1 / 76

Family Planning （计划生育）

Family Planning （计划生育）. Contraception Sterilization Artificial abortion. Learning Objectives. Mechanism and clinical application of each contraceptive method. 2. Artificial abortion surgery: indications, contra-indications, treatment of complications.

chung
Télécharger la présentation

Family Planning （计划生育）

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Family Planning （计划生育）

  2. Contraception • Sterilization • Artificial abortion

  3. Learning Objectives • Mechanism and clinical application of each contraceptive method. • 2. Artificial abortion surgery: • indications, contra-indications, • treatment of complications. • Sterilization surgery: • indications, contra-indications, • prevention of complications.

  4. Contraceptive methods • Systemic • contraceptives • IUDs or IUCDs • Barrier methods • Natural methods

  5. Contraceptive methods Systemic contraceptives IUDs or IUCDs Barrier methods Natural methods

  6. Systemic Contraceptives Mechanism: • Inhibition of ovulation • LHRH secretion↓ • No midcycle LH surge • 2. Interfering with fertilization by altering cervical mucus • 3. Interrupting implantation by altering morphology and function of the endometrium • 4. Altering the function of Fallopian tubes

  7. Systemic Contraceptives Types of the systemic contraceptives I. Oral contraceptives (1) Short-acting (2) Long-acting (3) Vacation pill II. Long-acting contraceptive injection III. Slow-releasing contraceptives IV. Transdermal patch

  8. Systemic Contraceptives • Oral contraceptives • 1. Short-acting Tablets (99.95%) • 1) Monophaser • 2) Biphaser • 3) Triphaser

  9. Short-acting Tablets

  10. Systemic Contraceptives Tablets Monophasers Components: (1) Estrogens: Ethinylestradiol，EE (炔雌醇) (2) Progestogens: Norethindrone, Megestrol, etc. 1. Compound Norethindrone Tablets 复发炔诺酮片(避孕片1号) Components: EE 35μg, Norethindrone 0.6mg 2. Compound Megestrol Acetate Tablets 复方甲地孕酮片 (避孕片2号) Components: EE 35 μg, Megestrol 1.0mg

  11. Systemic Contraceptives Tablets Monophasers 3. Compound Levonorgesterel Tablets 复发左旋炔诺孕酮片 （D-甲炔诺酮片、 复方左旋18甲基炔诺酮片） Components: EE 30 μg, Levonorgesterel 0.15mg 4. Compound Desogestrel Tablets (Marvelon) 复方去氧孕烯片 (妈富隆) Components: EE 30 μg, Desogestrel 0.15mg Less side effects: Nausea, breast, weight, acne, hirsutism

  12. Systemic Contraceptives Biphasers Ovidal (CTR24) 去氧孕烯双相片 Components: 1st phase (day 1～7): EE 40μg, Desogestrel (去氧孕烯) 0.025 mg 2nd phase (day 8～21): EE 30μg, Desogestrel (去氧孕烯) 0.125mg

  13. Systemic Contraceptives Tablet Triphasers Levonorgesterel Triphaser Tablets 左炔诺孕酮三相片 (左旋18甲三相片) Components: 1st phase (day 1～6): EE 30μg, Levonorgesterel (左炔诺孕酮) 0.050mg 2nd phase (day 7～11): EE 40μg, Levonorgesterel (左炔诺孕酮) 0.075mg 3rd phase (day 12-21) EE 30μg, Levonorgesterel (左炔诺孕酮) 0.125mg

  14. Systemic Contraceptives 2. Long-acting Tablets (96%～98%) 1) Compound Quinestrol Monthly Tablets 复方炔雌醚片(长效避孕片1号，复方炔雌醚月服片) Components: Quinestrol 3mg Chlormadinone acetate (氯地孕酮) 12 mg 2) Three in one Compound Quinestrol Monthly Tablets 三合一炔醚片 Components: Quinestrol 2mg Chlormadinone acetate (氯地孕酮) 6 mg Norgesterel (炔诺孕酮) 6 mg

