learn about various methods of contraception , how to use various contraceptive devices and also learn about the hormonal and emergency contraceptives' methods. here is the detail of post coital methods to prevent pregnancy and terminal methods for sterilization.
Functional ovarian cyst and its differential diagnosis Cheng Ting
Functional ovarian cysts are non-cancerous cysts that form due to a temporary hormonal imbalance. They are usually unilateral, asymptomatic, and less than 8 cm in diameter. Functional cysts contain clear fluid and will typically resolve on their own once the hormonal imbalance is addressed. Differential diagnoses for ovarian cysts include ectopic pregnancy, ovarian tumors, and other gastrointestinal or genitourinary conditions. Distinguishing features between functional and cancerous cysts include cyst size, consistency, location, presence of ascites, and diagnostic imaging results.
Male infertility can be caused by structural or functional abnormalities in sperm, including low sperm count, low motility, and abnormal forms. Oxidative stress from reactive oxygen species is another leading cause, as it can damage sperm DNA and membranes. The body normally defends against oxidative stress through antioxidant enzymes and compounds in seminal plasma. However, oxidative stress overwhelms these defenses in around 25-40% of infertile men. Various antioxidants taken as supplements, either alone or in combination, have been shown to reduce oxidative stress levels, boost sperm parameters, and improve fertility rates. These include CoQ10, lycopene, mixed carotenoids, omega-3 fatty acids, vitamin C, vitamin E, selenium, zinc
This document discusses the role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques. It reviews evidence on various tubal patency tests like laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, and their advantages and limitations. While laparoscopy is considered the gold standard, it requires general anesthesia and carries surgical risks. Hysterosalpingogram is widely available but less accurate and exposes patients to radiation. Hysterosalpingo contrast sonography provides images without radiation but may be limited in some patients. The document concludes that in vitro fertilization has largely replaced tubal surgery as it offers better success rates and can be done on an out
Echogenic fetal bowel seen on ultrasound is a soft marker for Trisomy 21 and other conditions. It can be associated with intra-amniotic hemorrhage, aneuploidy like Trisomy 21, intra-uterine CMV infection, cystic fibrosis, fetal growth restriction, gastrointestinal obstruction, and rare etiologies. Down syndrome presents with physical features like depressed nasal bridge and simian crease. Congenital CMV infection can cause brain damage, jaundice, and deafness. Cystic fibrosis affects the lungs, liver, and pancreas due to a defective gene. Fetal growth restriction increases the risk of fetal demise. Gastrointestinal obstruction encompasses conditions like biliary
Surgical Management of Uterine AbnormalityUlun Uluğ
This document discusses the surgical management of uterine abnormalities. It begins by defining congenital genital abnormalities and Mullerian anomalies. It then provides classifications for uterine anomalies and discusses their prevalence. Various uterine anomalies are described in more detail, including their associated symptoms, prevalence, and effects on pregnancy outcomes. The document discusses diagnostic challenges and various treatment approaches for different uterine anomalies, particularly for septate uteri. It concludes that management must be individualized based on each patient's anatomy and clinical situation.
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Functional ovarian cyst and its differential diagnosis Cheng Ting
Functional ovarian cysts are non-cancerous cysts that form due to a temporary hormonal imbalance. They are usually unilateral, asymptomatic, and less than 8 cm in diameter. Functional cysts contain clear fluid and will typically resolve on their own once the hormonal imbalance is addressed. Differential diagnoses for ovarian cysts include ectopic pregnancy, ovarian tumors, and other gastrointestinal or genitourinary conditions. Distinguishing features between functional and cancerous cysts include cyst size, consistency, location, presence of ascites, and diagnostic imaging results.
Male infertility can be caused by structural or functional abnormalities in sperm, including low sperm count, low motility, and abnormal forms. Oxidative stress from reactive oxygen species is another leading cause, as it can damage sperm DNA and membranes. The body normally defends against oxidative stress through antioxidant enzymes and compounds in seminal plasma. However, oxidative stress overwhelms these defenses in around 25-40% of infertile men. Various antioxidants taken as supplements, either alone or in combination, have been shown to reduce oxidative stress levels, boost sperm parameters, and improve fertility rates. These include CoQ10, lycopene, mixed carotenoids, omega-3 fatty acids, vitamin C, vitamin E, selenium, zinc
This document discusses the role of tubal patency tests and tubal surgery in the era of assisted reproductive techniques. It reviews evidence on various tubal patency tests like laparoscopy, hysterosalpingogram, hysterosalpingo contrast sonography, and their advantages and limitations. While laparoscopy is considered the gold standard, it requires general anesthesia and carries surgical risks. Hysterosalpingogram is widely available but less accurate and exposes patients to radiation. Hysterosalpingo contrast sonography provides images without radiation but may be limited in some patients. The document concludes that in vitro fertilization has largely replaced tubal surgery as it offers better success rates and can be done on an out
Echogenic fetal bowel seen on ultrasound is a soft marker for Trisomy 21 and other conditions. It can be associated with intra-amniotic hemorrhage, aneuploidy like Trisomy 21, intra-uterine CMV infection, cystic fibrosis, fetal growth restriction, gastrointestinal obstruction, and rare etiologies. Down syndrome presents with physical features like depressed nasal bridge and simian crease. Congenital CMV infection can cause brain damage, jaundice, and deafness. Cystic fibrosis affects the lungs, liver, and pancreas due to a defective gene. Fetal growth restriction increases the risk of fetal demise. Gastrointestinal obstruction encompasses conditions like biliary
Surgical Management of Uterine AbnormalityUlun Uluğ
This document discusses the surgical management of uterine abnormalities. It begins by defining congenital genital abnormalities and Mullerian anomalies. It then provides classifications for uterine anomalies and discusses their prevalence. Various uterine anomalies are described in more detail, including their associated symptoms, prevalence, and effects on pregnancy outcomes. The document discusses diagnostic challenges and various treatment approaches for different uterine anomalies, particularly for septate uteri. It concludes that management must be individualized based on each patient's anatomy and clinical situation.
Ovarian Reserve Testing in Infertility Dr. Jyoti Agarwal Dr. Sharda JainLifecare Centre
The Best Gametes
Give The Best Result
OVARIAN RESERVE
Plan fertility preservation
Fertility outcome
Response to ovarian stimulation
Predict pregnancy rate
Monitor fertility decline
Fertility after chemotherapy and cancer treatment
Invited Lecture delivered by Dr Sujoy Dasgupta in a CME, sponsored by Serum Institute of India Pvt Ltd in the Convocation Ceremony of Interns at Sagor Dutta Medical College
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Dr. Jaideep Malhotra is an IVF specialist based in Agra, India. He has over 50 published papers and 100 conference presentations. He is a fellow of many Indian and international obstetrics and gynecology organizations. He has received several awards for his work, including producing India's first IVF birth and test tube baby of Nepal. He practices at his nursing home in Agra and is a consulting IVF specialist at multiple other locations in Northern India and Nepal.
