository which is available in Nepal .
  • 75. Selection of Spermicide  Foam affective immediately after insertion.  Foam are recommended if spermicide is only contraceptive method to be used.  Vaginal tablets and suppositories are also convenient but require waiting 10-15 minutes after insertion before intercourse.
  • 76. General information  Spermicide should be used before each act of intercourse.  There is 10-15 minute waiting interval after insertion of vaginal tablets, suppositories or films.  Important to use recommendation of manufacturer.  Apply extra spermicide if intercourse does not take place between 1-2 hour
  • 77. APPROPRIATE FOR  Women who prefer not to use hormonal method or is contraindicated (e.g. smoker over age 35 )  Women who should not use IUD.  Women who are breastfeeding and need contraceptive.
  • 78.  Women wanting protection from STD and whose partner is not willing to use condom.  Couple needing temporary method and awaiting another method.  Couple needing a back up method.  Couple who have intercourse frequently.
  • 79. BENEFITS  Effective immediately ( foams and creams)  Do not affect breastfeeding  Can be used as backup to other method  No method related health risk
  • 80. BENEFITS  No systemic side effects  Easy to use  Increase wetness (lubrication) during intercourse  No prescription or medical assessment necessary.
  • 81. DISADVANTAGES:  High failure rate  Repeated after each sex  They must be introduced into those regions of vagina where sperms are likely to be deposited  They may cause burning sensation or irritation  High motivation required  Waiting time is there
  • 82. INTRA-UTERINE DEVICES  The first version of the modern IUCD was developed in 1909 by a German gynaecologist and sex researcher named Ernst Grafenberg.  It was a ring-shaped device made of silver wire and silkworm gut.  It was not widely used since until 1920s.
  • 83. INTRA-UTERINE DEVICES:  Plastic became popular in 1950s and became very useful in the development of new form of IUCD.
  • 84. Types:  -Non-medicated:First generation IUDs  -Copper IUD : Second generation IUDs  -Hormonal :Third generation IUDs
  • 85.  The IUCD currently available in Nepal is the copper T 380 A is shaped like a T and has copper on the stem and the arms, with a total exposed copper area of 380 square mm.  It has white string at the base, which extends through the cervix so that IUCD can be removed.  It can be left in place for 12 years.
  • 87. Mechanism of action of IUDs: Medicated IUDs:  The sterile foreign-body reaction in the uterine cavity causes both cellular [ Keeping the lining of the uterus thin and biochemical changes [Keeping the mucus in the cervix thick and impenetrable to sperm ]that may be toxic to sperm.  By altering the biochemical composition of cervical mucus, affect sperm motility and survival.
  • 88.  The copper acts as a natural spermicide within the uterus which produces contraceptive actions.
  • 90. Advantages of copper devices: -Effectiveness is about 99% -lower incidence of side-effects i.e pain,bleeding -easier to fit in nulliparaous women -better tolerated by nullipara -increased contraceptive effectiveness -low expulsion rate -effective as post-coital contraceptive,if inserted within 3-5 days of unprotected intercourse.
  • 91. Third Generation IUDs:  The most commonly used hormonal device is progestasert ,which is a T-shaped device filled with 38 mg of progesterone.  The hormone is released slowly in the uterus at the rate of 65 mcg daily.  Another hormonal device LNG-20 (Mirena) is a T-shaped IUD releasing 20 mcg of levonorgestrel.
  • 92. Mechanism of action of Third generation IUDs:  It increases the viscocity of the cervical mucus and thereby prevent sperm from entering the cervix and fallopian tube..  They also maintain high levels of progesterone , thereby sustaining an endometrial unfavorable to implantation.
  • 93. .  This causes a foreign-body inflammatory response leading to biochemical and cellular changes in the endometrial tissue and uterine fluid.  This action adds to progesterone's ability to interfere with sperm migration, fertilization and implantation.  Effectiveness:90%
  • 94. Mechanism of action of :LNG-20 IUD  Causes cervical mucus to thicken  Inhibit sperm motility and function  Inhibition of implantation
  • 95. Ideal IUDs candidate:  Has been at least one child  Has no ho of Pelvic disease  Has normal menstrual periods  Is willing to check IUD tail  Has access to follow up and treatment as needed  Is in monogamous relationship.