  15. Systemic Contraceptives 3. Vacation pill/morning-after pills 1. Norethisterone Tablets (炔诺酮探亲片) 2. Megestrol Acetate Tablets (甲地孕酮探亲避孕片1号) 3. Norgestrel Tablets (炔诺孕酮探亲避孕片) 4. Anordrin Tablets (53号抗孕片、53号探亲片、 事后避孕片、双炔失碳酯片Anordrin) 5. Me-Quingestanol Pill (甲醚抗孕丸) Components: Megestrol 0.5mg, Quingestanol Acetate 0.8mg

  16. Systemic Contraceptives II. Long-acting contraceptive injection 1. Compound Hydroxyprogesterone Caproate Injection 复方己酸羟孕酮避孕针 (避孕针1号) Components: Hydroxyprogesterone Caproate 250mg Estradiol Valerate 5mg 2. Compound Megestrol Acetate Injection (Inj.Mego-E) 复方甲地孕酮避孕针 (美尔伊避孕针、甲孕雌醇避孕针) Components: Megestrol 25mg 17β-Estradiol 3.5mg

  17. Systemic Contraceptives 3. Norethisterone Enanthate Injection 庚炔诺酮避孕针 Components: Norethisterone Enanthate (NET-EN, Norigest) 炔诺酮庚酸酯 200mg Lasts 2 month

  18. Systemic Contraceptives III. Slow-releasing contraceptives 1. Hypodermic implant (皮下埋植剂) (1) Norplant I (99.8%) (D-炔诺孕酮埋植剂 I、 左炔诺孕酮埋植剂 I) Levonorgestrel (左旋炔诺孕酮） 36mg×6 For 5 years (LNG, 85-30μg/day) (2) Norplant II (D-炔诺孕酮埋植剂 I、 左炔诺孕酮埋植剂 I) LNG 70mg×2 For 3 years (LNG, 45μg/day).

  19. Systemic Contraceptives • 2. Contraceptive vaginal ring • Megestrol Acetate-Silica Gel Circle (97%) • 甲硅环、甲孕酮硅胶避孕环 • Megestrol 200～250mg • For 1 year (Megestrol, 100-150 μg/day) • (2) D-Norgestrel-Silica Gel Circle • D-炔诺孕酮阴道避孕环、左旋炔诺孕酮阴道环 • Levonorgestrel 5mg • For 3 months (LNG, 20μg/day)

  20. Systemic Contraceptives 3. Slow-releasing injectable microglobes and microcapsules 3 months IV. Transdermal patch

  21. Systemic Contraceptives Long-term safety 1. Cancer 2. Thrombotic diseases (血栓性疾病） 3. Adverse effects on metabolism (1) Carbohydrate (2) Lipid (3) Protein No No if <50μg/day Glucose tolerance test↓ Triglyceride↑HDL ↑ Cholesterol ↑ Total protein ↓ Albumin ↓ Globulin ↑

  22. Systemic Contraceptives 4. Future fertility 5. Adverse effects on the embryo/fetus No adverse effect (Ovulates within 3 months) 1) Controversial for pregnancy during medication. 2) Consensus: safe if > 6 months

  23. Systemic Contraceptives Contraindications 1. Malignant or precancerous diseases and patients with uterine or breast masses 2. Hematopathy and thrombotic diseases 3. Severe cardiovascular diseases 1) P→lipid metab →coronary artherosclerosis 2) E→blood coagulation↑→myocardiac infarction 3) E→renin activity↑→hypertension

  24. Systemic Contraceptives Contraindications 4. Endocrine diseases: diabetes, hyperthyroid dysfunction 5. Lactation 6. Oligohypomenorrhea or older than 45 years old 7. Vaginal bleeding of unknown origin 8. Hepatitis and nephritis 9. Psychotic (精神病患者)

