family planning.ppt

FAMILY PLANNING
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GROUP ONE PRESENTATION
2
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OVERVIEW
World Health Report 2005, poor maternal
conditions account for the fourth leading
cause of death for women worldwide, after
HIV/AIDS, malaria, and tuberculosis.
Raising a child requires significant amounts
of resources: {time, social, financial, and
environmental}. Planning can help assure
that resources are available.
Women have attempted to end
unplanned pregnancies by a variety of
methods for centuries.
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Family planning
WHO DEFINITION.
Family planning “Is a package of methods and services, that”,
allows individuals and couples to anticipate and attain their
desired number of children and the spacing and timing of
their births. It is achieved through use of contraceptive
methods and the treatment of involuntary infertility. A
woman’s ability to space and limit her pregnancies has a direct
impact on her health and well-being as well as on the
outcome of each pregnancy.

CATEGORIES OF FAMILY
PLANNING
Family planning is divided into three
categories:
1)contraception (prevention of fertilization),
2)interception (prevention of implantation
e.g emergency contraceptives- plan B), and
3)abortion (interruption of an established
pregnancy).
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TYPES OF FAMILY PLANNING
COUNSELING
General counseling,
Method specific counseling,
Follow-up counseling.

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Pre-conception counselling,
testing and Mgt.
The reason for request
Age
Comprehensive medical,
surgical, family-social history.
Family size
Previous and current
conception and any
problems, experience
Which partner should use
the method
The stability of the
relationship and possibility of
break down
The quality of the couple’s
sex life
Failure rate
Compliancy and continuation
Risks and side effects
contraindications
Reversibility/ return to
fertility.

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Tests
β-hCG
Coagulation profile
STIs : RPR/VDRL, RCT, cervical gonorrhea and
chlamydia culture.
Cancer screening tests: Pap smear, endometrial
biopsy.

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Contraception
Defin: The prevention of conception (fusion of gametes to
produce a new organism). Contraception methods can be
either Temporary (reversible) or permanent (Irreversible e.g.
sterilization).
Contraceptive effectiveness is usually presented in terms of
failure rate rather than success rate
Failure rate per 100 woman year (wy).
One woman year is equal to 13 cycles.

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The characteristics of the ideal
contraceptive method
highly effective
no side effects or risks;
cheap;
independent of intercourse and requires no
regular action on the part of the user;
non -contraceptive benefits;
acceptable to all cultures and religions
easily distributed and administrated by non healthcare
personnel.

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Classification of contraception
Combined hormonal contraception
The pill
Patches
The vaginal ring
Progestogen-only preparations
Progestogen-only pills
lnjectables
Subdermal implants

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CONT’N
Hormonal emergency contraception
Intrauterine contraception
Copper intrauterine device (IUD)
Hormone-releasing intrauterine system (IUS)
Barrier methods
Condoms
Female barriers
Coitus interruptus

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Natural family planning
Fertility awareness
Lactational amenorrhea
Sterilization
Female sterilization
Vasectomy

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FACTORS TO CONSIDER WHEN CHOOSING A
METHOD OF CONTRACEPTION
Effectiveness
Convenience/ acceptability to the couples concerned
Duration of action
Reversibility and time of return to fertility
Effect on uterine bleeding
Frequency of side effects and adverse events
Affordability
Availability
Protection against sexually transmitted diseases
Medical contraindications

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Fertility awareness methods
These are more commonly known as natural
contraception.
WHO definition: the voluntary avoidance of
intercourse by the couple during the fertile phase of
the menstrual cycle in order to avoid pregnancy.
Disadvantages Advantages
Higher failure rate No side effects
Do not provide any protection
against STIs
Require long period of sexual
abstinence

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Fertility awareness methods
Cycle or rhythm method
Temperature method
Cervical mucus method
Cervical palpation method
Minor clinical indicators of fertility
Personal fertility monitors
Lactational amenorrhea method

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ADVANTAGES
Has no health risks.
No systemic side effects.
Affordable.
Can be used throughout the fertile life of women.
Once learned, can be used life-long.
Enables couples to gain fertility awareness.
 Can also be used to determine ovulation in infertile
couples (achieve or prevent )

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DISADVANTAGES
Method must be adopted by both partners and requires
their joint cooperation.
 In case of vaginal infections, it is difficult to distinguish
the ovulatory mucus.
Difficult to understand fertility signs when lactating.
In basal body temperature method, there may be errors
in determining the fertile/infertile periods due to the
effects of diseases, drugs, stress, activity or hot drinks.
It offers no protection against std

