1、Family planningSummarylFamily planning enables sexually active couples to prepare for their pregnancies,in order to optimize both fetal and maternal outcomes.lFertility control?Avoid unwilling pregnancylUnplanned pregnancies constitute major public health problems.Three categories of family planning
2、Three categories of family planning排排 卵卵受受 精精着着 床床卵泡发育卵泡发育InterceptionContraceptionAbortionChapter 1 ContraceptionMethods of contraceptionlIntrauterine device,IUDlHormonal contraceptionlOther contraceptive methodsIUDlConvenience,cost effectiveness and reversibilitylFor women who are in stable,mutual
3、ly monogamous relationships at low risk for sexually transmitted infections(STIs)lMost commonly used in China80%History of IUDlUsed in animals at firstl1909,the first human IUD,designed by a German doctor named Richard Richter,was made of silklAseptic techniquemodern IUDAncient IUDsCategories of mod
4、ern IUDslIUDs wound with copper wirelDifferent shapeslDifferent surface areas of copperlThe levonorgestrel-releasing intrauterine system(LNG-IUS,Mirena)左炔诺酮缓释系统，曼月乐lRelease levonorgestrel 20ug/dlSuitable for women with heavy menses or dysmenorrhealModern IUDsTCu-380TCu375 母体乐母体乐Mechanisms of contrac
5、eptionMechanisms of contraceptive action of IUDslKill the sperm or fertilized ovum bylMobilization of leukocytes in response to the presence of the foreign bodylLeukocytes may produce an environment hostile to the fertilized ovumlSpermicidal activity with copper deviceslPrevent implantation bylDisru
6、ption of endometrial maturation with the progesterone-releasing devicelAlteration of normal tubal actionlDisruption of normal oocyte maturationIndications to the use of IUDslWomen of childbearing age with no contraindication who accept IUDlUterine cavities sound to 6cm-9cmlParous women in a mutually
7、 monogamous relationship who do not have a current or prior history of STDs or salpingitislWomen desiring a method of high efficacy that is free of daily or coitally related activitylCurrent pregnancylAcute cervical,uterine,or salpingeal infectionlSuspected gynecologic malignancylPolymenorrhea(月经频发)
8、,hypermenorrhea(月经过多),or undiagnosed abnormal vaginal bleedinglSevere cervical relaxation,laceration or stenosis,or severe uterine prolapselCongenital anomalies of the genital organslUterine cavities sound to 9cmContraindications of IUDsContraindications of IUDslSevere acute or chronic general disea
9、seslHistory of STDslPelvic tuberculosislHigh risk of infection or bleeding after induced abortion or deliverylCopper allergic history lPrior ectopic pregnancylMultiple sexual partnersTime of IUD insertionl3-7 days after menstrual bleeding stops,without sexual intercourse l42 days after vaginal deliv
10、ery when perineal wound heal well and the uterus involute to normal sizel6 months after c-sectionlMirena should be inserted on the third day of menstrual bleedingInsertion of the round IUDInsertion of the uterine-shaped IUDInsertion of the LNG-IUDComplications of IUD insertionlModerate discomfort or
11、 pain when the uterus is sounded or when the IUD is insertedlBleedinglInfectionlPartial or complete perforation of the uteruslSyncopal reactionslUterine crampsFollow-up of IUD by ultrasoundFollow up the IUD 3 months,6 months,12 months after insertion and every year afterwardsIndications to the IUD r
12、emovallExpiry of the availability of an IUDlMenopause for 6 months or menstrual disorder during perimenopausal periodlNo more need for contraceptionlAsking for other contraceptive methods or sterilizationlSevere side effects or complicationslPregnancylAcute genital or pelvic infectionlPoor systemic
13、conditions or acute stage of general diseasesTime of IUD removal:l3-7 days after menstrual bleeding stops lAny time when there is severe vaginal bleedingContraindications to the IUD removalIUD removalSide effects of IUDslMenstrual disorders or abnormal vaginal bleedinglLower abdominal or lumbosacral
