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PSM MBBS > Demography, family planning > Flashcards

Demography, family planning Flashcards

1
Q

Annual growth rate

Malthusian model

A

AGR=(crude birth rate-crude death rate)/10

0.5-1% is moderately growing
India 1.2%
1% ➡️ doubling time 70 years
Malthusian model

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2
Q

Dependency ratio

A

(No of dependent population)/(No of independent population)*100

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3
Q

Demographic trap

A

Demographic trap is difficulty to decline the birth rate because of decline rate (and increase in birth rate)
It is seen in stage II

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4
Q

Sex ratio

Female deficit syndrome

A

Sex ratio =(no of females)/1000 males
Female deficit syndrome:
Decrease in no of female population
It leads to ecological imbalance

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5
Q

Effective literacy rate

A

(People who can read and write age >7 yr)/(total population of age >7 yr)*100

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6
Q

General fertility rate

A

Live birth/WRA*1000

Women in reproductive age group

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7
Q

Total fertility rate

A

(No of live birth ASFR)/WRA*1000
Women is reproductive age group
Assuming age specific fertility pattern

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8
Q

Age specific fertility rate

A

(No of children in a specific age group)/(total no female in that age group)*1000

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9
Q

Gross reproduction rate

A

(Total no of daughters ASFR)/ WRA * 1000

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10
Q

Net reproduction rate

A

(No of daughters ASFR and ASMR) / WRA * 1000
The most refined/sensitive/best epidemiological indicator
Best indicator for growth of population
Best indicator for family planning implementation services

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11
Q

Crude birth/death rate

A

(No of births or deaths in an area in a year)/ mid year population of same year *1000

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12
Q

Child women ratio

A

(No of children of 0-4 years)/WRA * 1000

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13
Q

Survey systems

A
  1. Civil registration systems
  2. Sample registration system
  3. National family health survey
  4. District level household survey
  5. Census
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14
Q

Planned family

A
  1. 1st child is after 20 years of the mother’s age
  2. Minimum of 3 years between 2 children
  3. Limited size of collagen (2 or 3)
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15
Q

Requirements of stable population

A
  1. CPR of 60%
  2. TFR of 2.1
  3. NRR of 1
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16
Q

Male condoms

A

Latex
Failure rate: 2 or 3 to 40 HWY (hundred women years)
M/C side of failure: incorrect usage

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17
Q

Female condoms

A

Polyurethane
Prelubricated with silicone
Failure rate: 4 or 5 to 20 HWY
Less effective in preventing pregnancies and STDs compared to male condoms

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18
Q

Diaphragm

A

Dutch cap
Not recommended under the National family planning program
Used before intercourse and left for 6 hours post coital ➡️ chance of toxic shock syndrome
Failure rate: 6-12 HWY

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19
Q

IUDs

A 
1. 1st generation:
 Lippes loop, Graffenberg’s ring
2. 2nd generation:
 CuT-220, CuT-380, CuT-380
 Nova T 
 Multiload device-
  •CuT 375
  •CuT 250
3. 3rd generation: hormonal
 LNG-20, Progestasert
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20
Q

3rd generation IUDs

A 
1. Mirena (LNG-20) 
 For 7-10 years
 Levonorgestrel 
 20 mcg progesterone/day
 Lowest failure rate
2. Progestasert:
 For 1 year
 Natural progesterone
 Loading dose 38 mg ➡️ 65 mcg/day
 Lowest expulsion rate
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21
Q

Second generation IUD

A
  1. CuT-220, CuT-380- used nowadays
  2. CuT-380 applicable for 10 years
  3. Nova T ➡️ for 5 years
  4. Multiload device-
    •CuT 375
    •CuT 250 for 3-5 years
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22
Q

Mechanism of action of IUD

A

Inhibits fertilization
Highly effective: 0.5-1.5 failure rate
1. Askers biochemical environment of cervical mucus
2. Thickens cervical mucus
3. Foreign body reaction ➡️ implantation 🔽