  • 96. Timing  Anytime during the menstruation cycle within 10 days of beginning of menses.  Immediate postpartum insertion: 1st week after delivery  Post-partum within 6-8 weeks . If using LAM then after 6 months.  Post abortion ( immediately or within 7 days ).
  • 97. Instructions:  Regularly check the tail or thread.  If fails to locate thread , consult health worker  Visit clinic if she experiences any side effects such fever , pelvic pain and heavy bleeding.  If menses is missed visit doctor.  Check IUD periodically may expulse during menstruation.
  • 98. Special concern for return visit  P : Period late, abortion spotting or bleeding.  A : Abdominal pain, pain with intercourse, severe cramping.  I : Infection exposure [gonorrhoea], abnormal discharge.
  • 99. Special concern for return visit  N : Not feeling well, fever, chills along with lower abdominal pain.  S : string missing
  • 100. Follow up  Objectives of follow up :  To provide motivation and support  Presence of IUD confirm  Diagnose and treat complication and side effects
  • 101. Side Effects and Complications:  -Bleeding  -Pelvic infection  -pain  -Uterine perforation  -ectopic pregnancy  -expulsion
  • 102. Contraindication: Absolute:  -suspected pregnancy  -PID  -vaginal bleeding of unknown aetiology  -cancer of cervix  -previous ectopic pregnancy
  • 103. Relative:  -Anaemia  -history of PID since last pregnancy  -fibroid uterine .  -unmotivated persons
  • 104. Indication of Removal of IUDs:  Persistent regular or irregular uterine bleeding and severe cramp like pain in lower abdomen  Increasing evidence of salphingitis  Perforation of uterus  Downward displacement of device into cervical canal
  • 105.  Pregnancy occuring with device in situ  Patient desirous of baby  Missing thread
  • 106. Advantages:  Simple to use ,requires no hospitalization  Insertion takes only few minutes  Once inserted stays in place as long as required  Contraceptive effect is reversible by removal of IUD  Highest continuation rate
  • 107. Disadvantage  -Bleeding  -pain  -Pelvic infection  -Uterine perforation  -ectopic pregnancy  -expulsion  Need trained person and need to go to health facility.
  • 109. Hormonal Contraceptives: When properly used,it is the most effective spacing methods of contraception.
  • 112.  Combined pill- It is the most effective reversible method of contraception.  It is combination of estrogen and progesterone.  The primary mechanism of action of hormonal contraceptives is that they suppress the secretion of gonadotropins (follicle stimulating hormone, FSH and luteinizing hormone, LH).
  • 113.  Combined pill-  This inhibition also prevents the LH surge that is necessary to trigger ovulation  The combine pill nowadays contain low dose of estrogen and progesterone.
  • 114.  In Nepal the most common COCs are low dose pill in 28 days package.  Lo- femenal is available at all Nepal government facilities.  It contain norgesteral 0.3 mg ( progestin) and ethinyl /estrogen 0.03 mg in each pill.  The last 7 brown pills contains ferrous sulphate.
  • 115.  They are found in market in the name of sunaulogulaf and Nilocan .
  • 116.  The pill is given orally for 21 consecutive days begining on the 5th day of the menstrual cycle,followed by a break of 7 days during which period menstruation occurs.
  • 117.  The bleeding which occurs is not like normal menstruation ,but is as episode of uterine bleeding from an incompletely formed endometrium caused by withdrawl of hormones.Therefore it is called withdrawl bleeding.
  • 118.  The pill should be taken everyday at a fixed time, preferably before going to bed at night.  If the user forgets to take a pill, she should take it as soon as she remembers, and that she should take the next day's pill at the usual time.
  • 119. Mechanism of action:  The mechanism of action of the combined oral pill is to prevent the release of the ovum from the ovary.  This is achieved by blocking the pituitary secretion of gonadotropins that is necessary for ovulation to occur.
  • 120.  It makes the cervical mucus thick and scanty and thereby inhibit sperm penetration.  It also inhibit tubal motility and delay the transport of the sperm and of the ovum to the uterine cavity.
  • 121. Timing of usage  Within 5 days of menses but backup method to be used for next 7 days.  Within 4 week postpartum  Within 7 days post abortion  If using LAM, after 6 months  Within 5 days after first trimester abortion but backup method to be used for next 7 days.
  • 122. Effectiveness  1oo% effective with perfect use  With typical use out of 100, 5 may become pregnant.