  25. Systemic Contraceptives Side effects • 1. Abnormal uterine bleeding • Breakthrough bleeding • If happens in the first half cycle: add EE (炔雌醇) • 50-150μg/day for 2 weeks. • If happens in the second half cycle: increase o.c. by • 0.5-1 tablet/day for 2 weeks. • 2) Cessation of menstruation • Once: no need to treat • Twice: change types of o.c. • Amenorrhea: discontinue o.c. and try ovulation induction • 3) Hypomenorrhea（月经过少） • No treatment or EE 50-100 μg/day for 22 days

  26. Systemic Contraceptives Side effects 2. Morning sickness-like reaction VitB6 20mg, VitC 100mg, anisodamine (山莨菪碱)10mg tid po for 7 days. 3. Weight gain P (containing weak androgen activity): stimulating anabolism (合成代谢） E: causing sodium and water retention 4. Pigmentation (moth patch) (蝴蝶斑) 5. Others Headache, breast swelling pain, appetite increase, skin rash, pruritus (瘙痒), etc.

  27. Contraceptive methods Systemic contraceptives IUDs or IUCDs Barrier methods Natural methods

  28. IUDs Types of IUD 1. IUD made with inert materials Stainless steel, nylon, etc Fewer adverse reactions, but higher expulsion rate and pregnancy rate 2. IUD added with active substances 1) IUD with copper 2) IUD with progestogens, zinc, PG synthetase inhibitor 3. Third generation IUD

  29. IUDs 1) IUD with copper TCu-200 (1 year cumulative rate) Expulsion rate: 5.61% Pregnancy rate: 1.51% Removal rate (due to adverse effects): 9.22% Removal rate (due to other reasons): 3.62% ‘Overall failure rate’ 19.96% 2) IUD with progestogens, zinc, PG synthetase inhibitor 3. Third generation IUD Anchoring IUD

  30. IUDs • Mechanism • Primarily an aseptic inflammation reaction • Phagocytic effect • Leukocytes • Prostaglandins • Luteolysis (黄体溶解) • Fibrinolysis（纤溶） • Immune factor • Interfering with implantation, sperms, development • of the fertilized eggs and embryos.

  31. IUDs Mechanism IUD with active substances 1. IUD with copper: (1) Inflammation reaction and PG (2) Toxic effect on sperms (3) Interference with implantation by changing mucus (thinner) and its secretion 2. IUD with progestogens: (1) Atrophic change in the endometrium (2) Change in the cervical mucus (3) Interference with metabolism in sperms

  32. IUDs Procedures 1. Timing 1) 3-7 days after completion of menstruation and no recent sexual intercourse. 2) Immediately after an artificial abortion (<10 cm) 3) 42 days after a normal vaginal delivery 4) 6 months after a cesarean section 5) Day 3 of menses for progestin containing IUD 2. Selection of IUDs: depending on space of uterine cavity 3. Method 4. Postoperative care

  33. IUDs Contra-indications • Pregnancy suspected • Infection of the reproductive tract • (3)Tumours of the reproductive tract or uterus malformation • (4) Tissue retention after abortion or delivery • (5) Cervical imcompetence, severe old laceration • of cervix and severe uterine prolapse • (6) Severe generalized diseases • (7) Polymenorrhea or menorrhagia?

  34. IUDs Adverse effects 1) Uterine bleeding Mechanical compression injuries Increased PGs and activated fibrinolysis Indomethacin (消炎痛) 25-50mg tid po EACA (氨基己酸), 2-4g tip po 云南白药, 0.4g tid po 2) Pain or discomfort

  35. IUDs Complications 1) Perforation of the uterus and IUD ectopia 2) Infection 3) Incarceration (节育器嵌顿)

  36. IUDs Problems associated with IUD • IUD and PID (pelvic inflammatory disease) • IUD and ectopic pregnancy • Displacement or expulsion of IUD • Pregnancy with IUD in place

More Related