Preventing Pregnancy: Family Planning and Contraceptive Methods
Prevention of pregnancy through family planning is crucial to avoid STDs, AIDS, and medical complications. Ideal contraceptives are effective, affordable, and easily accessible. Various methods such as spacing, terminal, and pregnancy vaccines offer choices for females, including rhythm, barrier, and chemical options. Understanding their characteristics and mechanisms can help individuals make informed decisions regarding their reproductive health.
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INTRODUCTION DEFINITION : Prevention of pregnancy. AIM Family Planning Prevents STD S AIDS. Medical Grounds To control stress of pregnancy, labour & lactation.
THE CHARACTERISTICS OF AN IDEAL CONTRACEPTIVE ARE LISTED BELOW Highly effective. No side effects. Independent of intercourse. Rapidly reversible. Cheap. Widespread availability. Acceptable to all cultures and religions. Administration and healthcare personnel not required. Easily distributed.
CONTRACEPTIVE METHODS IN FEMALES 1. Spacing methods 2. Terminal methods 3. Pregnancy vaccines
SPACING METHODS 1. Rhythm Methods. 2. Barrier Methods. 3. Chemical Methods. 4. Intrauterine contraceptive devices.
RHYTHM METHODS. 1. Calender method / safe period method / natural method. -Depend on time of ovulation. 2.Dangerous period ovulation occurs on 14 day & ovum viable for 48-72 hrs & sperm remain alive for 24-48 hrs. so pregnancy occurs if coitus occur in this period
3.Safe period rest of cycle i.e. 5-6 days after mensturation & 5-6 days before next cycle. Advantage most natural Disadvantage most unreliable when cycle are irregular & ovulation time is variable
BARRIER METHODS Flexible rim made up of spring. 1.MECHANICAL . a. Diaphargm. Cup shaped synthetic rubber or plastic. Inserted into vagina over the cervix. b.Cervical caps: Smaller than Diaphargm, Applied on cervix itself.
MECHANICAL Advantages. Inexpensive. Do not require medical consultation. Disadvantages. Demonstration by trained person needed for proper use. Failure most common due to displacement of device. Cervicitis ( inflammation of cervix) & local irritation.
CHEMICAL 1.Spermicidal agents. destroy sperms. Ricinoleicacid Nanoxynol-9. Octoxynol-3. Availableindifferentforms foamtablet,pastes,creams, jellies&vaginalsponge ( TODAY sponge imprignated nanoxynol-9.) Advantages inexpensive,well tolerated,providegood protection. Disadvantages messiness,localirritation &burningsensation. Combined --Polyurethane with
CHEMICALMETHODS. 1.Locallyappliedchemicals anti-spermicidal. Foams, jellies. 2.Drugs Steroidal Oral contraceptives and depot preparation. Non-steroidal --
STEROIDAL 1.ORALCONTRACEPTIVEPILLS(OCP) Recommendedinwomenofyoungeragegroup (upto35yrs) Mechanismofaction. Syntheticpreparationofestrogen&Progesterone. Whentakenorally,hormonelevelrises NegativefeedbackeffectactonAnteriorpituitary InhibitGonadotrophins(FSH&LH) InhibitOvulation
TYPES Combinedpill. Sequentialpill. Minipillpill. Postcoital(MorningAfter)pill.
COMBINEDPILL. Contains both Oestrogen(ethyl estradiol/mestranol)20- 50Mg. Progesterone(norethister one,norgestrel)0.5-2mg. Availability MALA-N(21Tab)& MALA-D(28Tab-7ferrous fumarate) Thursday, May 21, 2015
COMBINED PILL MECHANISMOF ACTION. PreventsOvulation. PreventsImplantation. Makescervical secretionsthick&viscid &prevententryof sperminfemalegenital tract. Dosage- Everydayorallyatnight for21days.(from5thday to25thdayofcycle) 7daybreakforMALA-N Duringthisbleeding occurs,whichisnot menstrualbleedingbutis withdrawalbleeding.