  • 123. ADVANTAGES  Highly effective  Easy to use and don’t interrupt sexual activity  Risk of PID is halved.  Decrease risk of ovarian and uterine cancer ( suppression of ovulation decrease recurrent ovarian injury)  Menstrual periods are regular and painless.
  • 124. ADVANTAGES  Decrease menstrual blood loss (50%), so reduce risk of anemia.  Protection against ovarian cyst.  Easily available for free of cost in health facilities.
  • 125. DISADVANTAGES  Failure rate is high if not taken regularly  Most common side effect are  headache,  breast tenderness,  feeling of being sick,  change in body weight ,  may also cause blood clots ,  change in libido,  depression and  brown patches on the skin etc
  • 126.  Minor side effects often clear up after 2-3 month of use.  Quantity of breast milk may be decreased.
  • 127. Contraindicated  Past history or presence of thromboembolism  Cancer of breast and genitals  undiagnosed vaginal bleeding  Severe migraine headache  Pregnancy  Heavy smoker ( more than 40 cigratee/day]
  • 128. Contraindicated  CVS disease  Age above 40 years  Smokers  amenorrhea
  • 129. Minipill [Progesterone only pill]  Commonly referred to minipill.  It contains only progesterone which is given in small doses throughout the cycle.
  • 130. Mechanism of action:  It works mainly by making cervical mucus thick and viscous,thereby prevents sperm penetration.  Endometrium becomes atrophic and implantation is impaired.
  • 131. Advantages:  No estrogen related side effect  Amount of progestin is lesser as compared to combined pill.  Easy to take.  Nursing mother can take minipill after the baby is six months.
  • 132. Disadvantages:  Menstrual irregularity is the most common problem  Irregular bleeding and spotting can be observed.  Failure rate is high  Increase risk of ectopic pregnancy
  • 133. Method of using oral contraceptive  Should start within 5 day of menstrual cycle.  Started lately after 5 days should use back up method for 7 days as it start its action only after 7 days.  For women who had abortion can use on the same day.
  • 134. Method of using oral contraceptive  Post partum not breasting can use after third week.  Some medication interfere with pills effectiveness.e.g anti convulsant (carbamezapine) , ATT(refampicin) , antifungal agent. So use back of method or change contraceptive.
  • 135. Advice to client for missing to take pill  If miss taking pill on one day, take as soon as use remember and take next pill at the regular time.  If you miss talking a pill on two or more days, take pill as soon as you remember. Take a pill each day until you finish the pack and use another backup contraceptive method.
  • 136. Advice to client for consultation Stop to take pill immediately and see health personnel if you have:  Sudden severe chest pain  Sudden breathlessness  Severe pain in the calf of one leg  Fits, unusual dizziness or fainting.  severe depression
  • 137. Possible side effects  Spotting or bleeding  Jaundice [may elevate liver enzymes]  Mastalgia[Breast pain]  Amenorrhea  High blood pressure.
  • 138. II.Depot preparation: a)DMPA(Depot-Medroxyprogesterone acetate):  Progesterone only injectables.  Brand name is Depo-Provera  Commonly called ‘Depo’  Called ‘Sangini’ in Nepal  The standard dose is 150 mg every 3 months I.M.
  • 139. Mechanism: a)Inhibition of ovulation-by suppresing midcycle LH peak b)cervical mucus becomes thick thereby prevents sperm penetration c)endometrium is atrophic thus pervents implantation.
  • 140. INDICATION OF DMPA  Having increased risk of CVD.  Other method using daily use are not suitable.  Estrogen related complication occur.  Amenorrhoea is acceptable or desirable.  Contact wit service provider on regular basis is difficult.
  • 141. Administration  The initial injection of DMPA should be given during the first 7 days of the menstrual period.  Within 4 weeks of postpartum  Within 7 days of post abortion  If using LAM after 6 months  If partially breast feeding after 6 weeks  Are given by deep intramuscular injection into the gluteus maximus.
  • 142. Advantages:  Highly effective  No back up method needed  Loose less blood and less menstrual cramping.  Decrease chance of anaemia and PID.  Reversible  No estrogen related side effects.  Can be used safely during lactation.  Rapidly effective within 72 hours.