This document describes the Fothergill's Operation procedure for uterine prolapse. The key steps are:
1. Amputating the elongated cervix while preserving menstrual function.
2. Approximating the cardinal ligaments in front of the cervical stump using a Fothergill stitch to support the uterus.
3. Repairing any enterocele or cystocele.
The operation is indicated for 2nd or 3rd degree prolapse with vaginal wall defects. Complications can include hemorrhage, cervical stenosis, recurrence of prolapse, and bladder or fistula injuries. A modification by Shirodkar involves cutting and crossing the uterosacral ligaments in
This document discusses different methods for inducing ovulation, including clomiphene citrate, letrozole, and gonadotropins. Clomiphene citrate is often the first line treatment for anovulatory infertility and works by selectively blocking estrogen receptors in the hypothalamus. Letrozole is an aromatase inhibitor that prevents estrogen production and induces monofollicular development. Gonadotropins such as FSH can be used when other methods fail or for assisted reproduction procedures, but carry risks of ovarian hyperstimulation syndrome.
MEDICAL MANAGEMENT OF ABNORMAL UTERINE BLEEDING BY DR SHASHWAT JANIDR SHASHWAT JANI
The document discusses medical management of abnormal uterine bleeding, focusing on progesterone. It provides background on abnormal uterine bleeding, including definitions, classification systems, evaluation, differential diagnoses, treatment options, and the roles of various hormones. The document specifically examines progesterone's role in hormonal regulation of the menstrual cycle and abnormal uterine bleeding. It also discusses various medical treatment options and when surgery may be indicated.
This document provides biographical information on Prof. Narendra Malhotra, including his professional designations, affiliations, awards, publications, special interests, and tests for ovarian reserve. He is a professor, past president of several medical organizations, managing director of health care companies, and director of IVF clinics. He has authored or edited numerous medical publications on gynecology and obstetrics. His special research interests include high risk obstetrics, ultrasound, assisted reproductive technology, and genetics.
This document discusses Mayer Rokitansky Kuster Hauser Syndrome (MRKH), a rare disorder characterized by the congenital absence of the uterus and vagina. It describes the signs and symptoms, including primary amenorrhea. Surgical techniques for creating a neovagina are discussed, including the McIndoe technique using a skin graft. Options for women with MRKH like surrogacy and adoption are mentioned. The document emphasizes that while women with MRKH cannot carry their own biological children, they should realize others experience pain and appreciate what they have.
This document discusses testicular feminization syndrome (TFS), also known as androgen insensitivity syndrome (AIS). TFS is caused by mutations in the androgen receptor gene that result in partial or complete inability of cells to respond to androgens. This leads to undervirilization or feminization of genetic males. The document classifies AIS into three classes based on severity of symptoms: complete AIS, partial AIS, and mild AIS. It provides details on genital embryology, expected phenotypes for each class, differential diagnoses, and epidemiology estimates.
This document summarizes guidelines for managing ovarian endometriomas. It discusses that endometriomas larger than 3cm should be surgically removed if causing pain or infertility. Complete excision of the cyst is preferable to drainage/ablation to reduce recurrence risk. While surgery provides relief, recurrence rates remain high, so post-operative hormonal therapy for 6 months can help delay recurrence compared to no treatment. Ovarian damage is a risk, so conservative surgery aims to preserve ovarian function where possible.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Classification & conservative surgeries for prolapseIndraneel Jadhav
This document discusses various classifications and conservative surgical treatments for pelvic organ prolapse. It begins by describing the normal anatomical supports that prevent prolapse, including the bony scaffolding, endopelvic fascia, and pelvic musculature. It then covers several classification systems for prolapse, including the Baden-Walker and POP-Q systems. Conservative surgeries discussed include abdominal sling operations, various sling procedures, anterior and posterior colporrhaphies, paravaginal defect repairs, and perineorrhaphies. Newer procedures like vaginal sacrospinous cervico-colpopexy and posterior intravaginal slingplasty are also mentioned. The document emphasizes that hyster
Vaginal hysterectomy is a procedure to remove the uterus through the vagina. It has advantages over abdominal hysterectomy like earlier recovery, less pain, and lower morbidity. The key steps involve exposing and clamping the uterine vessels and ligaments, then removing the uterus. The vaginal cuff and pelvic floor are repaired with sutures to prevent prolapse. Post-operative care involves bladder drainage, antibiotics, pain relief, and monitoring for potential complications like bleeding or infection.
This document discusses gestational trophoblastic neoplasia (GTN), which includes conditions like invasive moles and choriocarcinoma that develop from abnormal pregnancies. It provides details on risk factors, diagnosis, evaluation, classification, and treatment options for GTN. For low risk GTN, single agent chemotherapy like methotrexate or dactinomycin is highly effective at achieving remission with minimal side effects. Dactinomycin may have a slightly higher cure rate while methotrexate is preferable in low resource settings due to ease of administration.
This document discusses the use of lasers in gynecology. It begins by explaining the physical properties of lasers including their monochromacity, coherence, and collimation. It then discusses laser tissue interaction and the factors that influence laser effects. Common laser systems used in gynecology are described including their wavelengths and tissue penetration. The advantages of fiberoptic laser laparoscopy are provided. The principal uses of lasers in gynecology are listed as tissue cutting, coagulation, and vaporization. Examples of specific gynecological procedures where lasers are commonly used are given. The limitations and hazards of laser systems are briefly outlined.
MALE INFERTILITY Disorder of male sexual function ANILKUMAR BR
This document defines infertility as the inability to conceive after one year of unprotected intercourse. It can be primary or secondary infertility. Male infertility is often caused by issues with the hypothalamic-pituitary system, testes, or ejaculatory system. Testing includes semen analysis, hormone levels, and identifying risk factors like varicocele, infections, medications, lifestyle, and idiopathic causes. Treatment involves medications, lifestyle changes, assisted reproduction, and addressing the significant emotional burden of infertility.
This document discusses ovarian cortical strips transplantation as a method for fertility preservation. It describes how ovarian cortical tissue can be removed, prepared into thin strips, and transplanted to various locations in the body. Locations mentioned include remaining ovaries, pelvic walls, abdominal muscles, and under the skin of the forearm or abdomen. The goals are to maintain hormone levels and potentially allow for future natural conception. Success is determined by restoration of hormone levels and follicular development visible on ultrasound over subsequent months.
The document discusses several topics related to labour and delivery:
- The physiological mechanisms that initiate labour, including hormonal and anatomical changes in the mother and fetus.
- How uterine contractions progress cervical dilation and effacement in the first stage of labour.
- The second stage where contractions expel the fetus through the birth canal.
- The third stage where the placenta is delivered.
- Methods for assessing and monitoring labour including physical exams, cardiotocography to monitor the fetal heart rate, and use of the partogram to track labour progress.
Oxidative stress from reactive oxygen species can impair sperm function and contribute to male infertility. Antioxidants may help reduce oxidative stress and improve fertility outcomes. Oral antioxidant supplementation in men with oxidative stress issues has been shown to increase pregnancy and live birth rates when undergoing assisted reproductive technologies. However, more research is still needed to determine the best candidates, formulations, dosages and duration of treatment for oral antioxidant therapy in cases of male infertility related to oxidative stress.
This document discusses infertility and polycystic ovary syndrome (PCOS). It defines PCOS and outlines its diagnosis criteria. PCOS is diagnosed based on somatic or lab indicators of hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology, while excluding other disorders. Treatment options for PCOS include weight loss, exercise, clomiphene, aromatase inhibitors, metformin, and gonadotropins. Long-term management may involve birth control pills, metformin therapy, and lifestyle changes to reduce risks of weight gain, hyperandrogenism, and cardiac or metabolic diseases.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Methods of family limiting and spacing methods (1)deepasrideepasri
The document discusses various methods of family planning and birth spacing. It defines key terms like family planning, contraception, and describes different contraceptive methods like barrier methods (condoms, diaphragms, sponges), intrauterine devices (IUDs), hormonal methods (oral pills, injectables), and sterilization. It provides details on the use, effectiveness, advantages and disadvantages of each method. The document emphasizes the importance of family planning for health, social and economic reasons.