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1. Cycle or rhythm method
In this method, cycle length is recorded for a
minimum of six cycles
Formula:
First fertile day = shortest cycle – 20 days
Last fertile day = longest cycle – 10 days

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2. Temperature method
Following ovulation, there is a rise in progesterone level
which leads to rise in basal body temperature of 0.2 – 0.4
degree Celsius, which is maintained until the onset of
menstruation.
The fertile phase ends after three consecutive high
temperatures are recorded (>0.2 c above the six preceding
recordings). This is known as “3 over 6” rule.
Infertility, illness, medication can affect the body temp.
Failure rate of 2 per 100 wy has been recorded

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3. Cervical mucus method
(Billing’s method)
During follicular phase of cycle: cervical mucus
appears like “raw egg white, it is clear slippery and
stretchy (Spinbarkeit phenomenon).
Final day of ‘fertile mucus’ is considered to be the
day when ovulation is most likely to occur.
Abstinence must be maintained from the day when
fertile mucus is first identified until 3 days after peak
day.
Failure rate is 22 per 100 wy .

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4. Cervical palpation method
Daily self palpation of cervix helps detect changes
occurring in the external os relative to introitus.
Follicular phase – cervix rises
At ovulation – it reaches peak height from the
introitus with maximum softness and admits a finger
tip.
Towards the end of luteal phase – it descends,
becomes closed and firm and is closer to vulva.

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5. Minor clinical indicators of
fertility
oOvulation pain (Mittelschmerz)
oMid cycle show of blood
oOnset of breast symptoms
oSkin and mood changes

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6. Personal fertility monitors
Persona (Unipath, UK) – is a hand-held device that is
able to detect urine concentration of osteone – 3 –
glucuronide (E3 G) and LH
On potentially fertile days:
Red light – indicates abstinence from intercourse
Green light – safe days
Yellow light – urine sample is required

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7. Lactational amenorrhea
method (LAM)
A woman who is fully breastfeeding
and is amenorrhic during first 6
months after child birth has 2%
chance of getting pregnant
This is one the natural family
planning methods

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ADVANTAGES
Contraceptive protection starts right after birth.
Protects the woman effectively for at least 6 months.
Does not affect sexual intercourse.
Has no side effect.
Natural and easy-to-use.
Free of charge.
Highly beneficial for maternal and child health.
Supports breastfeeding and child development.

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DISADVANTAGES
Is limited to a specific period; under normal conditions, it is
effective for the first 6 months following the birth.
If all conditions are not met, the method ceases to be
effective as a contraceptive.
Another method (condom, spermicidal etc) must be
available for use in case one of the conditions changes..
Does not protect against STD.
HIV and hepatitis can be transmitted

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Advantages of barrier methods
Provide protection from STIs including HIV
and premalignant and malignant diseases of
cervix

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1. Male condom
ADVANTAGES
Allow man to participate
Easily accessible
Reversible
Low cost
Provide protection against STIs
No negative effect on health
Easy handling

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DISADVANTAGES
Dependant on sexual intercourse
Has to keep sufficient number
Reduce sensitivity in some couples
Interrupt sexual intercourse
Disposal problematic
May tear or slip off
Necessary to use a new every time

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ELIGIBILITY CRITERIA OF MALE
CONDOM
ALL MEN can use except those
man who have latex allergy
Failure rate ranges from 3 to 23
per WY

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SUSPICION OF CONDOM
BREAKAGE OR LEAKAGE
•Post-coital Pills or Emergency
Contraceptives (Within 72 hours after
suspected intercourse)
•Copper IUD (within 5 days)

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THINGS TO PAY ATTENTION TO IN
CONDOM USE
•Expiry date
•Use in all kinds of sexual intercourse.
•New condom in each intercourse.
•Do not carry the condom in a tight
pocket or in a wallet for a long time.
•Do not use dry, dirty and damaged
condoms that have lost their
flexibility.