14、 pain（腰骶部疼痛）lIncreased vaginal secretionsComplications of IUDslPregnancylExpulsion（移位）lPelvic infectionHealth benefits of IUDslThe LNG-IUS（曼月乐）results in a 70%to 90%reduction in menstrual blood losslThe LNG-IUS can release dysmenorrhealHormonal contraceptionlInvented by an American doctor named Greg
15、ory Goodwin Pincus in 1954lCategories:lOral hormonal contraceptives(OCs)lHormonal contraception by injection,implantation or transdermal routesMechanisms of contraceptive actionlSuppression of the LH surge prevent ovulation lThickening of the cervical mucus prevent sperm penetrationlAlter motility o
16、f the muscle of the uterus and oviducts Slowing of tubal transportlAtrophy of the endometrium prevent implantationlSevere cardiovascular diseaseslAcute or chronic hepatitis or nephritislThrombotic diseaseslEndocrine disorderslMalignant tumor,precancerous lesion,mass of uterus or breastlLactation per
17、iod（哺乳期）lOligomenorrhoea(月经稀少)or age 45lUndiagnosed abnormal vaginal bleedinglMental disordersContraindications of OCsUsage of OCslSynthetic steroids similar to the estrogen and progestinlCommonly used drugs:lMarvelon(妈富隆)=炔雌醇30g+去氧孕烯0.15mglYasmin(优思明)=炔雌醇30g+屈螺酮3.0mglDiane-35(达英-35)=炔雌醇35g+醋酸环丙孕酮2m
18、glCombined regimen(21 tablets)is begunlwith the onset of the menstrual cyclelstop for 1 week and then start the next cycleAdvantages of OCslOvarian and endometrial cancer lMenorrhagia(月经过多)and dysmenorrhea(痛经)lPID,endometriosis,benign breast changes,and ectopic pregnancy lIron-deficiency anemia and
19、acne lImprovements in hirsutism(多毛症)and symptomatic endometriosisDisadvantages of OCslThe risk of thromboembolic diseaselPulmonary embolismlCerebral thrombosislGreater risk of developing coronary thrombosislconfined to older users who smoke one or more packs of cigarettes per dayDisadvantages of OCs
20、lBreast cancer?No risk or unclear lCervical intraepithelial neoplasia slightly higher risklOther infrequent problemslHypertensionlCholelithiasis(胆石症)lBenign liver tumorsSide effects of OCslBreakthrough spotting and bleeding resolve after 1 to 3 months of uselMissed menstrual periods or amenorrhealNa
21、usealHeadacheslWeight gainOther contraceptive methodslMale condomlFemale condomlNatural family planning,NFPlVaginal spermicidesMale condomlDefinition:lThe latex rubber or animal intestine condom serves as a cover for the penis during coitus and prevents the deposition of semen in the vagina.Male con
22、domlFailure rates:2%-15%in the first year of uselUsed in conjunction with contraceptive vaginal jelly or foam can reduce the chances for condom failure due to mechanical or technical deficienciesAdvantages of condomlProvides highly effective and inexpensive contraceptionlProvides protection against
23、sexually transmitted diseases(STDs)lSome condoms contain a spermicide,which may offer further protection against failureFemale condom(vaginal pouch)阴道隔膜阴道隔膜宫颈帽宫颈帽Natural family planning methodlWomen are fertile for only a few days of the menstrual cyclelThe fertile period is from the time of ovulati
24、on to 2-3 days thereafterlCouples avoid intercourse during the at-risk days,or use another method(usually condom)during the womans fertile days.Natural family planning methodlA variety of methods are used to calculate a womans fertile days each cycle.lCalendar methodlBasal body temperaturelCervical
25、mucus changeslFertility monitorsNatural family planning methodlNot reliable and safe enoughlNot recommended!Postcoital or emergency contraceptionlTwo hormonal products are available for EC:lHigh-dose levonorgestrellHighdose combined estrogen/progestin pillslStarting as soon as possible after exposur
