Family Planning
د. نجمه محمودكلية الطبجامعة بغدادفرع النسائية والتوليدBarrier Methods of contraception
# Male condom:- It is one of the most popular method of contraception ,cheap, widely available, free of side effect except for allergic reaction, they made of latex rubber ,it protect against STD, most condoms lubricated with spermicidal cream or jelly. # Female condom:- made of plastic & thus less likely to burst , protect against infection, are expensive.Female condom
# Vaginal diaphragm & CX cup:-They all use with spermicidal cream or gel, diaphragm are inserted prior to intercourse & should be removed no earlier than six hours later . Female barrier offer protection against ascending infection but can increase risk of UTI & VX irritation
Natural family planning
This involve avoidance of intercourse during the fertile period of the cycle, fertile period is calculated by various techniques such as 1) changes in basal body temp. 2) Changes in CX mucous. 3) Changes in cx. 4) Multiple indices.,persona kits Lactational amenorrhea method(LAM) for this method to be effective contraception, the mother should be fully breast feeder & be amenorrhiec&the age of her child less than 6m.Coitus interruptus
This is a widely practised & does not require any medical supervision , this involve removal of penis from the vx immediately before ejaculation take place , it is not reliable as pre- ejaculatory secretion may contain million of sperms thus emergency contraception should be available.Emergency contraception
Defined as any drug or device used after intercourse to prevent pregnancy ,EC should be considered if unprotcted intercourse has occurred, if there has been failure of a barrier methode e.g aburst condom or if COCP has been forgotten . Types of EC:- 1) hormonal EC:- A combination of 100mg of ethinyle estradiol & 500 mg of levonorgestrel is taken twice , the two doses being 12 h apart & started within 72h of unprotected intercourse.
mechanism of action is believed to be prevention Of implantation due to endometrial shedding, SE N & V ,failure rate is 20 – 25 %.2) IUD for EC:-A Cu bearing IUD can be inserted for EC ,it is effective for 5 days following the anticipated day of ovulation, the IUD prevents implantation & the Cu ions exert an embryo toxic effect
Sterilization:- this is permanent method of contraception, they are chosen by older individuals who are sure that they completed their family &should take a consent from pt. Female sterilization:- this involve the a) mechanical blockage of both fallopian tubes to prevent sperms reaching & fertilizing the oocyte.
b) Hysterectomy c) Bilateral salpingectomy Female sterilization can be done :by 1) laparoscopically 2) minilaparatomy 3) colpotomy through posterior vx fornix
Techniques of female sterilization:- 1) Ligation 2) Electrocautery\ diathermy 3) Falope ring 4) Clips 5) Laser
Female sterilization
Complications of female sterilization:- 1) Anasthetic complications 2)Damage to intraabdominal organs 3) Ectopic pregnancy 4) wound infection 5) Menstrual disorder 6) failureVasectomy:- this involve division of vas deferenson each side to prevent release of sperms during ejaculation, it is technically an easier ,quicker & performed under local anesthesia, vasectomy is not effective immediately so men should do SFA 12 wk &then 16 wk to check presence of sperm
If 2 consecutive samples are free of sperms then the vasectomy can be considered complete & alternative method of contraception must be used until that time. Techniques for vasectomy:- 1) Ligation or clips 2) Unipolar diathermy 3) Excision
4) Non scalpel vasectomy 5) Silicone plugs,sclerosing agents. Complications of vasectomy:- 1) wound infection 2) Heamatoma 3) Sperm granuloma 4) Antisperm AB 5) Some suggest a linkage between vasectomy & testicular & prostatic tumor