Female condom (Vaginal Patch)- a detailed medical study martinshaji
The Female condom or vaginal pouch is an important contraceptive option but should be preferably used three months after normal delivery. Like the male condom, but unlike other barrier devices female condom offers good protection against sexually transmitted devices as well as pregnancy. The diaphragm and cervical caps shield only the cervix against some types of infections and speny but vaginal walls remain exposed and vulnerable to viruses & bacteria. The female condom, however, completely covers the vagina as well as the cervix. It is the only method controlled by the female partner that offers a level protection similar to that of the male condom.
please comment
thank you....
Update on LETROZOLE Current Guidelines for Ovulation Induction Dr. Sharda Jain Lifecare Centre
Update on LETROZOLE Current Guidelines for Ovulation Induction
LET NOT FORGET
WHY
??
LETROZOLE was withdrawn from
Indian market (2012)
“SAFETY ISSUES”
“Could Be Teratogenic In Human”?
Dr. Jaideep Malhotra is an IVF specialist based in Agra, India. He has over 50 published papers and 100 conference presentations. He is a fellow of many Indian and international obstetrics and gynecology organizations. He has received several awards for his work, including producing India's first IVF birth and test tube baby of Nepal. He practices at his nursing home in Agra and is a consulting IVF specialist at multiple other locations in Northern India and Nepal.
This document describes the Fothergill's Operation procedure for uterine prolapse. The key steps are:
1. Amputating the elongated cervix while preserving menstrual function.
2. Approximating the cardinal ligaments in front of the cervical stump using a Fothergill stitch to support the uterus.
3. Repairing any enterocele or cystocele.
The operation is indicated for 2nd or 3rd degree prolapse with vaginal wall defects. Complications can include hemorrhage, cervical stenosis, recurrence of prolapse, and bladder or fistula injuries. A modification by Shirodkar involves cutting and crossing the uterosacral ligaments in
This document discusses different methods for inducing ovulation, including clomiphene citrate, letrozole, and gonadotropins. Clomiphene citrate is often the first line treatment for anovulatory infertility and works by selectively blocking estrogen receptors in the hypothalamus. Letrozole is an aromatase inhibitor that prevents estrogen production and induces monofollicular development. Gonadotropins such as FSH can be used when other methods fail or for assisted reproduction procedures, but carry risks of ovarian hyperstimulation syndrome.
MEDICAL MANAGEMENT OF ABNORMAL UTERINE BLEEDING BY DR SHASHWAT JANIDR SHASHWAT JANI
The document discusses medical management of abnormal uterine bleeding, focusing on progesterone. It provides background on abnormal uterine bleeding, including definitions, classification systems, evaluation, differential diagnoses, treatment options, and the roles of various hormones. The document specifically examines progesterone's role in hormonal regulation of the menstrual cycle and abnormal uterine bleeding. It also discusses various medical treatment options and when surgery may be indicated.
This document provides biographical information on Prof. Narendra Malhotra, including his professional designations, affiliations, awards, publications, special interests, and tests for ovarian reserve. He is a professor, past president of several medical organizations, managing director of health care companies, and director of IVF clinics. He has authored or edited numerous medical publications on gynecology and obstetrics. His special research interests include high risk obstetrics, ultrasound, assisted reproductive technology, and genetics.
This document discusses Mayer Rokitansky Kuster Hauser Syndrome (MRKH), a rare disorder characterized by the congenital absence of the uterus and vagina. It describes the signs and symptoms, including primary amenorrhea. Surgical techniques for creating a neovagina are discussed, including the McIndoe technique using a skin graft. Options for women with MRKH like surrogacy and adoption are mentioned. The document emphasizes that while women with MRKH cannot carry their own biological children, they should realize others experience pain and appreciate what they have.
This document discusses testicular feminization syndrome (TFS), also known as androgen insensitivity syndrome (AIS). TFS is caused by mutations in the androgen receptor gene that result in partial or complete inability of cells to respond to androgens. This leads to undervirilization or feminization of genetic males. The document classifies AIS into three classes based on severity of symptoms: complete AIS, partial AIS, and mild AIS. It provides details on genital embryology, expected phenotypes for each class, differential diagnoses, and epidemiology estimates.
This document summarizes guidelines for managing ovarian endometriomas. It discusses that endometriomas larger than 3cm should be surgically removed if causing pain or infertility. Complete excision of the cyst is preferable to drainage/ablation to reduce recurrence risk. While surgery provides relief, recurrence rates remain high, so post-operative hormonal therapy for 6 months can help delay recurrence compared to no treatment. Ovarian damage is a risk, so conservative surgery aims to preserve ovarian function where possible.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Classification & conservative surgeries for prolapseIndraneel Jadhav
This document discusses various classifications and conservative surgical treatments for pelvic organ prolapse. It begins by describing the normal anatomical supports that prevent prolapse, including the bony scaffolding, endopelvic fascia, and pelvic musculature. It then covers several classification systems for prolapse, including the Baden-Walker and POP-Q systems. Conservative surgeries discussed include abdominal sling operations, various sling procedures, anterior and posterior colporrhaphies, paravaginal defect repairs, and perineorrhaphies. Newer procedures like vaginal sacrospinous cervico-colpopexy and posterior intravaginal slingplasty are also mentioned. The document emphasizes that hyster
Vaginal hysterectomy is a procedure to remove the uterus through the vagina. It has advantages over abdominal hysterectomy like earlier recovery, less pain, and lower morbidity. The key steps involve exposing and clamping the uterine vessels and ligaments, then removing the uterus. The vaginal cuff and pelvic floor are repaired with sutures to prevent prolapse. Post-operative care involves bladder drainage, antibiotics, pain relief, and monitoring for potential complications like bleeding or infection.
This document discusses gestational trophoblastic neoplasia (GTN), which includes conditions like invasive moles and choriocarcinoma that develop from abnormal pregnancies. It provides details on risk factors, diagnosis, evaluation, classification, and treatment options for GTN. For low risk GTN, single agent chemotherapy like methotrexate or dactinomycin is highly effective at achieving remission with minimal side effects. Dactinomycin may have a slightly higher cure rate while methotrexate is preferable in low resource settings due to ease of administration.
This document discusses the use of lasers in gynecology. It begins by explaining the physical properties of lasers including their monochromacity, coherence, and collimation. It then discusses laser tissue interaction and the factors that influence laser effects. Common laser systems used in gynecology are described including their wavelengths and tissue penetration. The advantages of fiberoptic laser laparoscopy are provided. The principal uses of lasers in gynecology are listed as tissue cutting, coagulation, and vaporization. Examples of specific gynecological procedures where lasers are commonly used are given. The limitations and hazards of laser systems are briefly outlined.
MALE INFERTILITY Disorder of male sexual function ANILKUMAR BR
This document defines infertility as the inability to conceive after one year of unprotected intercourse. It can be primary or secondary infertility. Male infertility is often caused by issues with the hypothalamic-pituitary system, testes, or ejaculatory system. Testing includes semen analysis, hormone levels, and identifying risk factors like varicocele, infections, medications, lifestyle, and idiopathic causes. Treatment involves medications, lifestyle changes, assisted reproduction, and addressing the significant emotional burden of infertility.