23
Q

Absolute contraindications of IUD

A
  1. 🤰
  2. Undiagnosed vagina bleeding
  3. PID
  4. Cervical cancer
  5. Carcinoma of genital tract
  6. Previous ectopic pregnancies
24
Q

Relative contraindications of IUD

A
  1. Previous history of PID
  2. Congenital malformations
  3. Cervical discharge
  4. Anemia
  5. Menorrhagia
  6. Unmotivated females
25
Q

Adverse effects of IUD

A
  1. Pain
  2. Bleeding
  3. PID
  4. Ectopic pregnancy
  5. Perforation
  6. Expulsion
  7. 🤰 with IUD in situ ➡️ abortion, if not:
    • thread visible ➡️ pull out
    • thread not visible ➡️ sepsis ➡️ evacuate the uterus
26
Q

Chemical classification of hormonal contraceptives

A 
1. Pregnane:
 Medroxy progesterone acetate
 Megestrol
2. Estrane:
 Norethisterone
 Lynestrenol
 Ethynodiol diacetate
3. Gonane: levonorgestrel
27
Q

Physical classification of hormonal contraceptives

A 
1. Oral pills:
 Combined oral
 Progesterone only
 Post coital
 Long acting
 Male 💊 
2. Depot formulations:
 Injectable
 Implants
28
Q

Combined oral pills

Examples and composition

A 
Mala N:
 National program (free)  
 21 tablets
Mala D:
 social marketing scheme
 21 + 7 (ferrous fumarate 60 mg)
21 ➡️ levonorgestrel 0.15 mg and ethinyl estradiol 0.03 mg
29
Q

Combined oral pills

Mechanism and effectiveness

A 
Mechanism:
1. Disrupts hypothalamus-pituitary axis 
2. Stoppage of OCP after 21 days leads to withdrawal bleed (less amount of bleeding) ➡️ less chance of anemia
Effectiveness:
 More effective than IUD
30
Q

Adverse effects of OCPs

A 
1. Metabolic:
 Obesity, hypertension, dyslipidemia
2. Cardiovascular:
 Atherosclerosis
3. Carcinogenic:
 Cervical, breast, HCC
4. Liver diseases, slight inhibition of lactation
5. Ectopic 🤰 in progesterone only pills
31
Q

Benefits of OCPs

A
  1. Regulation of menstrual cycles
  2. Contraceptive benefits
  3. 🔽 benign breast disease, fibroadenoma
  4. 🔽 Ca ovary, endometrium, ovarian cyst
  5. 🔽 PIDs
  6. 🔽 iron deficiency anemia
32
Q

Absolute contraindications of OCPs

A
  1. Ca breast, genital cancers
  2. 🤰
  3. Severe liver disease
  4. Thromboembolism, DVT
  5. Cardiac abnormalities
  6. Congenital hyperlipidemia
  7. Undiagnosed vaginal bleed
33
Q

Relative contraindications to OCPs

A
  1. Age >40
  2. Smoker 🚬 , age >35
  3. Diabetes mellitus, gall stone
  4. Epilepsy migraine
34
Q

Progesterone only injectables

A 
1. DMPA Depot medroxy progesterone acetate:
 150 mg IM, 3 monthly, >35 year old
2. NET-EN norethisterone enatiate:
 200 mg, 2 monthly
3. Depo Sub Q Provera 104:
 DMPA sc.
4. Antara program:
 MPA 150 mg IM, 3 monthly
35
Q

Combines injectables

A
  1. Cyclo provera
  2. Cyclofem
  3. Mesigyna
36
Q

Contraindications of progesterone only injectables

A
  1. Undiagnosed vaginal bleeding
  2. Genital malignancy of Ca cervix
  3. 🤰
37
Q

Implants

A

Subdermal
Commonly used in India is Norplant
Made of silastic capsules
R2: 2 rods containing 35 mg LNG

38
Q

Post coital/emergency contraception

A 
1. IUDs
 Best and most effective
 Within 5 days
2. LNG
 1.5 mg single dose within 72 hours
3. Mifepristone (RU-486)
 10 mg within 72 hours
39
Q