SEQUENTIALPILL Highdoseofestrogen withmoderatedoseof progesterone. Dose oestrogen5th-to 15thday,thenboth oestrogen+progesterone for5days. Highincidenceof endometrialcarcinoma sonotused. MICRO-PILL. Onlyprogesterone. Dose dailythrough wholeofmenstrualcycle. Action ovulationnot inhibited but fertility. Makescervicalmucosa thick&decreasemotility offallopiantube prevents
POSTCOITAL Mechanismof action. Preventsfertilization& implantationby hypermotilityof fallopiantube&uterus. Ifovulation& fertilizationoccurred thenitprevents implantationof blastocyst Within72hrsof unprotectedintercourse. Dose 2combinedpills immediatelyfollowedby 2pillafter12hrs. Indication onlyin emergency rape, contraceptivefailure,or unprotectedsex.
OCP Advantages 100 % effectivity Dis-Advantages. Hypertension. Thromboembolism. Metaboliceffects diabetes&obesity. Carcinogeniceffect breast&cervix. Contra-indications Womenhaving carcinomaofbreast& uterus. Liverdiseases Hyperlipidemia. Agegroupabove35 yrs.
DEPOTPREPARATION. INJECTABLE Oilysolutionsgiven intramuscularly. Progestrin Medroxyprogesterone acetate(DMPA) IM every3-6months,150- 400mg. Norethindrone enanthate(NET-EN) IMevery3 months,200mg. Combined Bothestrogen& progesterone IM,monthly MOA Preventovulation&alter cervicalmucosal secretions.
SUB-DERMALIMPLANTS Norplant2 2rodsof levonorgesterol Location beneath skinofarmor forearm. Contraception 5-6 yrs. Types Norplant 6flexible silastic(silicon)tubes
VAGINALRINGS. Containsnorgestrel. Progesterone absorbedthrough vaginalmucosa. Advantages Nodaily intakeLonglasting. Dis-Advantages Leadstosterility. Alterationsin menstrualbleeding pattern.
NON-STEROIDALCONTRACEPTIVES Mechanismofaction Suppresscorpusluteal function. Interferewithmotility offallopiantube Advantages Menstrualcycle remainsnormal. Completereversibility afterwithdrawal Centchroman. DevelopedbyCentral DrugResearchInstitute (CDRI) Tradename Saheli Dose 30mg twice/weekfor12 weeksfollowedbyonce inaweek
INTRAUTERINE CONTRACEPTIVE DEVICE(IUCD) Idealcandidate Hasbornonechild. Normalmenstrualcycle. Nopelvicinflammation. Readytocheckthedevice Mechanismofaction. Preventsimplantation& growthofovum. Byasepticinflammation& causingendometriumnot suitableforimplantation. Spermphagocytization by neutrophils¯ophages. Cuaffectsenzymes,motility Makescervicalmucusthick prevententryofsperm.
INTRAUTERINECONTRACEPTIVE DEVICE TYPES. Non-medicated. 1STgenerationIUCD. LippesLoop- serpentineorSshaped. MadeupofPlastic. (IUCD) Medicated. 2ndgenerationCumade2 types. CuT CuT200 NewerlikeNOVA-7,NOVA-T 3r dgeneration. Hormonereleasingcontaining progesteronereservoir releasecontinuouslyfor1yr. Thursday, May 21, 2015
CuT. Mostcommonlyused. MadeupofCu. T shapedattachedwithanylonthread.(tail)
METHODOFINSERTION. Withdrawlmethod. Idealtime during mensturationor within10days.( Ascervicalcavity diameterismore) Alsoduring1st afterdelivery. Thursday, May 21, 2015
IUCD Advantages. SafeEffective Reversible Easilypulledoutwhen notrequired. Longterm contraceptionwithout adverseeffect. Disadvantages Maycauseheavy bleeding. Maycomeout accidently.
CONTRAINDICATIONS OF IUCD Suspectedpregnancy. Pelvicinflammation. Heavybleedingduring mensturation. Sufferingfrom carcinomacervix.