This document discusses ovarian cortical strips transplantation as a method for fertility preservation. It describes how ovarian cortical tissue can be removed, prepared into thin strips, and transplanted to various locations in the body. Locations mentioned include remaining ovaries, pelvic walls, abdominal muscles, and under the skin of the forearm or abdomen. The goals are to maintain hormone levels and potentially allow for future natural conception. Success is determined by restoration of hormone levels and follicular development visible on ultrasound over subsequent months.
The document discusses several topics related to labour and delivery:
- The physiological mechanisms that initiate labour, including hormonal and anatomical changes in the mother and fetus.
- How uterine contractions progress cervical dilation and effacement in the first stage of labour.
- The second stage where contractions expel the fetus through the birth canal.
- The third stage where the placenta is delivered.
- Methods for assessing and monitoring labour including physical exams, cardiotocography to monitor the fetal heart rate, and use of the partogram to track labour progress.
Oxidative stress from reactive oxygen species can impair sperm function and contribute to male infertility. Antioxidants may help reduce oxidative stress and improve fertility outcomes. Oral antioxidant supplementation in men with oxidative stress issues has been shown to increase pregnancy and live birth rates when undergoing assisted reproductive technologies. However, more research is still needed to determine the best candidates, formulations, dosages and duration of treatment for oral antioxidant therapy in cases of male infertility related to oxidative stress.
This document discusses infertility and polycystic ovary syndrome (PCOS). It defines PCOS and outlines its diagnosis criteria. PCOS is diagnosed based on somatic or lab indicators of hyperandrogenism, oligo-anovulation, and polycystic ovarian morphology, while excluding other disorders. Treatment options for PCOS include weight loss, exercise, clomiphene, aromatase inhibitors, metformin, and gonadotropins. Long-term management may involve birth control pills, metformin therapy, and lifestyle changes to reduce risks of weight gain, hyperandrogenism, and cardiac or metabolic diseases.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
Methods of family limiting and spacing methods (1)deepasrideepasri
The document discusses various methods of family planning and birth spacing. It defines key terms like family planning, contraception, and describes different contraceptive methods like barrier methods (condoms, diaphragms, sponges), intrauterine devices (IUDs), hormonal methods (oral pills, injectables), and sterilization. It provides details on the use, effectiveness, advantages and disadvantages of each method. The document emphasizes the importance of family planning for health, social and economic reasons.
Female condom (Vaginal Patch)- a detailed medical study martinshaji
The Female condom or vaginal pouch is an important contraceptive option but should be preferably used three months after normal delivery. Like the male condom, but unlike other barrier devices female condom offers good protection against sexually transmitted devices as well as pregnancy. The diaphragm and cervical caps shield only the cervix against some types of infections and speny but vaginal walls remain exposed and vulnerable to viruses & bacteria. The female condom, however, completely covers the vagina as well as the cervix. It is the only method controlled by the female partner that offers a level protection similar to that of the male condom.
please comment
thank you....
This document discusses various family planning methods including spacing and terminal methods. Spacing methods like barrier methods (condoms, diaphragms, sponges), hormonal methods (pills, injections, implants), IUDs help prevent pregnancy temporarily. Terminal methods like vasectomy and tubectomy provide permanent protection from pregnancy. Natural methods, withdrawal and safe period are also described. Purpose of family planning, criteria for ideal contraceptives and details of various methods are outlined.
The document discusses various family planning methods including spacing and terminal methods. Spacing methods like natural methods (rhythm method, withdrawal), barrier methods (condoms, diaphragm, sponge), hormonal methods (pills), and intrauterine devices are temporary and help space pregnancies. Terminal methods like vasectomy and tubectomy are permanent. The criteria for ideal contraceptives and purposes of family planning like improving health and preventing HIV/AIDS are also mentioned. Details of various spacing methods like their use, merits, demerits are provided.
This document provides information on various family planning methods. It defines family planning as regulating the number and spacing of children through contraception or other methods of birth control. The document then describes and compares different spacing methods (natural methods, barrier methods, hormonal methods, IUDs, etc.) and terminal methods (vasectomy and tubectomy). For each method, it discusses the purpose, merits, demerits, how it works, and types/brands. The goal is to present individuals and couples with knowledge about contraception to help plan their families.
This document provides information on various family planning methods including temporary/spacing methods (barrier methods, intrauterine devices, hormonal methods, post-conceptional methods, and miscellaneous methods) and permanent/terminal methods (vasectomy and tubectomy). It describes each method in detail, covering their purpose, how they work, merits and demerits. The temporary methods discussed help prevent pregnancy as long as they are used correctly, while permanent methods provide lifelong protection from pregnancy.
The document summarizes the history and types of intrauterine devices (IUDs). It discusses early IUD designs from the 1900s and major developments, including the addition of copper and hormones to IUDs to increase effectiveness. The main types of IUDs are described - non-medicated, copper-containing, and hormone-containing. Key IUDs like the Lippes Loop, Copper T, and Mirena are explained. The document also covers IUD mechanisms of action, characteristics, insertion guidelines, potential infections issues, and appropriate users.
Intrauterine drug delivery system - nddsJafarali Masi
novel drug delivery system(NDDS) b.pharma semester 7,
Intrauterine Drug Delivery Systems: Introduction, advantages and disadvantages, development of intra uterine devices (IUDs) and applications
This document provides information on various contraceptive methods including barrier methods like condoms, diaphragms, and vaginal sponges. It describes how each method works, advantages and disadvantages, proper usage, and failure rates. Barrier methods prevent pregnancy by blocking sperm from entering the uterus. Condoms are the most commonly used barrier method and can be male or female condoms. Diaphragms are shallow cups that cover the cervix while sponges are small foam devices inserted into the vagina. Spermicides are chemical methods that can be used with barriers to kill sperm.
family planning (1).pdf community health nursingKanchanDyal
Family planning and birth control methods are important for controlling population growth in India. The key methods include natural methods like rhythm method and lactational amenorrhea, barrier methods like condoms and diaphragms, hormonal methods like oral contraceptive pills and injectables, and intrauterine devices. Each method has merits and demerits, and choosing the appropriate option depends on factors like effectiveness, side effects, cultural acceptance, and medical safety. Proper spacing of births and limiting family size to a desired number helps reduce poverty, illiteracy, and improve overall health and development.
This document provides information on various methods of contraception and family planning. It discusses the objectives of family planning, which include avoiding unwanted births and regulating the timing and number of pregnancies. It then describes different contraceptive methods like barrier methods (condoms, diaphragms, cervical caps), hormonal methods (birth control pills, injections, implants), emergency contraception, and natural family planning methods. For each method, it explains how it works, typical failure rates, advantages and disadvantages. It emphasizes the importance of contraception and responsible family planning.
Methods of contraceptives ,they are including spacing method and terminal method.spacing method divided into varies types.A)Natural method, physical barrier method, chemical barrier method,hormonal method.terminal method divided into 2types.1) female sterilization includes laproscopy and mini lap2)male sterilization includes vasectomy and no scalpel vasectomy.
This document discusses various methods of family planning. It describes natural family planning methods like withdrawal and calendar-based methods. It then discusses barrier methods like condoms, diaphragms, and spermicides. Intrauterine devices that contain copper or hormones are explained next. The document also covers hormonal contraceptives like oral contraceptive pills containing estrogen and progestin, and progestin-only pills, implants, and injectables. Advantages and disadvantages are provided for many of the methods.
