Name of the student: Class Subject Topic Group Group size Place Date Time Duration Method of teaching

A.V.AIDS :

D. Reddamma : M. SC.Nursing 1st year : : : : : : Obstetrics and gynecology nursing Contraceptive technology M.SC.Nursing 1 OBG specialty students 7 M.Sc nursing students . MSc. Nursing OBG specialty class room 14/06/11 : 2PM to 4PM : 2 hours Lecturer cum discussion method. : Black board , Flash cards , OHP , Chart , Power point.

Supervised by

Mrs.Radha Ramana Sree Lecturer. Govt. college of nursing. Hyderabad.

OBJECTIVES

GENERAL OBJECTIVES : By the end of the class the student will be able to gain in depth knowledge regarding contraceptive technology.

SPECIFIC OBJECTIVES : By the end of the class the student will be able to  Define contraceptive technology.  Classify types of contraceptive methods  Explain the meaning , types , effectiveness , advantages and disadvantages of Barrier methods ,Natural contraceptive methods, intra uterine contraceptive methods ,hormonal contraceptive methods, Permanent family planning methods.  Discuss the nurses role for advancement in contraceptive technology.  Research studies  Summary  Conclusion  Bibliography

INTRODUCTION
The desire for (birth) control is neither nor space bound. It is a universal characteristics of social life. time

Contraception is one of the essential elements of reproductive health and its use has a tremendous impact on women s health ,women are central to the developmental process and there for it is imperative to improve their reproductive health .They are also among the most vulnerable groups of society -more and more women all over the world are opting for fertility by choice and not by chance . Utilization of contraceptive methods helps women to avoid unwanted pregnancies and also in saving the lives of millions of women around the globe from health hazards. One of the most important planning country is essential in India pressure component of health and family of any puts

for the socio economic development is a developing country on its resources

over population

tremendous

and leads

to poverty and

unemployment . The expulsive growth of population affects the health status of mothers and children and also affects social and economic development of the country . Population expulsion leads to the creation of numerous social problems such as : Fewer job opportunities . Inadequate schooling facilities. A high percentages of literacy Inadequate sub standard housing. Urban detoriation. Increased detoriation in law and order situation

Hundreds and millions of people still are very poor, illiterate and unhealthy. It is because resources are limited , population is very large . It is there for very important to control and stabilize the population ,for this family planning and birth control is one of the most desirable solutions for controlling population growth. Contraception means interfering with implantation of the fertilized ovum in the uterus. Technology : technology is a broad concept that deals with the usage and knowledge of tools and crafts and how it affects the ability to control and adopt to the environment. Applications of knowledge to the practical aim of human life .Technology includes the use of materials, tools, techniques, and source of power to make life easier. An expert committee of WHO defined family planning as: A way of thinking and living that is adopted voluntarily upon the basic knowledge , attitude and responsible decision by individuals and couples in order to promote health and welfare of the family group and thus contribute effectively to the social development of a country. Another expert committee follows: defined and described family planning as

Family planning refers to practices that help individuals or couples to attain certain objectives . To avoid unwanted births To bring about wanted births To regulate the intervals between pregnancies. To control the time at which births occur in relation to the age of the parents. To determine the number of children in the family .

Barrier methods have a long history Egyptian papyri describe pessaries and vaginal douches which could have been effective .The pessaries both formed a barrier and consisted of substances either spermicidal or likely to show slow sperm motility, while the douches could have altered the chemical balance of the vagina rendering conception less likely many other societies are recorded as having had similar devices capable of lowering the probability of conception.

The condom or male sterilization was quite a late development .It became more widely used following the discovery of the vulcanization of rubber in the 1840s which also led to the development of various forms of occlusive cap for female use. These requires to be most effective ,careful fitting indeed the first were custom made for individual .The most commonly used type is the Dutch cap or diaphragm invented by German physician Wilhelm mensinga of Flensburg in the 1870s a domed rubber cap with a metallic spring in the rim which comes in a range of sizes and is easier to fit than similar devices used conscientiously with spermicide and left in for several hours following intercourse it has a success rate of around 95%in preventing pregnancy using sponges for birth control dates back probably to the eighteen century a method particularly efficacious if the sponge is soaked in some spermicidal or sperm weakening substance such as vinegar ,olive oil or even supply soapy water ,modern sponges for a single use only are permeated with spermicide . The recently promoted female condom .covering the entire interior surface of the vagina has a longer history than often realized and is primarily a protective against sexually transmitted diseases diseases.

