Jadella Implant is a form family planning which comes in two silicon rods,implan subdermal Over the years it release progestin to prevent ovulation thus prevent pregnancy
A brief introduction regarding oxytocics & tocolytics which are the indispensable drugs in obstetrics. It consists of illustrative images, classification of drugs with their dosage, uses & side-effects along with contraindications
A brief introduction regarding oxytocics & tocolytics which are the indispensable drugs in obstetrics. It consists of illustrative images, classification of drugs with their dosage, uses & side-effects along with contraindications
In settings with limited access to health care, misoprostol is an important intervention that could reduce maternal deaths both directly and through the more cost-effective use of health services. Misoprostol is, however, a powerful drug that needs to be used with care. Evidence-based information about the safest regimens should be widely disseminated so as to prevent its inappropriate use
In settings with limited access to health care, misoprostol is an important intervention that could reduce maternal deaths both directly and through the more cost-effective use of health services. Misoprostol is, however, a powerful drug that needs to be used with care. Evidence-based information about the safest regimens should be widely disseminated so as to prevent its inappropriate use
Immediate post-partum insertion of IUDs appeared safe and effective. Advantages being high motivation, assurance that the woman is not pregnant, convenience and few contraindications to the method. Expulsion rates appear to be higher than with interval insertion but continuation rate in term of numbers is encouraging.The popularity of immediate post-partum IUD insertion in countries like China, Mexico, and Egypt supports the feasibility of this approach in our country. Failure to follow up is distressing. Early follow-up may be important in identifying complications and improve compliance.
“Clinicians should proactively talk to their patients of reproductive age about ECPs and offer advance prescriptions for ECPs during routine gynecologic office visits….”
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.
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
This presentation privdes facts and statistics for non-invasive procedure such as Macrolane.
Macrolane is a Nasha Gel for volume restoration and contouring of body surfaces.
An IntraUterine System (IUS) or IntraUterine Drug Delivery System (IUDDS) is a small object that is placed inside the uterus above the endometrium and is active or medicated when it contains a therapeutic agent. It is a small string that is inserted through the cervix and placed in the uterus to prevent pregnancy.
It is a small string that hangs down from the IUD into the upper part of the vagina.
IUD is not noticeable during intercourse.
Case Report:Massive Ovarian Cyst in a Adolescent GirlTana Kiak
For benign tumours adhesion prevention strategies should be used. Surgical intervention should as much as possible be directed towards preservation of ovarian tissue. There is scarcity of published literature on this subject.
We need bigger studies to address the issue of how much fertility preservation is safely possible.Irrespective of indication for surgery, it is always preferable to attempt conservative, fertility sparing surgery in adolescents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
2. CONTENT
Brief Introduction
What is It
Component/Structure
Release Rate of Levonorgestrel
Pre-clinical Evaluation
Mechanism of Action
Efficacy/Fertility
Subjective Symptoms
Timing of Insertion
Implant Insertion Technique
Comparison - New Hormonal Implants
Monthly Stat for Implants -MGH
Summary
3. Brief Introduction
Implants are approved in more than 60 developed and
developing countries and are currently being used by
millions of women worldwide 1
. Owing to their high
contraceptive efficacy (which begins almost immediately
after insertion), low rate of complications and side-effects,
possibility of long-term use following a single intervention
and the rapid return of fertility after removal.
Contraceptive implants are good candidates for inclusion in
the method mix offered by family planning programmes,
especially in under-resourced setting 2
.
1. Ref: Contraceptive implants come of age. Progress in Reproductive Health Research 2003; No. 61. Geneva; World
Health Organization (www.who.int/reproductive-health/hrp/progress/61/news61.htm (accessed 1 September 2008).
2. Boostra H, Duran V, Weaver K. Norplant and the boom or bust phenomenom. IPPF Medical Bulletin October
1999;33:3–4.
4. Countries using Implant
Burundi
Ethiopia
Ghana
Malawi
Mali
China
Indonesia
Kenya In Progress (n=20)
Under Review (n=10)
Nepal
Pakistan
Rwanda
Tanzania
Uganda
Argentina
Bangladesh
Bolivia
Brazil
Burkina Faso
Chile
Colombia
Dominican
Republic
Ecuador
Fiji
India
Mexico
Mozambique
Nigeria
Peru
Russia
South Africa
Sudan
Venezuela
Zimbabwe
REGISTERED (n=6)
Sierra Leone
Madagascar
Zambia
5. Levonorgestrel subdermal implants provide effective long
term contraception.
Implants are a good choice of contraceptive method in
women who desire effective contraception, but who are
unable to, or prefer not to, comply with an oral regimen or
injection.
Implants maybe used to postpone
1st pregnancy
Space pregnancy
Provide long-term contraception when desired
family size is reached
What is it?