This document summarizes different barrier methods of contraception including male and female condoms, diaphragms, and cervical caps. It describes how each method works to prevent pregnancy by blocking sperm from entering the female reproductive tract. Details are provided on material composition and proper usage instructions. The advantages and disadvantages of barrier methods are outlined, noting their effectiveness against STIs but typically higher failure rates compared to other contraceptive options like pills or IUDs. References for further information are included at the end.
- The document discusses various methods of fertility control or contraception, including both temporary and permanent methods.
- Temporary methods include barrier methods like condoms and diaphragms, as well as hormonal methods like oral contraceptive pills containing estrogen and progesterone.
- Permanent sterilization methods are also discussed briefly. The majority of the document focuses on describing the proper use and effectiveness of various contraceptive methods.
An intrauterine device (IUD) is a long-acting reversible contraceptive device that is inserted into the uterus to prevent pregnancy for an extended period of time. There are two main types - non-medicated IUDs which cause inflammation to produce a sterile environment, and medicated IUDs which release copper ions or progesterone. Copper IUDs like the Cu-7 and T-shaped devices release copper ions that have spermicidal and spermatocidal effects as well as inhibiting sperm binding and fertilized egg implantation. Potential future IUD designs include membrane-controlled drug reservoirs and biodegradable polymer matrix systems to provide consistent drug release over time. While highly effective, IUD
The document summarizes different methods of birth control, including their effectiveness and potential side effects. It discusses barrier methods like condoms and diaphragms, hormonal methods like the pill, patch and ring, long-acting reversible methods like IUDs and implants, permanent surgical methods like tubal ligation and vasectomy, and natural family planning options like abstinence and withdrawal. Overall, it provides an overview of the various contraceptive options available to prevent pregnancy.
This document provides an overview of various contraceptive methods. It discusses temporary contraceptive methods including barrier methods like condoms and diaphragms, hormonal methods like oral contraceptive pills and emergency contraception, and intrauterine devices. It also covers permanent sterilization methods like vasectomy and tubectomy. For each method, it describes the mechanism of action, effectiveness, advantages, and disadvantages.
Similar to Contraceptives methods SlideShare by Patial S (20)
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
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Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Pictorial and detailed description of patellar instability with sign and symptoms and how to diagnose , what investigations you should go with and how to approach with treatment options . I have presented this slide in my 2nd year junior residency in orthopedics at LLRM medical college Meerut and got good reviews for it
After getting it read you will definitely understand the topic.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
2. Contraceptive methods
Preventive methods to help women avoid unwanted
pregnancies. They include all temporary and permanent
measures to prevent pregnancy resulting from coitus.
3. The contraceptive methods may be broadly grouped into two classes
- spacing methods and terminal methods, as shown below:
I. Spacing methods
1. Barrier methods
(a) Physical methods
(b) Chemical methods
(c) Combined methods
6. Condom
Male Condom is the most widely known
and used barrier device by the males
around the world.
In India, it is better known by its trade
name NIRODH, a sanskrit word, meaning
prevention. Condom is receiving new
attention today as an effective, simple
"spacing" method of contraception,
without side effects. In addition to
preventing pregnancy, condom protects
both men and women from sexually
transmitted diseases.
7. Condom prevents the semen from
being deposited in vagina.
The effectiveness of a condom
may be increased by using it in
conjunction with a spermicidal
jelly inserted into the vagina
before intercourse. The spermicide
serves as additional protection in
the unlikely event that the condom
should slip off or tear.
8. Advantages
Easily available
Safe and inexpensive
Easy to use
Don’t require medical supervisions
No side effect
Light compact and disposable
Provide protection against pregnancy as well as STDs.
9. Disadvantages
(a) it may slip off or tear during coitus due to
incorrect use, and
(b) interferes with sex sensation locally about
which some complain while others get used
to it.
The main limitation of condoms is that many
men do not use them regularly or carefully,
even when the risk of unwanted pregnancy or
sexually transmitted disease is high.
10. 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 STD
infection.
11. However, high cost and
acceptability are major
problems.
The failure rates during the first
year use vary from 5 per 100
women-years pregnancy rate to
about 21 in typical users .
12.
13. Diaphragm
The diaphragm is a vaginal barrier. It was
invented by a German physician in 1882.
Also known as "Dutch cap", the diaphragm is
a shallow cup made of synthetic rubber or
plastic material.
It ranges in diameter from 5-10 cm (2-4
inches). 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.
14. It is held in position partly by the
spring tension and partly by the
vaginal muscle tone. This means,
for successful use, the vaginal tone
must be reasonable. Otherwise, in
the case of a severe degree of
cystocele, the rim may slip down.
15. The diaphragm is inserted before sexual
intercourse and must remain in place for
not less than 6 hours after sexual
intercourse. A spermicidal jelly is always
used along with the diaphragm. The
diaphragm holds the spermicide over the
cervix. Side-effects are practically nil.
Failure rate for the diaphragm with
spermicide vary between 5 to 12 per 100
women-years
16. Advantages
The primary advantage of the
diaphragm is the almost total
absence of risks and medical
contraindications.
17. Disadvantages
Initially a physician or other trained person will be needed to
demonstrate the technique of inserting the diaphragm into the vagina
and to ensure a proper fit.
After delivery, it can be used only after involution of the uterus is
completed.
Practice at insertion, privacy for this to be carried out and facilities for
washing and storing the diaphragm precludes its use in most Indian
families, particularly in the rural areas. Therefore, the extent of its use
has never been great.
18. Disadvantages contd…
If the diaphragm is left in the vagina for an extended
period, there is a remote possibility of a toxic shock
syndrome, which is a state of peripheral shock requiring
resuscitation
19. Vaginal Sponge
Another barrier device
employed for hundred of
years is the sponge soaked in
vinegar or olive oil, but it is
only recently one has been
commercially marketed in
USA under the trade name
TODAY for the sole purpose
of preventing conception.
20. It is a small polyurethane foam
sponge measuring 5 cm x 2.5 cm,
saturated with the sperm nonoxynol-9.
The sponge is far less effective than
the diaphragm, but it is better than
nothing. The failure sets in parous
women is between 20 to 40 per 100
women and in nulliparous women
about 9 to 20 per 100 women years
21. Chemical method
In the 1960s, before the advent of IUDS and oral
spermicide (vaginal contraceptives) were used widely.
They comprise four contraceptives, categories:
22. a) Foams : foam tablets, foam
aerosols
b) Creams, jellies and pastes -
squeezed from a tube
c) Suppositories - inserted
manually, and
d) Soluble films - C-film
inserted manually.
23. The spermicides contain a base
into which a spermicide is
incorporated. The commonly
used modern spermicides are
"surface-active agents which
attach themselves to
spermatozoa and inhibit oxygen
uptake and kill sperms.
24. Drawbacks
(a) they have a high failure rate
(b) they must be used almost immediately before intercourse
and repeated before each sex act
(c) the must be introduced into those regions of the vagina
where sperms are likely to be deposited, and
(d) they may cause mild burning or irritation, besides
messiness.
25. The spermicidal should be free from potential systemic
toxicity. It should not have an inflammatory or
carcinogenic effect on the vaginal skin or cervix.
Spermicides are not recommended by professionals
advisers. They are best used in conjunction with barrier
methods.
26. Intrauterine devices:
Intrauterine device (IUD) is a small, flexible plastic frame to be
inserted into the uterine cavity.