Gossypol

A

Male contraceptive
Inhibition of spermatogenesis
Natural product - Chinese plant (cotton seed)
S/E: azoospermia

40
Q

Centchroman

Brand name: Chhaya

A

Non-hormonal contraceptive
Mechanism:
Selective Estrogen Receptor Modulator SERM
It has 30mg of methoxychroman hydrochloride
Chemical responsible: ormeloxifene
Can be used against dysfunctional uterine bleeding

41
Q

Centchroman

dose

A

Twice weekly for 3 months, followed by once weekly till required
If a female misses a dose in more than 2 days, alternate contraception is used, followed by normal schedule

42
Q

Centchroman contraindications

A
  1. PCOD
  2. Lactation
  3. Hepatic disease
  4. Cervical hyperplasia
  5. Hypersensitivity
43
Q

Natural method of contraception

A
  1. Coitus interruptus
  2. Calendar 📆 /rhythm method
    • cycle of beads
    • persona: a digital device
    Check hormonal levels in the morning urine
  3. Abstinence
  4. Basal body temperature
  5. Cervical mucus thickening (Billing method)
44
Q

Tubectomy

A

Can be done as a mini laparoscopic procedure
Incision size: 2.5-3 cm
Done under local anesthesia
Can be done in mass sterilization camps/PHC/ village level

45
Q

Vasectomy

A 
Most common type: 
 Non-scalpel vasectomy
No hematoma
🔽 passion
🔼 user friendly
NSV on India is funded by UNFPA (United Nations Fund for Population Activities)
46
Q

Complications of non-scalpel vasectomy

A 
1. Operative complications:
 Pain, local infection
2. Hematoma
3. Sperm granules:
 Appears 10-14 days past operation
 Reasoned spontaneously
4. Spontaneous recanalisation (0-6% chance)
5. Auto immune response: not harmful
 55% antigen antibodies
47
Q

Vasectomy

failure

A

Failure rate: 0.15 HWY
M/C reasons:
• Operative
• Non-compliance to post operative advice
People who have undergone vasectomy should use alternate contraception for a period of 8-9 weeks or 30 ejaculations

48
Q

ESSURE

A

Permanent method of contraception
A micro filament stent, micro essure is inserted into Fallopian tube
Technique is called Essure technique
Process: a tubal blockage is created
After 6 weeks, hysterosalpingography is done to confirm sterilization

49
Q

Reasons for MTP

A 
S. Social: unmarried, poor
H. Humanitarian: rape victim
E. Eugenic: genetic
F. Failure of contraception
T. Therapeutic: maternal
50
Q

Who can perform MTP

Where can it be performed

A

Any MBBS doctor who is a registered medical practitioner and has:
• at least 6 months residency in obg
• at least 25 cases of MTP under supervision
• a degree/diploma in og
Any healthcare centre with facility to do emergency laparotomy or major gynecology surgeries

51
Q

How to perform MTP

When

A

<6 weeks:
Ideal MTP
Misoprostol + mifepristone
>6 weeks:
Medical or surgical methods based on doctors opinion
It is usually done within 12 weeks of gestation
>12 weeks to <20 weeks MTP is done only after consultation with 2 doctors
Consent is required

52
Q

Failure rate of contraception measures

A

Life table analysis:
Observe the females in reproductive age group to analyze any accidental pregnancies
Pearls index:
=(no of accidental pregnancies) / (total no of women years exposure) *100

53
Q

Contraception of choice

A
  1. Unmarried sexual active 👱🏽‍♀️: barrier method > OCP
  2. Married nulliparous 👱🏽‍♀️ who wants to delay 👶: OCP
  3. Married 👱🏽‍♀️, mother of one, wants to delay 2nd 👶: IUD
  4. ‘3.’ but she is obese, has DM, dose not prefer IUD:
    • educated - Chaaya
    • uneducated - Antara
  5. Married👱🏽‍♀️ with 3 children, wants to delay 4th child:
    Tubectomy > cheaper vasectomy

PSM MBBS (5 decks)

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