  • 143. DISADVANTAGE  may lead to very irregular period  weight gain in some case  must return clinic every 3 month
  • 144. CLIENT INSTRUCTION  Instruct for return visit every 3 months  Can be given 2 week before and 2 weeks after.  If heavy vaginal bleeding , lower abdominal pain, severe headache and depression return to clinic.  Explain about possible side effect
  • 145. SIDE EFFECTS  Spotting or bleeding  Jaundice  Mastalgia  Amenorrhea  High blood pressure
  • 146. Subdermal implants [JADELLE]  The Newer Norplant R-2 comprise of progestin levenorgesterol into 2 small silicon capsule.  The device contain 75 mg of levenorgesterol in each 2 silicon rubber capsule.  Each rod is 2.5 mm in diameter and 43 mm in length
  • 147.  The silastic capsules or rods are implanted under the skin of the forearm or upper arm. Effective contraception is provided for 5 years.
  • 148. Mechanism: a)Inhibition of ovulation-by suppresing midcycle LH peak b)cervical mucus becomes thick thereby prevents sperm penetration c)endometrium is atrophic thus pervents implantation.
  • 149. Administration  May be given anytime during menstrual cycle if it is certain that she is not pregnant.  should be given during the first 7 days of the menstrual period.  Within 4 weeks of postpartum  Within 7 days of post abortion
  • 150. Administration  If using LAM after 6 months  If partially breast feeding after 6 weeks Indication  Want long term spacing that is 5 years
  • 151. Advantages:  Highly effective 99.7 percent  No back up method needed  Reversible  Can be used safely after childbirth and during lactation.  Long term protection 5 years  Can be removed anytime  Immediate return of fertility after removal  Protect against uterine cancer
  • 152. DISADVANTAGE  may lead to very irregular period  Need small surgical procedure and medical person  Does not protect from STD/AIDS  Cannot discontinue by own wish
  • 153. CONTRAINDICATED  suspected pregnancy  Liver disease  Breast cancer  Uterine bleeding
  • 154. Use with caution  Irregular bleeding  High blood pressure  High cholesterol  Headache  Drug( refampicin , antiepileptic)gall bladder disease
  • 155. Client’s instruction  Insertion area to be clean dry with pressure dressing in place for 2 days and band aid for 5 days  No staining the area for few days  If sign of infection such as inflammation , pain and fever return to clinic  Follow up after 7 days for check up of insertion site
  • 156. IMMEDIATE CONSULTATION IN CASE OF  Heavier periods than normal  Prolong and missed periods  Severe abdominal pains  Severe headache  Blurred vision
  • 157. II.Terminal methods: a)Male sterillisation:  Also called voluntary sterillisation where by reproductive function of male is permanently destroyed.  It is also called as vasectomy.  Now a days Non-scalpel vasectomy is more preferred rather than traditional one.
  • 159.  The Non-scalpel vasectomy (NSV), originally developed in China in 1974 by Dr. Li Shungian  It is an innovative approach to exposing the vas deferens using 2 specialized surgical instruments( extracutaneous forcep and sharp pointed curved mosquito hemostat).
  • 160.  The vas clamp is used to grasp the vas and small puncture is made in the scrotum with the sharp tipped forceps  the vas is lifted out for occlusion. No stitches are required  As compared to traditional incision technique, NSV resulted in less bleeding, hematoma, infection, and pain, and a shorter operative time
  • 161. Guideline for sterilization Preoperative a. The age of the husband should not ordinarily be less than 25 years nor should it be over 50 years b. The age of the wife should not be less than 20 or more than 45 years c. The motivated couple must have 2 living children at time of operation d. If the couple has 3 or more living children , the lower limit of age of the husband or wife may be relaxed.
  • 162. e. The client should sign the consent to undergo sterilization operation without outside pressure , should know the operation is irreversible and also the spouse has not been sterilized earlier. f. Accurate medical history and physical examination g. Client should take bath and clean clothes before surgery h. Ask to bring clean scrotal support clothes i. Shaving of pubic hair
  • 163. j. No anesthesia is used so can go ho afetr taking 3 min rest. k.Scrotal support, operative site to be kept clean and dry and rest for 2 days. l. 3-5 day refrain form sexual intercourse. m.Use other methods for 3 month.