There are two basic types of IUD :
1. Non-medicated
2. Medicated
are usually made of polyethylene or other polymers; in addition,
the medicated or bioactive IUDs release either metal ions
(copper) or hormones (progestogens).
27. Non Medicated Intra uterine devices
Inert or non-medicated or First
generation IUDs
These devices are made of plastic or
stainless steel only. Lippes loop made of
plastic (polyethylene) impregnated with
barium sulphate is still used in many
parts of the world. Stainless steel rings
are widely used in China only.
28. Medicated IUDs
Copper IUDs/ Second generation IUDs
Copper wire or copper sleeves are put on the plastic frame (polyethylene
frame). Examples include Copper T, CuT380 A, Multiload 375 etc.
The various types of Copper IUDs differ from each other by the amount of
copper. The initial Copper IUDs were wound with 200-250 mm2 wire
(CopperT 200). The modern copper containing devices contain more
copper and a part of copper in the form of solid tubal sleeves rather than
wire. This increases the efficacy and lifespan (Cu T-380 A).
29. CuT 380A - It is a T shaped
device with a polyethylene
frame holding 380 mm2 of
exposed surface area of copper.
The IUD frame contains barium
sulfate thus making it radio-
opaque.
30. CuT 380 slimline - It has copper
sleeves flushed at the ends of
horizontal arms to facilitate easier
loading and insertion. The
performance of CuT-380 Ag and
the CuT-380 slimline is equal to
that of CuT-380 A.
31. • CuT-380Ag - It is identical to
380 A except that the copper
wire on the stem has a silver
core to prevent fragmentation
and extend the life span of the
copper.
32. Multiload 375 - It has 375 mm2
of copper wire wound around its
stem. The flexible arms are
designed to minimize
expulsions. The multiload 375
and cu T-380 A are similar in
their efficacy and performance.
33. Nova T - It is similar to the CuT-
200, containing 200 mm2 of
copper. However, the Nova T
has a silver core to the copper
wire, flexible arms, and a large
flexible loop at the bottom to
prevent cervical perforation.
34. Hormone-Releasing IUDs/ Third
Generation IUDs
Hormone-Releasing IUDs/
• Progestasert - It is a T shaped IUD
made of ethylene and vinyl acetate
copolymer containing titanium dioxide.
The vertical stem contains a reservoir of
38 mg progesterone together with
barium sulfate dispersed in silicone
fluid. The progesterone is released at the
rate of 65 µg per day.
35. LNG - 20 (Mirena) - This T shape
& device has a collar attached to
vertical arm containing 52 mg of
levonorgestrel dispersed in poly
dimethyl siloxane. It releases 15µg
of levonorgestrel per day in vivo
and is effective for 7-10 year.
36. Mechanism of action
IUD mainly work by changing the intra-uterine
environment and making it spermicidal. Non-medicated
IUD cause a sterile inflammatory response by producing a
tissue injury of minor degree but sufficient enough to be
spermicidal.
37. Copper containing IUD, in addition, release free copper
and copper salts that have both a biochemical and
morphological impact on the endometrium and also
produce alteration in cervical mucus and endometrial
secretions. No measurable increase in serum copper is
observed.
38. Hormone releasing IUD add progesterone effect on endometrium to the foreign
body reaction. The endometrium becomes decidualized with atrophy of glands.
The progesterone IUD does not increase the serum progesterone level
and mainly acts by inhibition of implantation, sperm-capacitation and survival.
Levonorgestrel IUD produces serum concentrations of the progestin half those of
Norplant and therefore, ovarian follicular development and ovulation is
not inhibited. The LNG-20 IUD decreases the blood loss (by about 40-50%) and
dysmenorrhoea.
39. Contraindications
pregnancy
puerperal sepsis or immediate post septic abortion
distorted uterine cavity (congenital or acquired)
unexplained vaginal bleeding
suspected genital malignancy
high-risk candidate for STI
genital tuberculosis
active Pelvic Inflammatory Disease (PID)
40. Ideal candidates
The Planned Parenthood Federation of America (PPFA has described the
ideal IUD candidate as a woman :
1. who has borne at least one child
2. has no history of pelvic disease
3. has normal menstrual periods
4. is willing to check the IUD tail
5. has access to follow-up and treatment of potential problems,
6. and is in a monogamous relationship.
41. Timing of Insertion
After childbirth
• immediately after delivery of placenta
(post-placental insertion)
• four to six weeks after childbirth
42. After spontaneous or induced abortion
• immediately after 1st trimester abortion (aseptic).
• after 2nd trimester abortion it is advisable to wait till involution of
uterus is complete.
43. Menstrual cycle
• can be inserted any time, during menstrual cycle, if reasonably sure that woman
is not pregnant and has not been having sex without contraception.
• insertion during menstruation offers following advantages :
– pregnancy is ruled out
– insertion is easier due to open cervical canal
– any minor bleeding caused by insertion is less likely to upset the client
44. Information to the client after Copper T insertion
She can expect some cramping for a day or two after insertion,
vaginal discharge for a few weeks after insertion and slightly heavier
menstrual period with possible bleeding between the menstrual
periods during first few months after insertion
follow-up visit after 3-6 weeks or after next menstrual period to
ensure that IUD is in place and no infection has developed.
information about kind of IUD and when to have her IUD removed
or replaced.
45. when she should see a nurse or
doctor after IUD insertion?
– missed menstrual period
– lower abdomen pain / vaginal discharge / fever
– missing IUD string
– very heavy and prolonged bleeding that bothers her
46. Hormonal contraceptives
Hormonal contraceptives when properly used are the most effective
spacing methods of contraception. Oral contraceptives of the combined
type are almost 100 per cent effective in preventing pregnancy. They
provide the best means of ensuring spacing between one childbirth and
another. More than 65 million in the world are estimated to be taking the
"pill" of which about 9.52 million are estimated to be in India.
47. Classification
Hormonal contraceptives currently in use and/or under study may be classified as
follows:
A. Oral pills
1. Combined pill
2. Progestogen only pill (POP)
3. Post-coital pill
4. Once-a-month (long-acting) pill
5. Male pill
49. Combined pill
The combined oral contraceptive pill is often just called "the pill". It
contains artificial versions of female hormones oestrogen and
progesterone, which are produced naturally in the ovaries.
If sperm reaches an egg (ovum), pregnancy can happen. Contraception
tries to stop this happening usually by keeping the egg and sperm apart
or by stopping the release of an egg (ovulation).
50. The combined pill is one of the major spacing methods of contraception.
The "original pill" which entered into the market in the early 1960s
contained 100-200 mcg of a synthetic oestrogen and 10 mg of a
progestogen. Since then, a number of improvements have been made to
reduce the undesirable side-effects of the pill by reducing the dose of both
the oestrogen and progestogen.
51. At the present time, most formulations of the combined pill contain
no more than 30-35 mcg of a synthetic oestrogen, and 0.5 to 1.0 mg
of a progestogen. The debate continues about the minimum effective
dose of the progestogen in the pill which will produce the least
metabolic disturbances.
52. When to take Combined pill
The standard way to take the pill is to take 1 every day for
21 days, then have a break for 7 days, and during which
menstruation occur. When the bleeding occurs, this is
considered the first day of the next cycle.
53. The pill should be taken everyday at a fixed time, preferably
before going to bed at night. The first course should be started
strictly on the 5th day of the menstrual period, as any deviation in
this respect may not prevent pregnancy. 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.
