Emergency contraception methods include hormonal emergency contraceptive pills containing levonorgestrel or a combination of levonorgestrel and ethinyl estradiol, or insertion of a copper IUD. Levonorgestrel-only emergency contraception is more effective and has fewer side effects than the Yuzpe method. Emergency contraception is effective in preventing pregnancy when used within 5 days of unprotected intercourse but efficacy declines with increasing time between intercourse and treatment. Providing advance access to emergency contraception does not reduce use of regular contraceptive methods.
“Clinicians should proactively talk to their patients of reproductive age about ECPs and offer advance prescriptions for ECPs during routine gynecologic office visits….”
Depo Provera Contraceptive Injection (Medroxyprogesterone Acetate) is used to prevent pregnancy. This medicine works by preventing the growth and release of an egg (ovulation) during the menstrual cycle.
“Clinicians should proactively talk to their patients of reproductive age about ECPs and offer advance prescriptions for ECPs during routine gynecologic office visits….”
Depo Provera Contraceptive Injection (Medroxyprogesterone Acetate) is used to prevent pregnancy. This medicine works by preventing the growth and release of an egg (ovulation) during the menstrual cycle.
Contraception
Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures.
The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.
Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.
Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods
Natural
Barrier
IUDs
Emergency contraception
Terminal methods
Male fertilisation
Female fertilisation
Natural Methods
Coitus inteyrruptus / withdrawal
Rhythm Method
Lactational Amenorrhoea
Barrier Methods
Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
Combination
Combined use of Chemical and Mechanical methods.
Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.
Female condom
Femidom
Diaphragm
Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
Intrauterine Contraceptive Devices
Cu T200
T shaped device Polyethylene frame.
215 mm2 surface area of Cu wire.
Contains 124 mg of copper
Cu is lost at the rate of 50 µg/day.
Polyethylene monofilament tied at vertical stem.
Cu is radio opaque so additionally barium is
incorporated in the device.
Supplied in a sterilised sealed packet.
Lifetime 4 years.
Cu T 380A
380 mm square surface area of copper wire.
Replacement 10 years.
Multiload Cu 250
60-100 ug/day
Replacement 3 years
Multiload - 375
Mode of action
Biochemical and histological changes in endometrium.
Increased tubal motility.
Endometrial inflammatory response.
Prevents implantation.
Contraindication for insertion of IUCD
Presence of pelvic infection
Genital tract bleeding (undiagnosed)
Suspected pregnancy
Uterine fibroid
Severe dysmenorrhoea
Ectopic pregnancy history
Caesarean section
Cu allergy
Time of insertion
Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
Postabortal
Done immediately following termination of pregnancy.
Postpartum
After 6 weeks of delivery.
Postplacental delivery
Post delivery of placenta.
Method of Insertion
Preliminary steps:
History taking and examination
Patient is informed and consent is obtained.
Insertion is done in OPD aseptic conditions.
Placement of device in inserter.
Steps of operation
The patient is asked to remain empty bladder.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
The device is placed in the inserter and introduced through cervical
Postpartum psychosis is a severe mental illness which develops acutely in the early postnatal period. It is a psychiatric emergency. Identifying women at risk allows development of care plans to allow early detection and treatment. Management requires specialist care. Health professionals must take into account the needs of the family and new baby, as well as the risks of medication whilst breast-feeding.
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
in this slide physiological, psychological and social aspects of menopause, Hormonal replacement therapy, surgical menopause , guidance and counselling / role of midwifery nurse practitioner in menopause.
Contraception
Contraception is defined as the intentional prevention of conception through the use of various devices, sexual practices, chemicals, drugs or surgical procedures.
The preventive methods to help women avoid unwanted pregnancies are called contraceptive methods.
Need for contraception
• To avoid unwanted pregnancies.
• To regulate the timing of pregnancy.
• To regulate the interval between pregnancy.
Ideal Contraceptive
• Safe
• Effective
• Acceptable
• Reversible
• Inexpensive
• Long lasting
• Requires little or no medical supervision
Contraceptive methods
Spacing methods
Natural
Barrier
IUDs
Emergency contraception
Terminal methods
Male fertilisation
Female fertilisation
Natural Methods
Coitus inteyrruptus / withdrawal
Rhythm Method
Lactational Amenorrhoea
Barrier Methods
Mechanical
Male : Condom
Female : Condom, Diaphragm, Cervical cap
Chemical
Creams - Deleen
Jelly – Koromex, Volpar paste
Foam tablets – Aerosol foams, Chlorimin T or Contab
Combination
Combined use of Chemical and Mechanical methods.
Male condom
• Most commonly known and used contraceptive.
• Better known in India as NIRODH.
Female condom
Femidom
Diaphragm
Spermicides
Spermicides are surface active agents which attach
themselves to spermatozoa and kill them.
Available in various forms like
Intrauterine Contraceptive Devices
Cu T200
T shaped device Polyethylene frame.
215 mm2 surface area of Cu wire.
Contains 124 mg of copper
Cu is lost at the rate of 50 µg/day.
Polyethylene monofilament tied at vertical stem.
Cu is radio opaque so additionally barium is
incorporated in the device.
Supplied in a sterilised sealed packet.
Lifetime 4 years.
Cu T 380A
380 mm square surface area of copper wire.
Replacement 10 years.
Multiload Cu 250
60-100 ug/day
Replacement 3 years
Multiload - 375
Mode of action
Biochemical and histological changes in endometrium.
Increased tubal motility.