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THINGS TO PAY ATTENTION TO IN
CONDOM USE
Do not use teeth or perforating
tools (scissors, nails, etc)
Use the condom at the beginning of
intercourse before the exchange of
fluids and for male condoms, when the
penis is in full erection.
If condom damaged immediately
change

2. Female condom
Advantages:
Not weakened by oil based
lubricants
Protect from STIs
Can be used during
menstruation and presence of
excessive vaginal discharge
Failure rate: 5 – 21 per WY
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3. Occlusive caps
Diaphragms
Cervical caps
Vault caps
Vimule
Used in combination with spermicides to provide maximum protection

Diaphragm
DEF. its an intravaginal device made of latex with
a flexible metal or spring at the margin
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Chemical spermiscide

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Cervical caps
Fermcap has been available in the UK.
Reduces the risk of UTI
Failure rate is double to diaphragm 8-20 per 100 WY

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Vaginal sponge
They act as a carrier for spermicides and absorb semen and mechanically
blocks sperm ascent
Failure rate is 25 per 100 WY

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Spermicides
Chemicals that bring about sperm death by causing
osmotic changes in the sperm
Nonoxinol ‘9’
Failure rate is 0.3 – 40 per 100 WY
Cause vaginal irritation and ulceration and increase
risk of HIV transmission.
Used in conjunction with barrier methods.
 Can increase urinary tract infection in women

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Coitus interruptus
Withdrawal of penis from vagina before ejaculation
takes place and therefore requires considerable
control on the part of the man
Failure rate is 10 per 100 WY

HORMONAL CONTRACEPTIVES
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HORMONAL METHOD OF
CONTRACEPTION
Temporary method
Reversible method
Contains hormones already present in body (Estrogen, Progesterone)
Prevent pregnancy by inhibiting ovulation
Not interfere with sexual activity
Not prevent STIs

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TYPES OF HORMONAL METHOD OF
CONTRACEPTION
Combine hormonal contraceptive
Progesterone only contraceptive

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COMBINED CONTRACEPTIVES
COC pills
Transdermal
patch (EVRA)
Vaginal ring
(Nuva Ring)
Injections
(Lunelle)

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Combined Contraceptive pills
Mechanism of action:
1.Inhibit ovulation----Suppression of ovulation by inhibition
of the follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) responsible for follicle development and
ovulation (primary mechanism for COCs, and secondary for
POPS(
2.Vaginal and cervical mucus becomes thick and inhibit the
sperm transport
3.Endometrium becomes atrophic and unreceptive for
implantation

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ADVANTAGES OF COC
•Possible to get pregnant soon once stopped.
•Highly effective
•Reduce the amount of monthly blood loss
•Reduced menstrual irregularities
•Reduced risk of ectopic pregnancy
•Reduce dysmenorrhoea
•Decrease the incidence of functional ovarian cyst
•Decrease incidence of benign ovarian and breast disease
•Decrease the PID
•Prevent
• Ovarian cancer
• Endometrial

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DISADVANTAGES OF COC
Daily intake
No protection from STI
Having Side Effects

SIDE EFFECTS OF COC
Minor side effects
Nausea
Headache
Vomiting
Weight Gain
Breast Tenderness
Menstrual irregularities:
spotting, amenorrhea,
breakthrough bleeding
Major sides effects
• Venous
Thromboembolism
•MI
•Stroke
•Migraine
•Increase incidence of
breast ca, ca cervix and
liver cancer.
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HOW TO USE COC PILLS?
1 pill a day
Same time everyday
After dinner
Before going to bed at night

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WHEN TO START COC PILLS?
First 5 days - starts at once (no need of additional
method)
6th-28th days + no pregnancy – COC Starts + 7 days
additional method
Post-natal:
◦ breast-feeding the baby- start after 6 month
◦ No breast-feeding – COC Starts on 21st day
Miscarriage – Starts within first 7 days

TAKING PILLS AND MISSING
PILLS
1. Once a day at the same time everyday
2. Use condoms for first month
3. Use condoms when on antibiotics
4. Use condoms for 1 week if you miss a pill
or take one late
5. The pill offers no protection from STD’s
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FOLLOW UP COC
After 1 month.
If no complaint- 1 yearly
If complaint – any time.