55. It contains Levonorgestrel 0.15 mg and Ethinyl estradiol 0.03 mg.
Mala-D in a package of 28 pills (21 of oral contraceptive pills and 7
brown film coated 60 mg ferrous fumarate tablets) is made available to
the consumer under social marketing at a price of Rs. 3 per packet.
Mala-N is supplied free of cost through all PHCS, urban family welfare
centres, etc.
56. Progestogen-only pills
This pill is commonly referred to
as "minipill or "micropill". It
contains only progestogen, which
is given in small doses throughout
the cycle. The commonly used
progestogens are norethisterone
and levonorgestrel.
57. Progestogen-only pills
The progestogen-only pills never gained widespread use because of poor
cycle control and an increased pregnancy rate. However, they have a
definite place in modern day contraception. They could be prescribed to
older women for whom the combined pill is contraindicated because of
cardiovascular risks. They may also be considered in young women with
risk factors for neoplasia. The evidence that the progestogens may lower the
high-density lipoproteins may be of some concern.
59. Two methods are available :
(a) IUD : The simplest technique is to insert an IUD, if acceptable,
especially a copper device within 5 days.
(b) Hormonal : More often a hormonal method may be preferable. In
India Levonorgestrel 0.75 mg tablet is approved for emergency
contraception. It is used as one tablet of 0.75 mg within 72 hours of
unprotected sex and the 2nd tablet after 12 hours of 1st dose.
60. Two oral contraceptive pills containing 50 mcg of ethinyl
estradiol within 72 hours after intercourse, and the same dose
after 12 hours.
61. Four oral contraceptive pills containing 30 or 35 mcg of
ethinyl estradiol within 72 hours and 4 tablets after 12
hours.
62. Mifepristone 10 mg once within 72 hours.
Post-coital contraception is advocated as an emergency method; for
example, after unprotected intercourse, rape or contraceptive failure.
Opinion is divided about the effect on foetus, should the method fail.
Although the failure rate for post-coital contraception is less than 1 per
cent, some experts think a woman should not use the hormonal method
unless she intends to have an abortion, if the method fails. There is no
evidence that foetal abnormalities will occur. But some doubts remain
63. Once-a-month(long-acting) pill
Experiments with once-a-month oral pill in which
quinestrol, a long-acting oestrogen is given in combination
with a short-acting progestogen, have been disappointing.
The pregnancy rate is too high to be acceptable. In
addition, bleeding tends to be irregular
64. Male pill
The search for a male contraceptive began in 1950. Research is
following 4 main lines of approach:
(a) preventing spermatogenesis
(b) interfering with sperm storage and maturation
(c) preventing sperm transport in the vas and
(d) affecting constituents of the seminal fluid.
65. A male pill made of gossypol- a
derivative of cotton seed
producing azoospermia or
severe oligospermia.
66. Mode 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 gonadotropin that is necessary for ovulation to
occur. Progestogen-only preparations render the cervical mucus thick and
scanty and thereby inhibit sperm penetration. Progestogens also inhibit
tubal motility and delay the transport of the sperm and of the ovum to the
uterine cavity
67. EFFECTIVENESS
Taken according to the prescribed regimen, oral contraceptives of
the combined type are almost 100 per cent effective in preventing
pregnancy. Some women do not take the pill regularly, so the
actual rate is lower. In developed countries, the annual pregnancy
rate is less than per cent but in many other countries, the
pregnancy rate is 1 considerably higher.
68. Under clinical trial conditions, the effectiveness of progestogen-only
pills is almost as good as that of the combination products. However, in
large family planning programmes, the effectiveness and continuation
rates are usually lower than in clinical trials. The effectiveness may also
be affected by certain drugs such as rifampicin, phenobarbital and
ampicillin
69. Adverse effects
Cardiovascular effects
Carcinogenic effects
Metabolic effects
Hepatocellular edema
Cholestatic jaundice
Breast tenderness
Weight gain
Headache and migraine
Bleeding
70. Benefits
100 percent effectiveness in preventing pregnancy and thereby removing
anxiety about the risk of unwanted pregnancy.
Prevention of :
Benign breast disorders
Ovarian cysts
Iron deficiency anemia, pelvic inflammatory diseases
Ectopic pregnancy
Ovarian cancer.
71. Contraindication
Cancer of breast and genitals
Liver disease
History of thromboembolism
Cardiac abnormalities
Congenital hyperlipidemia
Undiagnosed uterine bleeding
Age over 40 years
Smoking and age over 35 years mild hypertension
Chronic renal disorder
72. Duration of use
The pill should be used primarily for spacing pregnancies in
younger women. Those over 35 years should go in for other
form of contraception. Beyond 40 years of age, the pill is not
to be prescribed or continued because of the sharp increase
in the risk of cardiovascular complications.
77. Side effects
Disruption of the normal menstrual cycle
Unpredicted bleeding
Amenorrhea
Anxiety
78. Contraindication
Breast cancer
Genital cancers
Undiagnosed uterine bleeding
High blood pressure
Cardiac abnormality
Breast feeding women with a baby less than 6 weeks of age
80. Combine injectable contraceptives
These injection contain
progesterone and an oestrogen.
They are given at monthly
interval, plus or minus three
days.
81.
82. Subdermal Implants
The Population Council, New York has
developed a subdermal implant known as
Norplant for long-term contraception. It
consists of 6 silastic (silicone rubber)
capsules containing 35 mg (each) of
levonorgestrel (85). More recent devices
comprise fabrication of levonorgestrel into 2
small rods, Norplant (R)-2, which are
comparatively easier to insert and remove.
The silastic capsules or rods are implanted
beneath the skin of the forearm or upper arm.
83. Effective contraception is provided for over 5
years. The contraceptive effect of Norplant is
reversible on removal of capsules. A large
multicentre trial conducted by International
Committee for Contraception Research (ICCR)
reported a 3-year pregnancy rate of 0.7. The
main disadvantages, however, appear to be
irregularities of menstrual bleeding and
surgical procedures necessary to insert and
remove implants.
84. Vaginal rings
Vaginal rings containing
levonorgestrel have been found to
be effective. The hormone is
slowly absorbed through the
vaginal mucosa, permitting most of
it to bypass the digestive system
and liver, and allowing a
potentially lower dose.
85. The ring is worn in the vagina for 3 weeks of the cycle and
removed for the fourth.
91. Abstinence
The only method of birth control which
is completely effective is complete
sexual abstinence. It amount to
repression of a natural force and is liable
to manifest itself in other direction such
as temperamental changes and nervous
breakdown.
92. Coitus interrupts
This is the oldest method of voluntary fertility control. It involve no cost or
appliances. It continues to be a widely practiced method. The male withdraw
before ejaculation, and thereby tries to prevent tries to prevent deposition of
semen into the vagina. The failure rate of this method is as high as 25%.
93. Safe period
This is also known as the calendar method.
This method is based on the fact that ovulation
occur from 12 to 16 days before the onset of
menstruation.
94. Fertile period : Shortest menstrual cycle- 18 and Longest
menstrual cycle- 10. (this will give the first to last day of the
fertile period)
E.g. Shortest menstrual cycle of a woman is 26 and longest
menstrual cycle is 32 days;
Then fertile period for that woman is : 26-18 , 31-10 i.e. 8 to 21
95. Drawbacks
Women menstrual cycle are not always regular.
Only educated and responsible couple with a high degree of
motivation and cooperation can use it effectively
Compulsory abstinence
This method is not applicable during the postnatal period.