Coitus interrupts probably pre dates any other form of birth control this is not a particularly reliable method of contraception a few men have self control to correctly practice the method at every single act of sexual intercourse. Although it is commonly believed that pre ejaculated fluid can cause pregnancy modern research has shown the pre ejaculated fluid does not contain viable sperm.

The rhythm method was developed in the early 20th century as researchers discovered that a women only ovulates once per menstrual cycle not until 1950s when scientists better understand the functioning of the menstrual cycle and the hormones that controlled it. Where methods of hormonal contraception and modern methods of awareness developed.

DEFINITION OF CONTRACEPTION

A process or technique for the prevention of pregnancy by a medication, devices or method that blocks or alters one or more of the processes of reproduction in such a way that sexual union can occur without impregnation. __Mosby s___ Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation ,fertilization and implantation. There are different kinds of birth control that acts at different points in the process. ___Encyclopedia _

TYPES OF CONTRACEPIVE METHODS

BARRIER METHODS OF BIRTH CONTROL

For many years women have prevented pregnancy by using some type of material inserted into their vagina to block sperm .One popular method involved a small piece of natural sponge soaked in vinegar Although it was not the most effective form of contraception it did help it also paved the way for today s generation of barrier methods.

MALE CONDOM
As far as male birth control goes male condom .Condom are considered to be a barrier method of birth control. The condom itself is a type of thin shield that is worn on an erect penis it is put on before sex occurs and is taken off immediately afterwards in order to avoid leakage. when condom is on sperm are trapped in the tip of the condom when a man ejaculates ,there by preventing the sperm from coming into contact with the vagina .Anew condom must be used every time you have sex on average condoms are effective at preventing pregnancy 85% of the time ever year .If condoms are used perfectly that is properly and consistently every time ,only two out of 100 women will become pregnant per year. Side effects of condom : y The majority of the people don t experience any side effects from using a condom however people with an allergy to latex may find condoms to be irritating y It is an important to note through that polyurethane condoms are more tickly to break while natural skin condoms are more expensive than other types of condoms they also do not protect against any sexually transmitted diseases ,risk of urinary tract infections .

Using condom : Condoms are one of the best ways for people who are sexually active to help avoid sexually transmitted diseases as well as help prevent an unwanted pregnancy ,it is very important to know how to properly use a condom

CONDOM TODAY :
Nowadays the most popular type of condom is made out of latex rubber ,but it is also possible to purchase condoms made from poly urethane as well as from animal tissue .They can come in variety of styles ,colors ,textures and even flavors .Since 1960s people have been able to purchase condoms without a prescription making them even more convenient and easy to use . In addition to helping preventing pregnancy ,condoms also protection against many sexually transmitted disease. offer

FEMALE CONDOM :
When it comes to birth control the only responsibility men have is remembering the condoms .Unfortunately they often can t be relied upon to remember even this small task .so it comes as no surprise that a female condom was developed .Although it is not effective at preventing pregnancy as the male condom ,it is the only other effective method of preventing sexually transmitted diseases aside from male condoms and abstinence . The female condom works in exactly the same way as male acting as a barrier to sperm made of thin polyurethane condom is a sheath with two soft flexible rings at either worn internally by the women during sex .The polyurethane condom by the female end and is covers one

ring with sit up against the cervix and acts as an anchor for the condom .The second ring larger and remains outside the body .it covers the part of the perineum and labia during intercourse. The female condom can be inserted as much as eight hours prior to sex but it should be removed immediately after sex .It should also not be used with male condom. Side effects and problem : There are relatively few side effects associated with the female condom some people may experience irritation as a result of wearing the condom but the risk is not as great as with latex condoms many people find that the female condom is too noisy while others have troubles interesting the condom .In some cases the condom may shift or slip into vagina during sex ,making the condom somewhat effective. Some people may also find that the outer ring makes sex uncomfortable while others find that the outer ring is useful in stimulating clitoris female condom is more expensive than male condom.

CERVICAL CAP
The cervical method is one of the more recently approved barrier birth control methods and offers excellent protection against pregnancy for some women. The cervical cap is a type of barrier birth control that is used to prevent unplanned pregnancy .unlike diaphragm ,the cervical cap is much smaller and fits more tightly around the cervix when in place out of silicon rubber there is currently only one type of cervical cap consists of a dome that covers the cervix ,a brim which holds cap tightly in place and a grove which can hold spermicide jelly or cream. Usage of cervical cap: The cervical cap should be inserted prior to intercourse you will need apply a small amount of spermicide to the bowel and brim of the

cap you will also need to apply about half a teaspoon of spermicide to the groove on the cervical cap in order to protect against pregnancy .Push the cap into your vagina and down towards your rectum then push cervical cap as far back as you can so that it covers your cervix. She the cap the can leave the cervical cap in place for up to 48 hours be sure to leave cap in place for at least eight hours after intercourse .To remove the insert your fingers into your vagina and push gently on the dome of cap.

