Contraception & Sterelization
Prarl index:-
Is the number of unwanted pregnancies which occur in 100 women using that method of contraception for a year.
1-Methods not requiring medical consultation:-
a.Coitus interruptus.
b.Condom.
c.Safe period(rhythm or calendar method).
Fertile period:-
It’s beging by deduce 18 days from the shortest cycle & end of the fertile period by deduce 11 days from the longest cycle.
d.Spermicide such as Nonoxynol-9.
e.Vagi nal tampons.
2-Meh as lippethods requiring medical consultation:-
a.Vaginal diaphragm& cervical cap.
b.COC(cmbined oral contraception).
c.IUC D , 3 types:-
1.Ine device such as lippes loop.
2.Copper-containing device such as copper T&7&multiload.
3.Medi cated IUCD such as LNG-IUCD(levonorgestrel) 1995.
4.Recently tailess or threadless IUCD.
Contraindications:-
1.pregnancy.
2.multiple fibroids.
3.congenital uterine abnormality.
4.acute or subacute PID or active vaginal inflammation.
5.Ca. of the cervix or of the body of uterus.
6.abnormal uterine bleeding.
7.valvular heart disease.
8.allergy to copper .
Side effects of IUCD:-
1.Menstrual disturbances : increase menstrual bleeding & dysmenorrheal.15% discontinue IUCD.
2.Perforation: 1/1000, diagnose by u/s or x-ray.
3.Expultion: 1-7% ,first 3 months.
4.Ectopic pregnancy; IUCD decrease by 80%, LNG decrease by 90%.
5.Pelvic infection: first 20 days, Dalkon shield.
6.Pregnancy with IUCD in place: increase abortion 3x, preterm labour, intrauterine infection, APH.
Oral contraceptive pills:-
3 types:-
1.combined COC.
2.Progesterone-only pills(mini pills),POP.
3.Sequential pills.
1.Combined pills COC:-
High-dose pills ,100ug estrogen
Low-dose pills,20-50ug, usually 30-35ug.
Efficacy: failure rate 0.1.
Advantages of COC:-
1.Menstrual periods lighter, shorter, more regular,less painful& premenstrual symptoms less.
2.Decrease incidence of iron deficiency anemia.
3.Decrease incidence of benign breast lumps, decrease functional ovarian cysts, endometriosis, acne&PID.
4.Decrease ovarian Ca.& decrease endometrial Ca.
5 year ; decrease 50% risk of ovarian Ca.
Contraindications:-
A-absolute:-
1.Ischemic heart disease& most types of valvular disease.
2.Arterial & venous thrombosis.
3.Breasr Ca.
4.Hyperlipidemia.
5.Active liver disease, liver tumour.
6.Undiagnosed genital tract bleeding.
7.Migraine: focal, treatment with ergotamine.
8.Porphyria.
9.Pregnancy.
10.Past cerebral hemorrhage& current TIA.
B-relative:-
Smoking, age more than 35 years, obesity, H.T,D.M,Breast feeding, hyperprolactinemia.
Risks& side effects:-
A.minor S/E:-
1.Disturbances of menstrual cycle:-
Bleeding; slight or break through.
Anaemia.
2.weight gain, headache,nausea& vomiting.
B.serious S/E:-
1.CVS:-
Venous side:-increase venous thrombosis& pulmonary embolism.
On arterial side :-H.T, CVA, coronary heart disease(increase risk only in smokers).
2.C.H.O metabolism :-decrease carbohydrate tolerance.
3.Malgnancy:-small increase breast Ca.
Small increase Ca. cervix.
Liver:-increase benign hepatic adenoma(rare).
Progesterone-only contraception:-
Indications of POP:-
1.when estrogen contraindicated.
2.lactating women.
S/E:-
1.Irregular vaginal bleeding.
2.Increase functional ovarian cysts.
3.Headache, nausea ,mood changes, acne.
4.Long-term risks:- very small increase Ca. breast.
(depo-provera protect from endometrial Ca.).
Injectable progestogens:-
2 types:-
1.Depo-provera.
2.Norethisterone-enanthate.
S/E:-
1.Irregular vaginal bleeding.
2.Delayed fertility, 1 year.
3.Amenorrhea.
4.Decrease BMD(bone mineral density).
Progesterone-only implants:-
1.Norplant.
2.Implanon: etonorgestril, 1999.
Emergency contraceptipn:-
1.2 tablets of high- dose estrogen & progesterone pills.
2.Levonorgestril 0.75, 2 doses.
3.IUCD, upto 5 days.
Sterelization:-
1.Female sterization:-
Methods of tubal occlusion:-
1-Electrocautery.
2-ligation.
3-Rings.
4-Chemical agents; quinacrine.
Complications;-
A/immediate :-
1.G.A.
1.Vascular damage or damage to bowel.
3.Gas embolism.
4.Thrombo-embolism.
5.Wound infection.
B/Long-term complications :-
1.Menstrual disturbances.
2.Abdominal pain & dysparunia.
3.Psychological problems & psycho-sexual .
4.Bowel obstruction.
2.Male strilozation; vasectomy:-
Complications:-
A/Immediate complications:-
1.Scrotal hematoma, infection.
2.2% Failure rate.
B/Late complications:-
1.Antisperm antibody.
2.Small inflammatory granuloma.
3.Increase risk of Ca. prostate, Need further research.