High failure rate due to wrong calculation
96. Natural family planning methods
1. Basal body temperature
2. Cervical mucus method
3. Symptothermic methods
103. Male sterilization
Male sterilization is a permanent method of
contraception for men. It works by blocking
the Vas (tubes connecting testicles to urethra).
After vasectomy procedure, there is no sperm
in semen. While testicles still produce sperm,
it is not transported outside the testicles and is
instead absorbed by the body.
104. Procedure
In vasectomy, it is customary to remove a
piece of vas at least 1 cm after clamping. The
ends are ligated and then folded back on
themselves and sutured into position so that
the cut ends face away from each other. This
will reduce the risk of recanalization at a
later date.
105. It is important to stress that the acceptor is not immediately
sterile after the operation, usually until approximately 30
ejaculations have taken place. During this intermediate
period, another method of contraception must be used. If
properly performed. vasectomies are almost 100 per cent
effective.
106. Following vasectomy, sperm production and hormone output are not
affected. The sperm produced are destroyed intra-luminally by
phagocytosis. This is a normal process in the male genital tract, but
the rate of destruction is greatly increased after vasectomy.
Vasectomy is a simpler, faster and less expensive operation than
tubectomy in terms of instruments, hospitalization and doctor's
training Cost-wise, the ratio is about 5 vasectomies to one tubal
ligation.
107. There are two methods of male sterilization:
1. Conventional Vasectomy which requires an incision.
2. Non-Scalpel Vasectomy (NSV) which does not require an incision
and is a simple, safe, sound, short, stitch less and scalpel less
procedure. It takes only 5-15 mins to perform and the beneficiary
can walk out within 10 minutes after the operation. It does not
interfere with manual labour of any kind nor does it affect a
person’s sex drive.
108. Conventional Vasectomy
The doctor first numbs the scrotum of the client with a local
anaesthetic. They then make 2 small cuts in the skin on each side of
scrotum to reach the tubes that carry sperm out of testicles (vas
deferens).
Each tube is cut and a small section removed. The ends of the tubes
are then closed, either by tying them or sealing them using heat.
The cuts are stitched, usually using dissolvable stitches that go away
on their own within about a week.
109. Non-Scalpel Vasectomy (NSV)
The doctor first numbs the scrotum with local anaesthetic. They then
make a tiny puncture hole in the skin of scrotum to reach the tubes.
This means they don't need to cut the skin with a scalpel.
The tubes are then closed in the same way as a conventional
vasectomy, either by being tied or sealed.
There's little bleeding and no stitches with this procedure. It's
thought to be less painful and less likely to cause complications than
a conventional vasectomy.
110. Misconceptions
NSV leads to inability in ejaculation NSV does not affect
erection or ejaculation. Ejaculatory fluid, semen, is made in the
prostate and the seminal vesicles, which are not cut during
vasectomy. The amount of fluid that comes out of the testicle
with sperm is less than 1% of the overall ejaculated volume.
The muscle contractions that force fluid out during ejaculation
come from the pelvis and are not affected by NSV.
111. NSV leads to decrease in levels of testosterone The
testicles make both sperm and testosterone. The testicle
makes testosterone and transports it through the blood
stream, not the vas deferens. Testosterone levels do not go
down as a result of permanent sterilization.
112. NSV leads to prostate cancer There is no established
relationship between NSV and prostate cancer. Prostate
cancer is primarily identified through screening. A man
who undergoes vasectomy is more likely to get screened
for prostate cancer than a man who doesn’t.
113. NSV affects semen production Vasectomy does not
decrease semen production. Men continue to make semen
in the same way as before the procedure.
114. Complications
(a) Operative': The early complications include pain,
scrotal haematoma and local infection. Wound infection is
reported to occur in about 3 per cent of patients. Good
haemostasis and administration of antibiotics will reduce
the risk of these complications.
115. (b) Sperm granules Caused by accumulation of sperm, these are a common
and troublesome local complication of vasectomy. They appear in 10-14 days
after the operation. The most frequent symptoms are pain and swelling.
Clinically the mass is hard and the average size approximately 7 mm. Sperm
granules may provide a medium through which re anastomosis of the severed
vas can occur, The sperm granules eventually subside. It has been reported
that using metal clips to close the vas may reduce or eliminate this problem
117. Post operative advise
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
To use contraceptives until aspermia has been established.
118. To avoid taking bath for at least 24 hours after the operation.
To wear a T bandage or scrotal support for 15 days and to keep the site clean
and dry.
To avoid cycling or lifting heavy weights for 15 days; there is , however, no
need for complete bed rest.
To have the stitches removed on the 5th day after operation.
119. Female sterilization
Female sterilization is a permanent procedure
to prevent pregnancy. It works by blocking the
fallopian tubes (tubes connecting ovaries to
uterus). Sterilization is a viable option for
women who decide not to have any more
children. Sterilization does not give protection
from Sexually Transmissible Infections (STIs).
120. There are two methods of female sterilization:
Interval Sterilization(suprapubic approach) which can be
done any time after ruling out pregnancy and at any time
after 6 weeks of giving birth.
Post partum sterilization(subumblical approach) which
can be done within 7 days after giving birth.
121. (a) Laparoscopy
This is a technique of female sterilization through abdominal approach
with a specialized instrument called "laparoscope". The abdomen is
inflated with gas (carbon dioxide, nitrous oxide or air) and the instrument
is introduced into the abdominal cavity to visualise the tubes. Once the
tubes are accessible, the Falope rings (or clips) are applied to occlude the
tubes. This operation should be undertaken only in those centres where
specialist obstetrician-gynaecologists are available. The short operating
time, shorter stay in hospital and a small scar are some of the attractive
features of this operation
122. Patient selection :
Laparoscopy is not advisable for postpartum patients for 6
weeks following delivery; however, it can be done as a
concurrent procedure to MTP. Haemoglobin per cent should
not be less than 8. There should be no associated medical
disorders such as heart disease. respiratory disease, diabetes
and hypertension. It is recommended that the patient be kept
in hospital for a minimum of 48 hours after the operation.
123. The cases are required to be followed-up by health
workers (F) LHVs in their respective areas once between
7-10 days after the operation, and once again between 12
and 18 months after the operation.
124. Complications :
Although complications are uncommon, when they do
occur they may be of a serious nature requiring
experienced surgical intervention. Puncture of large blood
vessels and other potential complications have been
reported as major hazards of laparoscopy
125. Minilap operation
Minilaparotomy is a modification of abdominal tubectomy. It is a much
simpler procedure requiring a smaller abdominal incision of only 2.5 to 3
cm conducted under local anaesthesia. The minilap/Pomeroy technique is
considered a revolutionary procedure for female sterilization. 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.
126. Procedure
For a mini-laparotomy, either a general or regional
anesthesia (most commonly an epidural)will be given to
the patient. The surgery would then be performed in the
following steps:
127. The surgeon will make a small but visible incision right
beneath the umbilicus.
The fallopian tubes will then be pulled up and out of the
incision.
The tubes will then be put back into place and the incision
closed with stitches.
128. Advantages of postpartum minilap tubectomy:
Woman is already admitted in a facility and her current health status
usually can be established from delivery and prenatal records.
• The uterus is high in the abdomen and a small incision (1.5-3.0 cm)
just below the umbilicus is usually sufficient to access the tubes.
• Local anaesthesia with light sedation/analgesia is usually sufficient.
• Hospital stay beyond what is required for a normal delivery (often
72 hours ) is not required after the procedure.