familyplanning计划生育.ppt

Highlights Mechanism, indication, contraindication ,side effects and complication of contraception (hormonal contraception, intrauterine device) Indication, contraindication and complication of sterilization Indication, contraindication and complication of induced abortionSection 1 ContraceptionContraception Hormonal Contraception Intrauterine Device (IUD) Others Hormonal ContraceptionHormonal Contraception Oral contraception, OC Contraceptive injection Contraceptive delivery system Oral contraception Short-acting oral contraceptives Monophasic Biphasic Triphasic: more and more widespread Vacation pillsOral contraception Short-acting oral contraceptives Monophasic Biphasic Triphasic: more and more widespread Vacation pillsContraceptive injection Long-acting Single progesterone; combined type One month; three monthsContraceptive delivery system Implantation Vaginal ring Microspheres and microcapsules injection Contraceptive patchMechanism of hormonal contraception Mechanism of hormonal contraceptionMechanism of hormonal contraception Preventing ovulation Altering the cervical mucus Altering the endometrium Alter the function of oviductsIndication of hormonal contraception Child-bearing age No contraindiction Healthy women Contraindication of hormonal contraception Serious cardiovascular diseases Acute and chronic hepatitis, or nephritis Blood disease or thrombotic diseases Endocrine disease Cancer, precancerous lesions, uterine or breast lumps Lactation period Menstrual rare or older than 45 years old Unexplained vaginal bleeding Mental disease Side effects of hormonal contraception Nausea, dizziness, fatigue, drowsiness, loss of appetite Breakthrough bleeding Missed menstrual periods or amenorrhea Weight gain Pigmentation Headache, breast tenderness, increased appetite, itching Side effects of hormonal contraception Endometrial cancer, cervical cancer, breast cancer, epithelial ovarian cancer Fertility80% ovulation in 3 months, 95%98% ovulation in a year Offspring health Impaired glucose tolerance; increase of HDL, triglyceride & total cholesterol; total protein decreased Thromboembolic disease Intrauterine Device (IUD)Intrauterine Device (IUD) Inert intrauterine devices Activity IUD-with copper with drugs progesterone(Mirena) indomethacin others MirenaT 形塑料支架放置直径4.8mm19mm32mm纵形管内含52mg左炔诺孕酮取出用尾丝Mechanism- IUD Mobilization of leukocytesproduce an environment hostile + influence the movement of the oviducts Interference of endometrial maturation Copper device kill sperm + interruption of cell metabolism Progesterone-releasing device alteration of normal tubal cilial action + disruption of normal oocyte maturationMechanism- MirenaIndication- IUD Women of childbearing age No contraindiction With Voluntary requirements Contraindication-IUD Pregnancy or pregnancy suspected Inflammation of genital tract Tumor of genital tract Menorrhagia, frequent menstruation, irregular vaginal bleeding Uterine injury diseases Genital malformations Contraindication-IUD Abnormal uterine cavity Severe systemic disease venereal disease Pelvic tuberculosis Poor uterine contraction, residual, inflammation after abortion, delivery or cesarean section Copper allergy Insertion time-IUD 37 days after menstruation Delayed menstruation, lactation amenorrhea -rule out pregnancy 42 days postpartum During abortion or cesarean section Insertion steps- MirenaSide effects & complication-IUD During insertion-bleeding, uterine perforation After insertion-infection; ectopic, crack, deformation of IUD; menstrual abnormalities; vaginal discharge increased; pelvic infection; ectopic pregnancy Other contraception Topical contraceptives-condom; femal condom; contraceptive diaphragm ; vaginal spermicides Natural family planning-20% failure rate Biotechnology contraception-LHRHa; immunocontraception; anti-fertility vaccine Section 2 SterilizationTubal sterilization operation Safe, permanent High reversibility Surgical approach-laparotomy (tubal ligation); laparoscopy; transvaginal Indication-tubal ligation Voluntary No contraindiction Therapeutic sterilization Contraindication- tubal ligation Pelvic inflammatory diseses Abdominal skin inflammation 2 times of T37.5 in 24hrs Can not tolerate surgery due to systematic diseases Sever neurosisPreparation - tubal ligation Time choice- 37 days after menstruation; during abortion, delivery or cesarean section Good explanation History, physical examination, blood and urine laboratory examination Gynecological abdominal surgery preparation Anesthesia - tubal ligation local infiltration anesthesia Intravenous anesthesia Epidural anesthesia Endotracheal intubation anesthesia Steps - tubal ligation Emptying the bladderdisinfection of Surgical field Incition Extract tube Extinguish tube Ligate tube-Uchida method Check, close abdomen Complication - tubal ligation Bleeding or hematoma Infection Organ damage Sterilization failure Section 3 Remedial measures for contraception failureInduced abortionInduced abortionearlymid-pregnancymedical abortionartificial abortionVacuum suctionCurettageVacuum suction Indication-pregnancies of 10 weeks, duration or less -With Voluntary requirements without contraindiction - Can not continue the pregnancy duo to disease Contraindiction-emergency stage of all diseases -Inflammation of genital tract - 2 times of T37.5 before operation - Poor healthy situationSteps- Vacuum suction Preparation Detect uterine cavity Dilate cervix Vacuum suction Check Steps- Vacuum suctionCurettage 1014 pregnancy gestation Sufficiently dilate cervix Gradually displaced by medical abortion Complication- artificial abortion Uterine perforation Integrated response to abortion Incomplete suction Failure suction Bleeding Inflammation Embolism Laceration of cervix Adhesion, pelvic infection, abnormal menstruation, endometriosis, infertility medical abortion Pharmacology of mifepristone & Misoprostol Gestation7 weeks, 1840 years old Uterine with scar, many times of artificial abortion, severe pelvic malformation Fear of artificial abortion Mild side effects, bleeding Emergency contraception Drugs IUDSection 4Choice of the methods of family planningHow to choose Newlyweds Family with one child Family with two or more children Lactation Perimenopausal period