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Family Planning Flashcards

1
Q

Goals of Family Planning

A

Goals of Family Planning
●Every pregnancy will be both
●Wanted
●Planned and prepared for
●If we achieve these goals, we will
●Reduce
●Number of abortions, maternal mortality and poor fetal outcome
●Number of HIV infected babies
●Population explosion
●Increase
●Maternal and infant health

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2
Q

Family planning pictures

A

Slides

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3
Q

Birth rate in china

A

Slides

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4
Q

Definition of Family planning

A

Family planning is “the ability of 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.“

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5
Q

Note

A

Family planning may involve consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which a person wishes to have them.
●Things that may play a role on family planning decisions (highly variable from person to person): marital situation, career or work considerations, financial situations.
●If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

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6
Q

Issues regarding choice

A

Issues regarding choice
●Age
●Efficacy required
●Ease of use
●Smoking status

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7
Q

First Visit
Topics to cover for each method

A

First Visit
Topics to cover for each method
●Efficacy
●Individual suitability
●Absolute contra-indications
●Side effects
●Adverse reactions
●Advantages other than contraception
●Mode of use
●Onset of action
●Follow-up arrangements
●Timing of return to fertility
●Protection against sexually transmitted disease

History
●Existing medical problems
●Regular medication
●Family history
●Menstrual history
●Obstetric history
●Previous contraceptive use

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8
Q

Methods of Contraception

A

Methods of Contraception
●Hormonal Contraception；
●Intrauterine contraceptive device (IUD)
●Emergency Contraception；
●Natural family planning；
●Male Contraception；

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9
Q

Hormonal methods

A

Hormonal methods
●Oral contraceptives
●Pills
●Depo-Provera
●Norplant
●Vaginal ring

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10
Q

HORMONAL CONTRACEPTION

A

HORMONAL CONTRACEPTION
●ORAL HORMONAL CONTRACEPTIVES
synthetic steroids
●Combined oestrogen/progestogen
●Progestogen only

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11
Q

HORMONAL CONTRACEPTION Mechanisms of Action

A

Mechanisms of Action
●Consistently inhibit the midcycle gonadotropin surge , prevent ovulation.
●Alter the cervical mucus
●Alter motility of the muscle of the uterus and oviducts
●Alter the endometrium
●Alter ovarian responsiveness to gonadotropin stimulation

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12
Q

Types of Frequently Used Contraceptives

A

Types of Frequently Used Contraceptives
●Short-term Contraceptives：Marvelon；
●Long-term Contraceptives：Oral Contraceptives，Contraceptive Injections ；
●Vacation Pills；
●Norplant;
●Slow-released Contraceptive Vaginal Ring (CVR)
●Micro-sphere and micro-cyst Contraceptive Injections ；
●Transdermal Patch；

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13
Q

Indications and Contraindications of Contraceptives

A

Indications and Contraindications of Contraceptives
●Indications ：
healthy women of reproductive age；

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14
Q

OC Contraindications

A

OC Contraindications
●Thrombophlebitis or thromboembolic disorders
●Past history of DVT or thromboembolic disorders
●Cerebral vascular disease or coronary artery disease
●Known or suspected carcinoma of the breast
●Carcinoma of the endometrium
●Undiagnosed abnormal genital bleeding
●Jaundice
●Hepatic adenomas or carcinomas
●Known or suspected pregnancy
●Smoker over age 35

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15
Q

What are the advantages of Oral Hormonal Contraceptives?

A

The pill has health benefits.
Both combination and progestin-only pills reduce menstrual cramps, lighten periods, and lower your risk of ectopic pregnancy. The combination pill can also help prevent or lessen: acne. bone thinning.

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16
Q

OC Noncontraceptive Benefits

A

OC Noncontraceptive Benefits
1. Reduced risk of ovarian and endometrial cancer
2. Menstrual benefits: reduction in menorrhagia and dysmenorrhea, iron-deficiency anemia, Regulates the menstrual cycle
3.Improvements in acne, hirsutism and symptomatic endometriosis.