  • 164. NUR 352 GYNAECOLOGY NURSING 164 VASECTOMY
  • 165. Effectiveness:99% Advantages:  simple and safe.  No stitches  Less discomfort  Faster procedure  Faster recovery  complication is few  Reversible is possible
  • 166. Disadvantage  Delay effectiveness ( require 3 months or 20 ejaculation)  Does not protect STD/AIDS  Difficult to reverse  Risk and side effect of minor surgery
  • 167. Contraindication  Large vericocelel[enlargement of pampiniform plexus in scrotum]  Hydrocele [ fluid-filled sac surrounding a testicle that causes swelling in the scrotum.  Scar tissue  Inguinal hernia  Previous scrotal surgery  Intra mass
  • 168. Complication: Immediate:  Swelling and wound pain  Blood clots  Infection  spontaneous recannalisation:  Most epithelial cell will recannalise after damage.
  • 169. -Autoimmune response:  Blocking of vas caused reabsorption of sperm  lead to development of antibodies against sperm in blood. -Psychological Client may complain of  Reduction of sexual vigour(strength)  Impotence (inability to develop or maintain an erection of the penis )  Headache etc.
  • 170. Post-operative advice 1. The patient should be told that he is not sterile immediately after the operation; at least 30 ejaculations may be necessary before the seminal examination is negative. 2. To use contraceptives until aspermia has been established. 3. To avoid taking bath for at least 2 days after the operation.
  • 171. 4. To wear a T-bandage or scrotal support (langot) for 15 days and to keep the site clean and dry. 5. To avoid cycling or lifting heavy weights for 15 days. There is, however no need for complete bed rest. 6. To have the stitches removed on the 5th day after the operation.
  • 172. Female sterlization  It is a voluntary sterillisation method where by reproductive function of female is permanently destroyed.  Most common procedure is minilaparotomy.
  • 174.  It is a much simpler procedure requiring a smaller lower abdominal incision of only 2-3 inch conducted under local anesthesia.  Fallopian tube are located , cut out and tyed.  After that abdominal opening is closed.  Client can be discharged 3-4 hr of operation
  • 176. NUR 352 GYNAECOLOGY NURSING 176
  • 177. TIMING OF PROCEDURE  Anytime during menstrual cycle, if client is not pregnant.  48 hr after delivery  6-8 weeks postpartum
  • 178. ADVANTAGE  Highly effective  Permanent method  Does not interfere sexual intercourse  Can be performed in OPD basis  Can be done 48 hr after delivery.
  • 179. DISADVANTAGE  Expensive than vasectomy  Not reversible  No protection for STD/HIV  Risk and side effect of minor surgery
  • 180. CONTRAINDICATION  Pregnancy  Respiratory problem  PID/UTI  Mass in pelvis  Heart disease  Severe anaemia  Allergic  Fibroid and abdominal surgery
  • 181.  It is also found to be a suitable procedure at the primary health centre level and in mass campaigns.  It has the advantage over other methods with regard to safety, efficiency and ease in dealing with complications.  Minilap operation is suitable for postpartum tubal sterilization
  • 182. Laparoscopy  Female sterilization through abdominal approach with a specialized instrument called "laparoscope“ is called laparoscopy.  A tiny incision is made and a thin, long instrument (called a laparoscope) that contains a small lens and lighting system to magnify and illuminate the structures inside the lower abdomen is inserted.
  • 184. Laparoscopy  Once the tubes are accessible, the rings (or clips) are applied to occlude the tubes
  • 186. ADVANTAGE  Operation require 15 min  Only small scar  Immediate effective  Effective permanent method  Can be done on OPD basis  No interference in sexual activity
  • 188. COMPLICATION  Fever  Wound infection  Injury to other organ e.g. hematoma, injury to abdominal organ.  Intraoperative haemorrhage  Nausea and vomiting
  • 189. Preoperative preparation  Complete medical history and physical examination  Fasting for 8 hr before surgery and do not take any medication  Inform consent  Bath and clean before operation  Empty bladder  Jewellery and hair pin to be remove  Change gown in OT  Tab diazepam 5 mg 45 min before operation
  • 190. Postoperative preparation  Vital to be checked every 15 min until patient become stable  Rest 2-3 hr after operation  Light snack and tea can be given  Can bath after 5 days  Keep clean and dry  Postoperative analgesic medication for 5 days  Follow up visit after 1 week  Sexual relation after 1 week  Any complication follow up visit

Editor's Notes

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  3. GYNECOLOGY NURSING (NUR352)
  4. GYNECOLOGY NURSING (NUR352)
  5. GYNECOLOGY NURSING (NUR352)
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