TERMINALMETHODS Permanentmethod. Indication. Whenfamilyis complete. Medicalgrounds
TERMINAL METHODS. Surgical methods. 1.Tubectomy. Fallopiantubesidentified, cut,cutendsligated& buried. 2.Laparoscopic occlusion. Tubesoccludedusingsilicon rubberbands,ringsorclips Method quicker,simple,no hospitalization. Thursday, May 21, 2015
MEDICALTERMINATIONOF PREGNANCY MedicalterminationofpregnancyorMTPor abortionisallowedunderMTPact1971. Criteria. PersonwhocandoMTP Placewhereitshouldbeperformed.
MEDICAL TERMINATION OF PREGNANCY Indications. Medicals continuationofpregnancyishazardous tothemother. Eugenic substantialrisktothechildifborn. Humanitarianground. whenpregnancyisresult ofrape. Failureofcontraceptivemethods.
PREGNANCYVACCINES Underexperimentaltrials. 2types. Activeimmunization subunitsofHCG antibodiesagainstbetaHCG destroyHCGproducedbysyncytiotrophoblast. Tetanustoxoid increasesantigenecitycapacity. VaccineagainstZonaPellucidaproteins
CONTRACEPTIVE METHODSIN MALES
METHODS 1. Spacingmethods. Natural. Barrier. Chemical. 2. Terminalmethods. 3. Miscellaneousmethods.
SPACINGMETHODS NaturalMethod(CoitusInterruptus) Oldestmethodofvoluntaryfertility. Malewithdrawspenisbeforeejaculationintovagina. Failurerate high -Asprecoitalsecretionsmaycontainsperm&evena dropisenoughtocausefertilization. -WrongTimingofWithdrawl
BARRIERMETHOD Condom Most widely used. Made up of fine latex sheath. Instructions Shouldbewornonerect penisbeforeintercourse. Airmustbeexpelled Heldcarefullywhen withdrawingfromvagina. Anewcondomshouldbe usedforeachsexualact. NIRODH
BARRIERMETHOD Mechanismofaction, Preventsdepositionofsemenintovagina. Advantages Easilyavailable,safe,inexpensive Usedosenotrequiremedicalsupervision. Provideprotectionagainst STDs. Dis-advantage Mayslipoffortearoff. Interferewithsexualsensation.
CHEMICALMETHOD AntispermatogenicDrugs inhibit spermatogenesis Malepill(Gossypol) Hormonalpreparation --Testosterone --Testosteronewith Danazol --Cyproteroneacetate calciumchannelblocker-- Nifedipine
MALEPILL(GOSSYPOL) Mechanismofaction exactactionnotknown. Causesazoospermia. Advantages neither hormonenor antihormonalactivity Nochangeinlibido& potency. Disadvantages permanentazospermic after6months Composition Gossypol,phenolic derivativesof cottonseedoil. Dose orally. 200mg/D. 2months followedby60mg/wk. Thursday, May 21, 2015
HORMONALPREPARATION Testosteronewith Danazol. Cyproteroneacetate. Relatedtoprogesterone. Potentanti-androgenicagent. Causesoligozoospermia&loss oflibido. Testosterone 400mgorally causesazospermia. Thursday, May 21, 2015
CALCIUMCHANNELBLOCKERS. BlockCachanneloncellmembraneofsperm. PreventsCainflux membranebecomesrigid &loadedwithcholesterol. RigidmembranepreventsitsbindingtoZona Pellucida. SopatientonCachannelblockers (Nifedipine)forhypertensionbecomes sterile. Thursday, May 21, 2015
TERMINAL METHODS. Vasectomy VasOcclusionwithNo-scalpel technique 1.ElastomericPlugs 22.SHUG 33.RISHUG
MISCELLANEOUSMETHODS. Hot baths. Hot bath (460for few weeks.) Suspensories. It holds testes close to the body. Insulated scrotal sack Thursday, May 21, 2015