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17
Q

OC Noncontraceptive Advantages

A

Advantages
●4.Relieves perimenopausal symptoms
●5.Treatment of dysfunctional uterine bleeding
●6. Protection against ectopic pregnancy
●7. Reduced incidence and severity of PID
●8. Maintenance of bone density

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18
Q

ORAL HORMONAL CONTRACEPTIVES

●Disadvantages And Side Effects

A

●Disadvantages And Side Effects
1. thromboembolic disease
including pulmonary embolism and cerebral thrombosis
venous thromboembolism,coronary thrombosis
2. change the lipid/lipoprotein profile in an adverse direction
3.hypertension, cholelithiasis, and benign liver tumors

●4.Intermenstrual bleeding including breakthrough bleeding and spotting 10%-20%
●5.amenorrhea: infrequent
●6.Nausea :10%
●7.headaches :less frequent
●8.weight gain

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19
Q

OC Health Risks-breast Cancer

A

OC Health Risks-breast Cancer
●No significant increased risk among current or former users
●Small increased risk of breast cancer diagnosis
●Link to earlier diagnosis of breast cancer

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20
Q

OC Health Risks-cervical Cancer

A

OC Health Risks-cervical Cancer
●Numerous studies have linked OC use and cervical neoplasia
●Findings are difficult to interpret

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21
Q

The Minipill
Or Progestin-Only Pill

A

●Formulation:
●Contains norethindrone or nogestrel
●28 days of active hormones

●Candidates:
●Women who cannot or will not take estrogen ：those having a documented hypersensitivity to estrogens
●Postpartum and lactating women
●pregnancy rate of about 2-7 per 100 woman years
●side effects
1.irregularity of the ovulatory cycle
2.ectopic pregnancies

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22
Q

Long-Acting Contraceptives

A

Long-Acting Contraceptives
Currently available:
●Injectable DMPA (Depo-Provera)
●Copper IUD (Paragard)
●Progestin IUD (Mirena )

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23
Q

INJECTABLE HORMONES

A

Slides

INJECTABLE HORMONES

progestin-only
DMPA (depo-Provera)
150mg every 90 days

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24
Q

DMPA Side Effects

A

DMPA Side Effects
●Menstrual changes
●Delayed return of fertility
●Alopecia
●Reduced libido
●Weight gain?
●Depression?