Contraindications
(relative)
Known hyperlipedemia
Migraine without aura
Undiagnosed breast mass
Past history of breast cancer
and no evidence of
recurrence for 5 years
DM
Gallbladder disease
Breast feeding – between
6wks and 6 months
Post-partum- less than 21
days
Smoking
Obesity
Cardiovascular disease
Hypertension
Family history of VTE
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absolute contraindications
VTE current or past history
Major surgery with prolonged emobilization
Nonthrombotic mutation
Current and history of ischemic heart disease
Stroke
Migraine with aura
Valvular and congenital heart disease
Current breast disease
Cirrhosis
SLE
Liver tumor

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TRANSDERMAL PATCH (EVRA)
20 ug etheniyl estradiol and 150 ug norelgestromin
released per 24 hours
It is first transdermal patch applied once weekly for 3
weeks followed by patch free week
Pearl index is 1.24 per 100 WY

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VAGINAL RING (NUVA RING)
15 ug ethinyl estradiol and 120 ug etonorgestrel
It is placed vaginally once every three weeks and
removed in the menstrual period and followed by
one week ring free interval
Efficacy, cycle control and side effects similar to
COC
Additional side effects: vaginitis, leucorrhea, foreign
body sensation, coital problem, expulsions

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COMBINED INJECTABLES
(LUNELLE)
25 mg medroxyprogesterone acetate and
5 mg estradiol cypionate
Once in a month
Is available in some parts of the world
like USA

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ADVANTAGES OF COMBINED INJECTABLE
HORMONAL CONTRACEPTIVE
High rate of contraceptive effect.
Possible to get pregnant soon once
stopped
It is easy to use (1 inj/month)
Applied from menarche to menopause.
Provide protection against ovarian cyst &
ovarian cancer.

PROGESTERONE-ONLY
HORMONAL CONTRACEPTIVES
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TYPES OF PROGESTERONE-ONLY HORMONAL
CONTRACEPTIVES
Pills
◦ Progesterone-only pills (Mini Pills)
Injectables
◦ Depomedroxy Progesterone Acetate (DMPA 150 mg) (Depo-
provera)
◦ Norethisterone enanthate
Intrauterine systems – levonorgestrel intrauterine system (LNG-IUS)
Implants
◦ Norplant (Levonorgestrel)
◦ Implanon (Etonorgestrel)
◦ Jadelle

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PROGESTERONE ONLY PILLS
Traditional POPs :
1. micronor
2. noriday
3. norgeston
4. femulen
Desogestrel only
Cerazette

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Progesterone only pills cont..
Mechanism of action
Alter the cervical mucus
Alter the endometrium
Inhibits the ovulation
Effectiveness
failure rate is 0.3-8.0 per 100 WY
Side effects
bleeding patterns are common: amenorrhea,
regular/irregular and mood changes
Risk: no causal association between POPs use and
Cardiovascular disease and breast cancer. Use safely in
migraine.

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How to take POPS
Initiating:
Postpartum breastfeeding women-delay 6 weeks
Postpartum non-breastfeeding women - can start
immediately
Menstruating women:
◦ Preferably first 5 days of menstrual cycle
◦ Can start anytime provider is reasonably sure that woman
is not pregnant
Schedule:
Take 1 pill each day
Take the pill within 3 hours of the same time each
day (preferably the same time)
No break between packs

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Contraindications POP category 3
Current and history of IHD and Stroke
Past history of breast cancer, no evidence of
recurrence for 5 years
HIV on ARV therapy
Severe cirrhosis
Live tumor
SLE positive and unknown antiphospholipid
antibodies .

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Contraindications
POP category 4
breast cancer

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Progesterone only injectables
◦ Depomedroxy Progesterone Acetate (DMPA 150 mg) given IM every
12 weeks. Commonly used.
◦ Norethisterone enanthate given IM but 8 weekly
◦ Mode of action : Same as POP
◦ Effectiveness: failure rate is <4 in 1000 over 2 years of DMPA
◦ Return of fertility: it is usually delayed up to 1 year following
discontinuation
◦ Dicontinuation: 50 % user discontinue within one year due to
bleeding problem and weight gain
◦ Side effects: Bleeding problem, and weight gain, Amenorrhea,

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Progesterone only injectables cont..
Drug interaction:
◦ Enzyme inducing drugs do not reduce the contraceptive
efficacy of DMPA
Health concerns:
◦ Cardiovascular disease – are not associated with increased
risk of stroke, VTE, and MI. Safely used when estrogens
are contraindicated.
◦ Bone mineral density – associated with a small los of BMD
which mostly recover when DMPA is discontinued ,
young women who use DMPA could have an increased risk
of developing osteoporosis later in life

