1、计划生育,Contraception &Family Planning,意 义 控制人口数量 提高人口质量,受孕必备条件 正常精子 输卵管壶腹部 受精卵着床 成熟卵子 （孕卵） 通畅的生殖管腔 子宫内膜同步改变,避孕 激素避孕hormonal contraceptives ：口服短效、长效、长效避孕针、缓释系统,非激素避孕：non- hormonal contraceptives宫内节育器、外用避孕药具、自然避孕法、免疫避孕、黄体生成激素释放激素类似物避孕。 紧急避孕 Emergency contraceptives,第一节 激素避孕 hormonal contraceptives,一、激素避
2、孕机制 1. 抑制排卵 Prevent ovulation by inhibiting gonadotropin secretion. 抑制下丘脑的促性腺激素释放激素 因而使垂体的促卵泡素和促黄体素分泌受抑制而不发生排卵。,2. 对生殖器官的直接作用 （1）改变宫颈粘液性状： The progestin component thicken the cervical mucus, retarding sperm penetration 宫颈粘液变粘稠量减少、不利于精子穿透。,（2）改变子宫内膜形态与功能：The endometrium changes both in function and i
3、n morphology.Its not suitable for the fertilized egg to imbed. 避孕药中孕激素干扰了雌激素效应，子宫内膜增殖受抑制；腺体及间质提早发生类分泌期变化，不适于孕卵着床。,（3）改变输卵管的功能 Change the function of the tube,二、激素避孕远期安全性 1. 长期服用甾体激素避孕药与生殖器肿瘤 2. 长期服用甾体激素避孕药与日后生育 3. 长期服用甾体激素避孕药与子代发育 4. 长期服用甾体激素避孕药与人体三大代谢,三、 Indication and contraindications of OC,Indic
4、ations: Any reproductive-aged woman,Contraindications,Patients with severe diseases of important organs, such as hepatitis,cardiovascular disease. Patients with endocrine disease or blood disease (thromboembolic disease). Patients with malignant tumor,uterine disease,Patients older than 45 years or
5、with hypomenorrhea. Smoking and older than 35 years. May cause premature ovarian failure, myocardial infarction Lactating woman less than half year after delivery.,四、OC Side Effects and management Nausea Breast tenderness Menstrual changes Weight gain Headache,五、激素避孕临床应用种类 类型：复方短效口服 复方长效口服 复方或单方长效针剂
6、 缓释系统 透皮贴剂,NEW METHODS “The Patch”,第二节 非激素避孕 non- hormonal contraceptives,一、宫内节育器（IUD） 避孕机制-杀精毒胚、干扰着床 非细菌性炎性反应、前列腺素作用、溶黄体作用、纤溶作用、免疫作用、铜离子作用、孕酮的作用（多环节抗生育作用） How IUDs act to prevent conception is not known. The most widely observed phenomenon is mobilization of leukocytes in response to the presence o
7、f the foreign body,classification,Copper IUDs Medicine-releasing IUDs,副作用：出血、腰酸腹胀 并发症：子宫穿孔、节育器异位、节育器 嵌顿、感染,二、外用避孕药具 barrier Contraceptives Condoms Male latex, polyurethane, animal skin Female polyurethane Diaphragms Cervical cap Spermicides,Male condom,The Female Condom,The Diaphragm,The Cervical Ca
8、p,Spermicides,三、自然避孕法 四、免疫避孕法 五、黄体生成激素释放激素类似 物避孕,第三节 紧急避孕Postcoital/emergency contraception (EC) （一）避孕机制 阻止或延迟排卵 干扰受精或阻止着床,（二）方法 1、紧急避孕药 甾体激素类和非甾体激素类。 一般应在无保护性生活后3日内口服紧急避孕药。 Drugs:Taking hormonal/non-hormonal contraceptives within 3 days after unprotected sexual intercourse.,2、紧急安放带铜宫内节育器 一般应在无保护性生活
9、后5日内放入带铜宫内节育器。 IUDs: IUD insertion within 5 days after unprotected sexual intercourse.,第四节 输卵管绝育术 Tubal sterilization 方法：结扎切断、电凝、钳夹、环套、 药物粘堵输卵管管腔。,途径：可经腹、经腹腔镜或经阴道 术后并发症：腹腔内积血或血肿、感染、脏器损伤、绝育失败,第五节 人工流产INDUCED ABORTION 定义：避孕失败的补救措施，采用人工或药物方法终止妊娠。 Induced abortion is the deliberate termination of pregna
10、ncy in a manner that ensures that the embryo or fetus will not survive.,Surgical abortion,Medical abortion,方法及对象 1） medical abortion：adopted to 7 weeks gestation RU-486(mifepristone) given orally in conjunction with a prostaglandin, Comlplications include failure to terminate a pregnancy, incomplete
11、 abortion.,2）负压吸宫术Vacuum aspiration ：Early abortion adopted to 6 to 10 weeks gestation. 3）钳刮术Embryulcia ：To terminate pregnancy 1114 weeks of gestation. 4）中期引产Induction of Labor by Intra -amniotic instillation (for initiating mid-trimester abortion) 5）剖宫取胎术ceaserian：引产禁忌或同时要绝育。,并 发 症 Complications a
12、nd managements of artificial abortion 子宫穿孔 人工流产综合反应 吸宫不全 近期并发症： 漏吸 术中出血 术后感染 栓塞 宫颈裂伤,Artificial abortion syndrome,Symptoms-bradycardia,arrhythmia,drop in BP,heavy sweat,et al. Prevention and management-injecting atropine0.51mg preoperation.Use the appropriate vacuum pressure and operate tenderly dur
13、ing operation.,Incomplete abortion,Part of placenta and/or fetus can be remained in the uterine cavity ,mainly due to the unskilled operator.Symptoms-vaginal bleeding for more than 10days. Management-if there is no infection,scraping the uterine cavity ASAP;if there is infection,using antibiotics th
14、en scraping.,infection,Symptoms-acute endometritis,pelvic inflammation. Management-using prophylactic antibiotics,Uterine perforation,One of severest complications of artificial abortion.It can be caused by the probe,sucker, cervical dilator or forceps. Managements-once it occurs,operation should be
15、 stopped at once.Antibiotics/oxytocin should be used and the patient should be hospitalized and be at closed observation.If we are not sure whether there are internal injuries,laparotomy should be performed.,Intrauterine adhesion,Mainly occurs at the cervix. Managements-Dilating the cervix using a p
16、robe or dilator and dissolute the adhesion.After the dissolution,insert an IUD into the uterine cavity.,Sucking nothing,Its mainly because of the incorrectly examination of uterine position or ectopic pregnancy,Bleeding,Mainly due to the late gestational age and the weak contraction of uterus. Managements-use oxytocin and take the placenta and fetus quickly.,Amniotic fluid embolism,Amniotic fluid enters into the veins.It rarely occurs.,第六节 计划生育措施的选择 1、新婚 2、已育一子女 3、已育两个或多个子女 4、哺乳期 5、围绝经期,重点内容 计划生育工作内容 避孕药物作用机理 人工流产定义、方法及对象 手术流产的并发症,