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DMPA Health Risks & Benefits
DMPA Health Risks & Benefits ●Loss of bone mineral density? ●Lowered HDL(high density lipoprotein) level ●Protection against endometrial cancer, no impact on risk of other types of cancer ●Reduces PMS （ premenstrual syndrome, iron-deficiency anemia, risks of PID （pelvic inflammatory disease,,ectopic pregnancy
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IMPLANTION
IMPLANTION ●Norplant ●2 sticks LNG[=levonorgestrel] 70mg /one ●progestin only ●Norplant an implantable contraceptive that releases levonorgestrel a system that contains 36 mg of levonorgestrel in each of 6 Silasticrods ●Efficacy is high first-year pregnancy rates are only 0.2% cumulative 5-year rates of 3.9%
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Implant Side Effects, Health Risks
Implant Side Effects, Health Risks ●Irregular bleeding ●Amenorrhea ●Headache ●Hair loss ●Weight gain ●Functional ovarian cysts
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Implant Benefits
Implant Benefits ●Improvement of dysmenorrhea ● Improvement of PMS
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Implants pictures
Slides
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vaginal ring
vaginal ring ●plastic device, measuring approximately 2 inches in diameter. ●releases 120 μg of the etonogestrel (the major metabolite of desogestrel and 15 μg of ethinyl estradiol daily
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Vagina ring picture
Slides
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NONHORMONAL CONTRACEPTION
NONHORMONAL CONTRACEPTION ●Coitus interruptus ●Barrier Contraceptives Male condom Female condom Diaphragms Cervical cap Spermicidal preparations/ Spermicides ●Natural family planning
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MALE CONDOM
MALE CONDOM ●A male condom is a thin sheath made of latex or other materials
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MALE CONDOM ●advantages
MALE CONDOM ●advantages 1. highly effective 2.inexpensive 3. protection against pregnancy & sexually transmitted diseases (STDs). ●Latex and polyurethane condoms also provide limited protection against HPV that can cause genital warts ●HSV that can cause genital herpes ●Hepatitis-B virus
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Female condoms
Female condoms ●Has two flexible rings ● ●The inner ring at the closed end of the condom eases insertion into the vagina, covering the cervix and holding the condom in place ● ●The outer ring , The larger, open ring stays outside the vagina, covering part of the perineum and labia during intercourse.
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Female condoms ●advantage
Female condoms ●advantage 1. being under the control of the female partner 2. offering some protection against STDs.
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The Diaphragm picture
Slides
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POSITIONS FOR INSERTION picture
Slides
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Insertion and Removal pictures
Slides
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The Cervical Cap Types
The Cervical Cap ●A cervical cap is a soft, deep rubber cup (like a thimble) with a firm, round rim that fits snugly over the cervix. TYPES Cavity rim cap Vimule cap Dumas cap
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Spermicides pictures
Slides
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Spermicides the form of Spermicides
Spermicides the form of Spermicides ●Creams ● Films ● Foams ● Jellies ●Sponges ●suppositories
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Spermicides
spermicides ●The majority of spermicides contain nonoxynol-9 ●when used alone, failure rate about 15% per year. ●not effective in preventing cervical gonorrhea chlamydia HIV infection
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NATURAL FAMILY PLANNING METHOD
NATURAL FAMILY PLANNING METHOD ●Also called periodic abstinence or fertility awareness or rhythm method ●requires that coitus be avoided during the time of the cycle when a fertilizable ovum and motile sperm could meet in the oviduct.
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NATURAL FAMILY PLANNING METHOD ●METHOD
METHOD ●1. Calendar (“rhythm”) method ●2. Basal body temperature (BBT) method ●3. Cervical mucus (ovulation or Billings) method
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Rhythm Method (“safe Period”)
Rhythm Method (“safe Period”) ●24 hours are allowed for ovum survival ●3 days are allowed for the sperms ●Coitus must be avoided from the 9th to the 16th day
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The Fertility Cycle
Slides
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Note
●there is a slight drop in temperature 24-36 hours after ovulation. The temperature then rises abruptly about 0.３ -0.4℃ (0.5-0.7°F) and remains at this plateau for the remainder of the cycle. the fertile period at least 2 days before ovulation to no less than 2 days after ovulation The third day after the onset of elevated temperature is considered to be the end of the fertile period
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The cervical mucus (Billings) method
The cervical mucus (Billings) method ●several days before and until just after ovulation, the mucus becomes thin and watery ●at other times the mucus is thick and opaque