6. Long-Acting & Permanent Methods
The advantages that implants and other methods such as
the IUD offer over other contraceptive methods is that they
are not user-dependent in the way that condoms, injectables
& combined oral contraceptives (COC) are 3
.
Ref. 3.Russell J. Contraceptive failure in the United States. Contraception 2004;70:89–96.
7. Components
Implants is a set of two flexible cylindrical implants
consisting of a dimethylsiloxane/ methylvinylsiloxane
copolymer core enclosed in thin-walled silicone tubing.
Each rod contains 75 mg of the progestin levonorgestrel.
The core of each rod is a mixture, half of levonorgestrel,
half of the elastomer.
The rods are sealed with polydimethylsiloxane adhesive &
sterilized.
Each rod is approximately 2.5 mm in diameter & 43 mm in
length 4
.
Ref. 4. Harold Nash, and Sandra Waldman. Jadelle ィ Levonorgestrel Rod Implants:.A
Summary of Scientific Data and Lessons Learned from Programmatic Experience Irving
Sivin,
8. Medical adhesive
43mm thin-walled silicon tubing
levonorgestrel & Siloxane copolyme
12.5mm
Components
Session IV A, Slide #3
Implanon Applicator
9. Structure
The sole active ingredient in the rods is levonorgestrel (-)-13-
ethyl-17-hydroxy-18,19-dinor-17α-pregn-4-en-20-yn-3-one.
It has a molecular weight of 312.45 and the structural formula.
Medical grade silicone rubber materials, including the type
used in Jadelle, have been employed in various implantable
devices for humans since 1950 4
.
Silicone rubber implant have be employed in various
implantable device
Prosthetic devices
Heart valves
Drainage tubes
QuickTime™ and a
decompressor
are needed to see this picture.
Ref. 4. Harold Nash, and Sandra Waldman. Jadelle ィ
Levonorgestrel Rod Implants:.A Summary of Scientific Data and
Lessons Learned from Programmatic Experience Irving Sivin,
10. Release Rate of Levonogestrel
Diffusion of Levonogestrel from the rods produces a continuous
low dose of the progestin and is is delivered directly into
interstitial fluids from the subcutaneous implants
After placement of Jadelle rods,levonorgestrel concentrations
reach a maximum level within 2-3 days after implant
Decline rapidly over the 1st month both due to a decrease in the
rate of release & because of decreased circulating levels of sex
hormone binding globulin (SHBG), a protein that binds
levonorgestrel.
Jadelle/Day Dosage/Rate Remarks
1 month 100g/day
12 months 40g/day
24 months 30g/day -stabilizing thereafter
11. Pre Clinical Evaluation
Levonorgestrel implant is a totally synthetic &
Biologically active Progestin- does not contain
estrogen- a subdermal contraceptive implant
A double silicon rods preload in a sterile disposable
applicator to facilitate easy & rapid insertion
Release of Levonorgestrel sufficient to prevent
conception within 24hrs after implant
Effective role for 5 years
12. Mechanism Of Actions
At least 3 mechanism are active in preventing pregnancy
1. Ovulation inhibition- by suppressing of
gonadotrophins (LH&FSH) secretion
2. Thickening of the cervical mucus
-increase viscosity of the cervical
mucus that preventing passage of
sperm into the uterus
3. Decrease endometrial
thickening during the use of
implants.
13. Efficacy/Fertility
It is convenient, safe, and over 99% effective
Prevents against pregnancy for up to 5 years, can be
removed @ anytime
Return to fertility rapidly after removal.
Another Jadelle implant can be inserted immediately
after removal for protection against pregnancy
It is invisible
Can be used without anything else
14. Subjective Symptoms
The cost is K1040-K2080 and around K200-K400
for removal
Headache
Nausea
Breast pain & Mood changes
Others include- pain, itchiness, infection and
expulsion on insertion site
This does not protect you from STDs
15. Timing of Insertion
Should be inserted on day 1-5 during menstrual cycle
Immediately or on week after 1st/2nd trimester
abortion
In Postpartum women
Non BF women immediately or within 6 wks after
labor
BF women should not use implants before 6 wks
after labor.
However,studies have shown no significant effects on the
growth or health of infants whose nursing mothers began
using levonorgestrel implants immediately or 5-7 wks after
childbirth. There is no experience to support the use of
Jadelle earlier than six weeks after childbirth in lactating
women
16. Implant Insertion Technique
Session IV A, Slide #2
One-Rod Implant Insertion:
Required Equipment
• An examination table
• Sterile surgical drapes
(optional) and gloves
• Antiseptic solution
• Local anesthetic, needles,
and syringe
• Implanon applicator
• Skin closure, sterile
gauze, and compresses
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
Two rods implant Insertion
Required Equipment
17. Session IV A, Slide #4
Implanon Insertion: Step 1
• Have the client lie on
her back with the arm
that she doesn’t
normally use flexed at
the elbow and
externally rotated.