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Progesterone only injectables
cont…
Non contraceptive benefits
◦Improvement in dysmenorrhea and
symptoms of endometriosis
◦Category 3 contraindication – same as POP
◦Category 4 contraindication – same as POP

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WHEN TO START INJECTABLES?
Start 1st Injection within 5 days of menstruation
6th-28th days + no pregnancy – Starts Injection +
additional method
Post-natal:
◦ breast-feeding the baby- start after 6 wks to 6
months
◦ No breast-feeding – immediately after birth

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ADVANTAGES OF DMPA
Very high level of protection against pregnancy
Easy to use 1 injection in 3 months is sufficient
Used safely between 18-45 years
Breast feeding women can use it
Cigarette smokers can use it safely
Protects against endometrial and ovarian cancer
Used who have gall bladder and
Used who have heart disease

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ELIGIBILITY CRITERIA FOR METHOD
Healthy women of all ages (Nulliparous or multiparous)
Smokers
Obese
Who should not use estrogen

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RULES OF USING DMPA
One every 3 month

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FOLLOW-UP
After 3 months
No complain – once a year
If complain – at any time

PROGESTERONE-ONLY HORMONAL
CONTRACEPTIVES IMPLANTS
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PROGESTERONE-ONLY IMPLANTS
Norplant (Levonorgestrel)-
◦ Reversible
◦ 6 capsules
◦ Subcutaneously
◦ 5 years
Jadelle (Levonorgestrel)
◦ 2 rod
◦ 5 years
Implanon (Etonorgestrel)
◦ Reversible
◦ 1 rod
◦ Subcutaneously
◦ 3 years

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WHEN TO START IMPLANON?
Start 1st Implant within 5 days of menstruation
6th-28th days + no pregnancy – Starts Injection + additional method
Post-natal:
◦ breast-feeding the baby- start after 6 wks to 6 months
◦ No breast-feeding – immediately after birth

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MECHANISM OF ACTION
Ovulation suppression
Cervical mucus thickness.

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EFFECTIVENESS OF METHOD
100%
The over all pregnancy rate is less than 1 in 1000 over 3 years use.
Interacts with enzyme-inducing medication, and reduces its effectiveness. Therefore other methods eg.
Condom

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ADVANTAGES OF IMPLANON
Very high level of protection against pregnancy
Easy to use only 1 in 3 years is sufficient
Used safely between 18-45 years
Breast feeding women – Safe
Cigarette smokers – Safe
Need no regular attention
No side effects connected to estrogen
Fertility return within 3 months of removal

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DISADVANTAGES
Surgical application
Pain, redness, sensitivity in the area of application
Menstrual problem
◦ Amenorrhoea
◦ Irregular
◦ Heavy
Severe headache
Weight gain 3-12%

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RULES OF USING IMPLANON
One every 3 Years
Health concerns:
◦ VTE no increased risk
◦ Bone marrow density- no evidence of any effect
◦ Endocarditis- no need of prophylactic antibiotics for
insertion or removal
Complication: only 1%
Discontinuation:
◦ 43% within 3 years (because of bleeding)

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FOLLOW-UP
After 1 week
After 3 months
Every year
POI contraindication category 3: same as POP. Un
explained vaginal bleeding
POI category 4: same as POP

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EMERGENCY
CONTRACEPTION
1. Progestogen-only emergency
contraception: levonorgestrol –
levonelle 1500
◦Single dose within 72 hours of UPSI
◦use more than once in a cycle,
◦double the dose if patient is taking
enzyme-inducing drugs.

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Emergency contraception cont..
2. IUD
◦ copper IUD inserted up to 5 days after episode of
UPSI
◦ Failure rate is 1%
3. ULIPRISTAL ACETATE – ella One
◦ Selective progesterone receptor modulator
◦ Lincensed up to 120 hours of UPSI
◦ Only one tablet

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IUD TYPES
Copper IUDs used
◦ Multiload (Cu375 and Cu380A)
Hormone IUDs used
◦ Intrauterine system LNG-IUS (Mirena)

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IUD’s MECHANISM OF
EFFECT
Copper IUDs,
by preventing the sperm from reaching the upper genital track
Copper is toxic to sperm and ovum,
By preventing implantation.
Levonorgestrel-releasing IUDs:
Hormonal-local effect.
Endometrial proliferation is prevented,
Thickening the cervical mucus.
Little effect on ovarian activity

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Effectiveness
The failure rate of LNG-IUS is <1%
The failure rate of CU-IUD is < 2%