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Intra Uterine Devices
Intra Uterine Devices ●Inert ●Copper bearing ●Progestogen releasing
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the Copper TCu380A (Paragard)
Slides
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a levonorgestrel-releasing system (Mirena) ● Mirena can be used for up to 5 years Pictures
Slides
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Complications Of Insertion of Intra Uterine Devices
Complications Of Insertion ●1.moderate discomfort or pain 2.syncopal reactions 3.Partial or complete perforation of the uterus (rare) 4. uttering cramps
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Disadvantages And Side Effects of Intra Uterine Devices
Disadvantages And Side Effects ●1. Pregnancy ●2. Expulsion rates : Copper T (Paragard) = 6% Progesterone-releasing IUDs = 3~8% ●3. Bleeding or Pain ●4. Pelvic Infection: pelvic inflammatory disease or salpingitis . higher risk : multiple sexual partners prior STDs
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Contraindications To The Use Of IUDs ●Absolute contraindications
Contraindications To The Use Of IUDs ●Absolute contraindications 1.current pregnancy 2. undiagnosed abnormal vaginal bleeding; 3. acute cervical, uterine, or salpingeal infection; 4. past salpingitis; 5. suspected gynecologic malignancy
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Relative contraindications
Relative contraindications ●1.nulliparity or high priority attached to future childbearing; 2. prior ectopic pregnancy; 3.history of STDs; multiple sexual partners; 4.moderate or severe dysmenorrheal; 5.congenital anomalies of the uterus or the abnormalities such as leiomyomas; 6. iron deficiency anemia (for the copper IUD); 7.valvular heart disease 8.frequent expulsions or problems with prior IUD use.
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Suitable Candidates For An IUD
Suitable Candidates For An IUD parous women in a mutually monogamous relationship who do not have a current or prior history of STDs or salpingitis
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POSTCOITAL OR EMERGENCY CONTRACEPTION
POSTCOITAL OR EMERGENCY CONTRACEPTION ●Is a therapy used to prevent unwanted pregnancy after unprotected intercourse or after a failure of a barrier method.
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methods
methods ●1.Yuzpe method It consists of two tablets, each containing ethinyl estradiol 0. 05 mg and 0. 5 mg norgestrel ingested 12 hours apart for a total of 4 tablets. initiated within 72 hours of intercourse the effectiveness is about 74% 2.Progestin-only post-coital contraception Levonorgestrel 3.IUD 120h 4.Contraceptive pill 72h 5.mifepristone
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Tubal Sterilization Operation ●Permanent Method ●Indications: •Contraindications • Methods • Pathways
Tubal Sterilization Operation ●Permanent Method ●Indications: 1. Volunteer to sterilization without contraindications； 2. Not suitable for pregnant women due to severe systemic disease； Contraindications： ● 1. Temperature >37.50C twice within 24 hrs; 2. Can not bear operation owe to poor healthy situation； 3. Severe neurosis； 4. Acute vaginitis and pelvic infectious diseases. ●Methods: Abscise ，Ligation，Electric coagulation，Ring clamp ●Pathway: Go through abdominal or by laparoscope;
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NEW METHODS: OrthoEvra “The Patch”
Slides
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Remedies for Failed Contraception —Induced Abortion
Remedies for Failed Contraception —Induced Abortion ●Indications: Volunteer to terminate pregnancy without contraindications； 1. <10w , Surgical abortion by vacuum aspiration； 2. 10-14 w ,Surgical abortion by dilatation and extraction； Contraindications ●1. Temperature >37.50C twice within 24 hrs; 2. Can not bear operation owe to poor healthy； 3. Severe neurosis ； 4. Acute vaginitis and pelvic infectious diseases.
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Medical abortion
Medical Abortion ●Mifepristone combined with Misoprostol； Optimal time： <49 days, from the 1st day of LMP[=last menstrual period] ； Contraindications： Disease of adrenal gland， Diabetes mellitus， Hematopathy， Thrombotic disease, Hypertension， Glaucoma ；
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FAMILY PLANNING METHODS CHOICE
FAMILY PLANNING METHODS CHOICE ●The choice for newly wedded couple is male condom, female condom or spermicidal jelly. The couple with one child or more children should get a long term planning for contraception. The first choice for them is IUD. The other methods include male condom, oral hormonal contraceptives, Norplant and spermicidal jelly. The women during breastfeeding: IUD or condom(slides) The women in climacteric could apply any methods for contraception except hormonal contraceptives. ●The condom is available for the people with STDs or HIV.
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Contents to Master for Family Planning
Contents to Master for Family Planning ●Mechanism of Oral contraceptives (OC). ● Advantages of Oral Hormonal Contraceptives ●Indications and contraindication of oral contraceptives ●Indications and Contraindications of Intrauterine device (IUD)；
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ASSIGNMENT
Slides

Family Health (7 decks)

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