26、elRecommended to be started within the first 72 hourslMorning after IUD(Copper)insertion within 120 hours Chapter 2 SterilizationFemale SterilizationlAchieve sterilization by occluding the uterine tubeslA permanent method of contraceptionlRequiring an intraperitoneal(腹膜内的)incision and general anesth
27、esialLigation of the oviducts is usually performedlthrough a colpotomy incisionlthrough an abdominal incisionlby laparoscopyComplications of female sterilizationlIntraperitoneal hematocele or hematomalInfectionlInjury of ureter,bladder or rectumlPostbilateral tubal ligation syndrome:lPainlMenstrual
28、disturbances(prospective controlled studies show no statistical significant difference)lFailure of sterilizationlEctopic pregnancyTechniquelUchida method of sterilizationlPomeroy type of tubal ligationlChoose the technique most comfortable for the physicianChapter 3 Induced abortionDefinitionslAbort
29、ion is the interruption(spontaneous or induced)of an established pregnancy before 20 weeks gestational agelMiscarriage is used by the lay public to describe the spontaneous lossl“Elective”or“therapeutic”abortion are terms used to describe induced pregnancy termination.Induced abortionlDefinition:lde
30、liberate termination of pregnancy in a manner that ensures that the embryo or fetus will not survivelMethods(for the first trimester):lSuction curettagelDilatation and evacuationlMedical abortionSuction curettagelSafest and most effective method to terminate pregnancies of 10 weeks duration or lessl
31、Advantages:lEmpties the uterus more rapidly,minimizes blood losslReduces the likelihood of perforation of the uterusSuction method for induced abortionComplicationslInfection 1%lExcessive bleeding 2%lUterine perforation 1%lSyncopal reactionslRetained tissuelLeakage sucklMajor complicaitons 0.2%0.6%l
32、persistent feverlhemorrhage requiring transfusionlunintended major surgeryUterine perforationDilatation and evacuationlFor inducing midtrimester abortion(pregnancies of 10-14 weeks duration)lA modification of suction curettagelSerial placement of cervical dilatation sticks is used to effectly dilata
33、te cervical canal with less likelihood of injurylLarger suction cannulas and specially designed forceps are used to extract tissueComplicationslHemorrhage(usually due to atony or laceration)lPerforation lInfection lRetained tissuelAmniotic fluid embolismLate complicationslUterine cavity or cervical
34、adhesionlChronic pelvic inflammatory diseaselMenstrual disorderslSecondary infertilityMifepristonelEffects first-trimester abortion 49 dayslA synthetic drug developed by French pharmacologists,which acts at least partially as an antiprogestational agent.lGiven orally in conjunction with a prostaglan
35、din such as misoprostolComplicationslFailure to terminate a pregnancylIncomplete abortionlSignificant uterine crampingFollow-up of patients after induced abortionlTake temperature several times daily and report fever or unusual bleeding at oncelAvoid intercourse or the use of tampons for at least 2
36、weekslDiscuss the possibility of emotional depressionFollow-up of patients after induced abortionlPelvic examination to rule out endo-and parametritis,salpingitis,failure of involution,or continued uterine growthlEffective contraception should be made available according to the patients needs and de
37、siresChapter 4 Family planning methods choiceFamily planning methods choicelFor newly wedded couplelSuggested:OCs，male condom,female condom or spermicidal jellylNot suggested:IUDlFor couple with one child:IUD,male condom,OCs,Norplant and spermicidal jellylFor couple with two or more children:operation for sterilization of women or menFamily planning methods choicelFor women during breastfeedinglSuggested:IUD or condomlNot suggested:OCslFor women in climacteric:any methods except hormonal contraceptives