Advantages of using y y y y

cervical cap:

It does not affect your fertility or your menstrual cycle. It can be left in your vagina for up to 48 hours It usually un noticeable to both partners It requires less spermicide than the diaphragm which increases the pleasure of oral sex.

Disadvantages of using cervical cap: y It must be fitted by your health care provider y It is difficult to insert properly and may become dislodged during the intercourse. y Unlike some other kinds of birth control it is not effective protection against STDs.

THE DIAPHRAGM:
The diaphragm is a very popular choice for women when it comes to contraception .Avery comfortable and affordable option ,the diaphragm can be washed and reused and has proven to be very effective against pregnancy .The diaphragm is type of barrier birth control that is used to prevent sperm from entering the uterus made out of a thin flexible silicon rubber the diaphragm looks

much like a small dome or cup designed with a flexible ring around the top ,the diaphragm is inserted into the vagina prior to sexual intercourse. The diaphragm should be used along with a spermicidal cream or jelly in order to increase its effectiveness. Diaphragm is available by prescription from your health care provider Using a diaphragm: When you are fitted for your diaphragm your health care provider will teach you how to insert ,remove and use your diaphragm properly .Diaphragm can be inserted up to six hours prior to intercourse you will need to add to more spermicide inside of your vagina every two hours or each time you have sexual intercourse for this reason it is usually recommended that you insert your diaphragm no more than two hours prior to sexual intercourse.

Advantages of using the diaphragm; y The diaphragm is easy to insert and remove. y The diaphragm is inexpensive and reusable y When inserted correctly ,the diaphragm cannot be felt by either partner. y The diaphragm does not affect future fertility or your menstrual cycle. Disadvantages of using the diaphragm: y If left in for more than 24 hours the diaphragm can increase risk of toxic shock syndrome. y Continual use of spermicide can irritate the lining of vagina and possibly increase risk of contracting an STD. y The diaphragm can increase the likelihood of bladder infection. y The diaphragm does not protect against STDs.

CONTRACEPTIVE SPONGE
Contraceptive sponges are small ,disposable sponges they are usually made up of polyurethane foam and are infused with spermicide .sponges work but not only blocking sperm from entering the uterus but also by absorbing and killing off the sperm. To use a sponge she nee d to first moisten it with water so that it becomes foamy and then insert it into vagina ,positioning it so that it sits over the cervix. Women who have given birth vaginally are much more likely to have this method of birth control fail contraceptive sponge do not offer any protection against sexually transmitted diseases .There for it is necessary to still use a condom to help protect against STDs when have sex Side effects: Since contraceptive sponges do not use hormones to prevent pregnancy there are few side effects associated with their use women who are allergic to spermicide may experience irritation when they use contraceptive sponge.

LEA S SHIELD
Recently many women have been looking to leas shied for protection against unplanned pregnancies introduced in 2002.Leas shield can be very effective against pregnancy when used correctly ,reusable hormone free it has been popular choice for women since its introduction .Leas shield is a vaginal barrier contraceptive that is made of medical grade silicone .It is a cup shaped device that is inserted into the vagina in order to prevent sperm from entering the cervix . Designed to be reusable leas shield is completely washable and lasts for a period of about six months .Leas shield is available by prescription from your health care provider Usage of leas shield: Leas shield is inserted much like a tampon simply squeeze and push it into your vagina as far as it will comfortably inserted properly she should not be able to feel the shield vagina. The shield has a flexible ring which can be used to removal. She can inserted leas shield any time prior to intercourse spermicide around the ring of shield and push it into place. the shield go .When inside of help with

just place

After she has removed leas shield take the time to wash and dry the device properly .The leas shield can be washed in warm ,soapy water and left to air dry on a clean towel .Any water based cleaner can be used with the shield .After it has dried be sure to place the shield the inside its protective case so that it doesn t become dirty or damage. Who can use lea s shield: y Any women who is inserted to controlling pregnancy can use leas shield y Cant use hormonal birth control methods . y Are nursing.

y Want a back up method if you have forgotten to take your birth control pill . y Find diaphragm or cervical cap uncomfortable. Effectiveness of leas shield: Leas shield is generally effective as other barrier birth control options .When used correctly and consistently the shield has a failure rate of about 12% per year .When used with spermicide the failure rate drops to about 8% per year.