• Implanon should be
inserted sub-dermally
just under the skin.
QuickTime™ and a
decompressor
are needed to see this picture.
Jadelle Insertion: Step 1
18. Session IV A, Slide #6
Implanon Insertion: Step 3
• Mark the insertion site
with a marker.
• Make 2 marks:
– First, mark the spot where
the rod will be inserted.
– Second, mark a spot a few
centimeters proximal to the
first mark. This second
mark will later serve as a
direction guide during
insertion.
QuickTime™ and a
decompressor
are needed to see this picture.
Jadelle Insertion: Step 2
3 Finger breath Medial Epicondyle
19. Session IV A, Slide #7
Implanon Insertion: Step 4
• Clean the client’s upper
arm with antiseptic
solution. Frame the
insertion area with a
drape that has an
opening (optional).
• Anesthetize the insertion
area with anesthetic
spray or by injecting 2 cc
of 1% lidocaine just under
the skin along the
planned insertion tunnel).
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
Jadelle Insertion: Step 4-5
Injection 10cc of 1% Lidocaine just under the skin
20. Session IV A, Slide #8
Implanon Insertion: Step 5
• Remove the needle
shield.
• Stretch the skin around
the insertion site with
thumb and index finger.
Session IV A, Slide #9
Implanon Insertion: Step 6
• Insert the tip of the
needle, at about a
20 degree angle.
QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
Jadelle Insertion: Step 6
Jadelle Insertion: Step 7
21. QuickTime™ and a
decompressor
are needed to see this picture.
QuickTime™ and a
decompressor
are needed to see this picture.
Session IV A, Slide #10
Implanon Insertion: Step 7
• Release the skin.
• Lower the applicator
to a horizontal
position.
Session IV A, Slide #11
Implanon Insertion: Step 8
• Lift the skin with the tip
of the needle, keeping
the needle in the
subdermal connective
tissue.
• While lifting the skin,
gently insert the entire
needle. Keep the
applicator parallel to
the surface of the skin.
Jadelle Insertion: Step 8
Jadelle Insertion: Step 9
22. Session IV A, Slide #16
Implanon Insertion: Step 13
• Verify the presence of the implant by
palpating the site.
• Apply a sterile gauze and wrap the
arm with a pressure bandage.
• Before the client is discharged,
observe her for a few minutes for
signs of bleeding from the insertion
site.
• Fill out the user card and give it to
the client.
• Review post-insertion instructions
and other key messages.
• Dispose of the applicator and syringe
properly.
QuickTime™ anda
decompressor
areneededto seethis picture.
Jadelle Insertion: Step 10
23. Sino-implant (II) Jadelle Implanon
Manufacturer Shanghai Dahua
Pharmaceutical
Bayer HealthCare Schering Plough /
Organon
Formulation 150 mg
levonorgestrel
In 2 rods
150 mg
levonorgestrel
In 2 rods
68 mg etonogestrel
In 1 rod
Mean Insertion
& Removal time
Insertion: 2 min
Removal: 4.9 min
Insertion: 2 min
Removal: 4.9 min
Insertion: 1.1 min
Removal: 2.6 min
Labeled
duration of
product use
4 years 5 years 3 years
Trocars Disposable Autoclavable /
Disposable
Pre-loaded
disposable
Cost of implant
(US$)
K17.00 K55.00 K52.00
Cost per Year
(if used for
duration)
K5.20 K12.40 K17.42
New hormonal implants
Comparison of Sino-Implant, Jadelle, Implanon
24. Monthly Stat for Implants
There were total of 102 implants done for the first half of April
2014, MGH 70, Ialibu 28 & MTC 14
1 2
5
10
52
0
10
20
30
40
50
60
TOTAL NUMBER
Extra-uterine
Pregnany
Purperal
Sepsis
Cearean
Section
Para >5 Para 1-4
INDICATIONS
JADELLE IMPLANTS-MGH
Remarks: Positive Response to Jadelle Implants
25. Summary
Contraceptive implant system provides effective,long-
acting, reversible contraception for women.
Two thin, flexible rods made of silicone tubing and filled
with levonorgestrel, a synthetic progestin, are inserted
just under the skin of a woman’s upper,inner arm in a
minor surgical procedure.
Protection from pregnancy is provided within 24 hours,
when insertion is performed during the first week of a
woman’s menstrual cycle.
The woman rapidly returns to her normal fertility when
the implants are removed.
Sub-dermal implantable contraceptives are highly
effective, easy to use and carry a low risk of side-effects.
These features make them a good option for women in
under-resourced settings.
26. You cannot have maternal health without reproductive health. And
reproductive health includes contraception and family planning and
access to legal, safe abortion.
Hillary Clinton quotes