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APPLICATION TIME
Within the first 12 days of menstruation. .
Any time when the woman is not pregnant.
LNG-IUD within the first 7 days following the beginning of menstrual cycle.
It can be applied any time if it is certain that there is no pregnancy. However,
sexual intercourse must be avoided or an extra contraceptive method must be
used for 7 days.
Postpartum period:the first two days (48 hours)

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ADVANTAGES OF CU-IUDs
 Safe and highly effective.
 Long-lasting protection.
 Reversible.
 No systemic side effects.
 Independent from sexual intercourse.
 No interaction with lactation.
 No interaction with drugs.
 Affordable.

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ADVANTAGES OF LNG- IUDs
 Same as Cu-IUDs
 Treats menorrhagia complaints,
 Reduces loss of blood during menstruation
up to 90%,
 Reduces risk of ectopic pregnancy,
 Reduces dysmenorrhea
 Used in the management of endometrisis

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DISADVANTAGES OF Cu-IUDs
 Discomfort in the lower section of the
abdomen, dysmenorrhoea,cramps, mid-
cycle bleeding/spotting
 Can be ejected. Usually within the first 3
months
 Do not protect against STD.
 Slight risk of perforation.

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DISADVANTAGES OF LNG- IUDs
 Irregular menstruation.
 Amenorrhea and hypomenorrhea

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Risks of CU-IUD and LNG-IUD
Expulsion (in first 3 months and often after menstruation, 1
in 20 women)
PID – 6 fold increase after 20 days of insertion
Perforation – 2 per 1000 insertion (at the time of insertion)
Bleeding pattern and pain
Vasovagal syncope – 0.2-2.1% at the time of insertion
Lost thread
Ovarian cyst ( more in LNG-IUD)
Ectopic pregnancy (only in CU-IUD) – 0.02 /100 WY
Pregnancy (more in CU-IUD)

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WHO CANNOT USE CU-IUD / LNG-IUD
 Undiagnosed Vaginal bleeding
 Active PID
 Pelvic Tuberculosis
 Untreated Ovarian/Cervical Cancer.
 STD / HIV ( AIDS)

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WHO CAN USE IUD?
 Healthy Women of All ages.

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IUD Follow-up
At the end of the first menstruation after the application.
Anytime if warning signs present.

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REMOVING AND REPLACING IUD
At the end of effective period

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Contraindication of IUD
category 3
LNG-IUS CU-IUD
Same as POP VTE
Post-partum (Between 48 hours
and <4wks
Same
Pelvic TB Same
Ovarian ca
SLE Same
AIDS Same

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Category 4 for both
Puerperal sepsis
Post abortal sepsis
Unexplained vaginal bleeding
Cervical, endometrial, and ovarian cancers.
Current PID
GTD
Pelvic TB
Current Breast cancer (only LNG)

Sterilization
permanent
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Surgical procedure that removes all or part of the vas deferens (usually as
a means of sterilization); is sometimes reversible

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METHODS OF MALE STERILIZATION

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EFFECTIVENESS:
Failure rate is 1 in 2000
ADVANTAGES
Easy admission
Single procedure
Effective & lasting protection
Low failure rate
Independent of sexual intercourse
No side effects in future

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DISADVANTAGES
Difficult to reverse
Does not protect from STD
Contraceptive effect begins after 20 discharges. It requires additional
method in this period.
Scrotum pain, bleeding, hematoma may occur.

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INDICATION:
Those couples not wanting any more children.
Whose wife shouldn’t strictly become pregnant for health reasons.
CONTRA INDICATIONS
Single man
Men without any children
Men with psychological issues
Men undergoing marriage related problems

How Is Procedure Performed?
•No Need for Pre Medication.
•Local Anesthesia.
SIDE EFFECTS
•Fever
•Bleeding
•Pain
•Hematoma
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POST-VASECTOMY
RECOMMENDATIONS
•Avoid heavy and compelling efforts and moves
for 48 hours.
•2-3 days home rest.
•Incision should be kept dry and clean for first
48 hours.
•For 2-3 days sexual intercourse is not
recommended.
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FOLLOW UP
•Within 7 days after procedure.
•Man should be advised on effective
contraception until two consecutive semen
sample 4 weeks apart confirm azoospermia (the
first sample should be taken 8 weeks after
surgery)
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TUBAL LIGATION
•Irreversible, permanently effective surgical
procedure for sterilization in which a woman's
fallopian tubes are clamped and blocked, or severed
and sealed.
• Interruption of the continuity of the
oviducts by cutting, cautery, or by a plastic
or metal device to prevent future
conception.
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Methods of female sterilization