Endometrial inflammatory response.
Prevents implantation.
Contraindication for insertion of IUCD
Presence of pelvic infection
Genital tract bleeding (undiagnosed)
Suspected pregnancy
Uterine fibroid
Severe dysmenorrhoea
Ectopic pregnancy history
Caesarean section
Cu allergy
Time of insertion
Interval
2-3 days after menstrual phase.
During lactational amenorrhoea.
Postabortal
Done immediately following termination of pregnancy.
Postpartum
After 6 weeks of delivery.
Postplacental delivery
Post delivery of placenta.
Method of Insertion
Preliminary steps:
History taking and examination
Patient is informed and consent is obtained.
Insertion is done in OPD aseptic conditions.
Placement of device in inserter.
Steps of operation
The patient is asked to remain empty bladder.
The patient is placed in lithotomy position.
Local antiseptic cleaning is done.
Posterior vaginal speculum is introduced.
Anterior lip of cervix is grasped with Allis tissue forcep.
The device is placed in the inserter and introduced through cervical
Postpartum psychosis is a severe mental illness which develops acutely in the early postnatal period. It is a psychiatric emergency. Identifying women at risk allows development of care plans to allow early detection and treatment. Management requires specialist care. Health professionals must take into account the needs of the family and new baby, as well as the risks of medication whilst breast-feeding.
Dilatation and curettage (D & C) is a procedure to remove tissue from inside the uterus. Doctors perform D & C to diagnose and treat certain uterine conditions — such as a heavy bleeding — or to clear the uterine lining after an abortion or miscarriage.
in this slide physiological, psychological and social aspects of menopause, Hormonal replacement therapy, surgical menopause , guidance and counselling / role of midwifery nurse practitioner in menopause.
EMERGENCY CONTRACEPTION & RECENT ADVANCEMENT OF CONTRACEPTION.pptxTanuShekhawat6
EMERGENCY CONTRACEPTION & RECENT ADVANCEMENT IN CONTRACEPTION
Introduction
Emergency contraception (EC) is a method of contraception used as an emergency procedure before menstruation is missed, to prevent pregnancy following unprotected intercourse or expected failure of contraception.
Cont..
Emergency contraception is any method of contraception which is used after intercourse and before the potential time of implantation. This nomenclature, advocated by WHO lately and accepted by international Medical Advisory Panel and others recently.
Alternative terms: Postcoital contraception- still commonly used and 'morning after' contraception
Emergency contraception is not true contraception but rightly called interception. Interceptive - agents that do not interfere with fertilization but act on blastocyst before or soon after missing periods.
Emergency contraception is a backup plan. It cannot be used as an ongoing method of contraception because:
i) relatively high failure rates
ii) High incidence of irregular bleeding
INDIAN SCENARIO: NEED
India has the highest number of unsafe abortions in the world.
6,20,472 abortions reported in India in 2012, Two-third of them were unsafe
A woman dies every two hours due to unsafe abortion.
Widespread availability of EC can help reduce these abortions.
INDICATIONS
1. For aged couples who meet very infrequently.
2. Following single act of sexual exposure in young girls
3. When pregnancy is apprehended owing to rupture of condom, premature ejaculation in couples practising coitus interruptus etc.
4. In case of rape.
ADVANTAGES
Saves the couple from unwanted pregnancies
From unnecessary operative interferences for fear of pregnancy
From the agony of waiting for the next menstrual cycle.
Prevents adolescent pregnancies
Helps to reduce unsafe abortion
COMBINED ETHINYL ESTRADIOL AND LEVONORGESTREL (YUZPE METHOD)
Yuzpe method (Canadian Prof. Albert Yuzpe) consists of the oral administration of 2 doses of 0.1mg(100 µg) ethinyl estradiol (EE) and 0.5mg(500 µg) levonorgestrel 12 hours apart.
Failure rate- 0-2%
Ovral tablets (each containing 50 µg ethinyl estradiol and 250 µg levonorgestrel) are most commonly used to provide these doses.
Others- Noral, Ovidon
PROGESTIN-ONLY (LEVONORGESTREL)
In India- EC pill, Pill 72, unwanted
LNG-ONLY PILLS
2 doses of 0.75mg LNG pill to be taken orally 12 hours apart within 72hours of intercourse. OR Single dose of 1.5mg LNG pill to be taken within 72 hours of intercourse.
Trials have shown that a high proportion of pregnancies were averted even up to 5days (120hours). WHO recommends levonorgestrel for emergency contraceptive pill use.
Failure rate- 0-1%
Cont.
Side Effects:-
1. Nausea- in 50% using Yuzpe regimen & 20% for Levonorgestrel.
2. Vomiting - in 20% Yuzpe regimen & 5% using LNG-only pills.
If vomiting occurs within 2 hours of taking the pills - the dose should be repeated. In cases of severe vomiting - administer pills vaginally.
3. Irregular uterine bleedi
the deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse. The major forms of artificial contraception are barrier methods, of which the most common is the condom; the contraceptive pill, which contains synthetic sex hormones that prevent ovulation in the female; intrauterine devices, such as the coil, which prevent the fertilized ovum from implanting in the uterus; and male or female sterilization.
Most oral contraceptives contain a combination of 2 types of hormones: an estrogen and a progestin. Both of these hormones are naturally found in women’s bodies. There are many different types of estrogens and progestins, and different types of pills contain different combinations, but they all work similarly. Some pills contain only progestin, sometimes called the “mini-pill.”
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