EFFECTIVENESS
•Failure rate is 1 in 200
ADVANTAGES
• Immediate Effect.
•Single procedure.
•Failure rate is very low.
•No health problem.
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DISADVANTAGES OF TUBAL
LIGATION
•Difficult to revoke and expensive.
•Does not protect from Sexually Transmitted
diseases.
•Pregnancy may be experienced even at low
levels.
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EXPLAIN TO THE CLIENT THAT AN ABDOMINAL (MINILAP, POSTPARTUM OR
LAPAROSCOPIC) OR VAGINAL APPROACH CAN BE USED FOR TL.
IT CAN BE PERFORMED WITHIN 48 HOURS OF CHILDBIRTH.
AN INTERVAL PROCEDURE AFTER 6 WEEKS POSTPARTUM
AT ANY TIME IF THE WOMAN IS NOT PREGNANT.
TUBAL LIGATION ELIGIBILITY
CRITERIA:
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TUBAL LIGATION NOT
ADVISABLE FOR
•Single Woman
•Women without any children
•Women who are not positively sure whether
she or her husband want more children.
•Women with psychological issues.
•Women undergoing marriage related problem.
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APPLICATION TIME FOR
TUBAL LIGATION
•In the most suitable and shortest time.
•Allow time between counseling and procedure for
couple to consider their decision.
•Women who are surely known not being pregnant.
•May be performed after delivery.
•May be performed after abortion in 1st trimester.
( Contd)
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APPLICATION TIME FOR
TUBAL LIGATION
•Can be performed during C-section operation.
•Prenatal period is the most suitable period to
provide counseling services for those who will
have tubal ligation or vasectomy immediately
after delivery.
•Early post partum period may not be a suitable
time for the applicant to decide about
terminating her fertility.
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HOW IS TUBAL LIGATION
PERFORMED?
•General, regional or local anesthesia based on
the decision of physician.
•3-4cm of incision in minilaprotomy.
•1cm of incision is made under the umbilicus in
laparoscopy.
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SIDE EFFECTS OF TUBAL
LIGATION
•Not Harmful for health.
•Health problem occurs rarely.
•Severe health problem in only 2% cases.
•Possible Complications after minilaparotomy
• Bleeding, Injuries in Organs, Infection
•Possible Complications after Laproscopy
• Excessive abdominal growth, gas embolie
•Anaesthetical complications.
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FOLLOW UP IN TUBAL
LIGATION
•Within 7 days.
•If non absorbable suture is use, it shall be
remove.
If any complaints.. Postoperative fever, dizziness
with fainting, persistent or increasing abdominal
pain, and bleeding or fluid discharge from the
incision
REFERRAL
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Reversal of sterlization
For the female laparotomy does not always work (microsurgical
techniques are associated with 70% success) and carries 5% ectopic
pregnancy
For the male, technically feasible upto 90%, but pregnancy is <60%

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ABORTION
Defin: Abortion is the interruption (spontaneous or induced) of an
established pregnancy before 28 weeks' gestational age.
Women have attempted to end unplanned
pregnancies by a variety of methods for centuries.
In UK Abortion Act was passed in 1967, So Abortion can be carried out
legally up to 24 weeks of gestation.

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Abortion
In many countries, illegal abortion still
remains the cause of considerable
morbidity and mortality. Abortion is a
subject that attracts very strong opinions
and there is a widespread divergence of
views on the subject worldwide, mainly
related to cultural and religious
backgrounds.

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Counselling
Every woman who tests positive for an unplanned pregnancy needs to be
made aware of all of her options, including continuing the pregnancy,
abortion, and adoption.

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The method used is Comprehensive abortion care which provides abortion
services when needed and post-abortal care including management of
complications.
Abortion techniques
Medical: an antiprogestin (like Mifepristone) and a prostaglandin analogue
(like misoprostol) .
Surgical: dilatation of the cervix
and evacuation of the uterus preferably under general anesthesia (D&E),
MVA.

Couples who use no birth control have a
85% chance of a pregnancy within the
first year.
SOMETHING TO THINK ABOUT…
1/29/2023

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