SPERMICIDES

Spermicides are available as vaginal foams ,gels ,creams ,tablets and suppositories ,usually they contain surfactants like nonoxynol-9 ,octoxynol or benzalkonium chloride .These agents mostly cause sperm immobilization .The cream or jelly is introduced high in the vagina with the help of the applicator soon before coitus. y Foam tablets (1-2)are to be introduced high in the vagina at least 5minutes prior to intercourse y In isolation it is not effective but enhances the efficacy of condom or diaphragm when used along with it y There many occasional local allergic manifestations either in the vagina or vulva.

NATURAL FAMILY PLANNING METHODS

Natural family planning methods refers to a variety of methods used to prevent or plan pregnancy based on identifying a fertile days for all natural methods abstinence or avoiding unprotected intercourse during the fertile days is what prevents pregnancy. The effectiveness and advantages of NFPM address the needs of diverse population with varied religious and ethical beliefs. They also provide an alternative to women who wishes to use natural methods for medical or personal reasons ,for reproductive health service providers NFPM methods expands options and improves the quality of family planning services .A variety of natural methods have been established and are used globally however there is a need for better tools ,training and instructions in NFP in order to minimize the potential benefits of these methods .Ongoing effects seek to improve the variety of NFP services and develop new methods and technology that can allow simpler ,more effective natural methods to be delivered to a broader range of couples. Advantages y Increased self awareness and knowledge for their fertility. y Increased reliance on their own resources rather than a family planning programme or other sources of contraception. y Increased dependence from costly or distant medical services. y Freedom from artificial substances and the side effects or potential medical risks of other methods. y Reduced resupply costs association with commodity based methods. y Enhanced partner communication and intimacy. Disadvantages: y No protection from sexually transmitted infections . y Required training by qualified instructor . y Very unforgiving of incorrect use.

y Requires partner consent and co operation. y Less appropriate for women with regular on unpredictable menstrual cycle. y Requires daily or regular monitoring and recording. NATURAL CONTRACEPTIVE OPTIONS Abstinence: Refraining from penetrative sex provides 100% protection from pregnancy and offers effective prevention of transmission of sexually transmitted infections as well as while this may be an impractical long term family planning method for married couples .There are examples of periods of prolonged abstinence in certain culture settings ,programmes aimed at unmarried adults and adolescents to delay first sex can have a positive impact in pregnancy prevention and can have other health education and economic benefits too . Withdrawal or coitus interruptus: The withdrawal method of family planning is unlike other natural methods in that it is male controlled with drawl has been used for centuries following discovery that ejaculation into the vagina leads to pregnancy ,this methods prevents pregnancy by preventing contact between the sperm and the egg. Calendar methods based on calculations of cycle length: In calendar rhythm method a women make an estimate of the days she is fertile based on past menstrual cycle length .She does this with the expectation that the length of her current cycle and thus the time of her fertile phase will not very greatly from previous menstrual cycle.

Various versions of the calendar method exist. with each using a specific rule to determine when fertile phase is most likely to occur .All of the variations involve setting the day of avoidance of unprotected intercourse by subtracting the upper limits of the rule from the number of days in the shortest of the previous 6 menstrual cycles and subtracting lower limits of the rule from the number of days of the longest of the previous 6 menstrual cycles .For examples a womens last 6 menstrual cycles range from 26 to 31 days in length she has been taught the 11-18 rule ,The calendar method is reportedly the most common of the natural methods. OVULATION METHOD Also known as the cervical mucus method this technique is not for every women. It requires a women to be very comfortable with her body since she will need to regularly check her cervical mucus .But it can also help a women become much more attended to the changes that happen within her body every month. Action: This family planning techniques is based on the idea that a lack of cervical mucus indicates that an egg has not yet been released by the ovaries. Additionally without the mucus ,sperm will not be survive inside a women until the time that an egg is released. As get closer to ovulation cervical mucus will become thinner and stickier .When ovulation is about to occur your cervical mucus will be clear ,slippery and very stretchy similar to a law egg while .This type of mucus is ideal for sperm to swim up to uterus while this a great for a women who are trying to conceive ,women who are trying to avoid pregnancy will want to abstain from sex or use another form of birth control like condom or sponge during this time.

Checking the mucus: y There are three ways in which you can check your cervical mucus. y Use your finger or toilet paper to wipe across the opening of the vagina and then take a look at the mucus. y Wear a panty liner and examine any cervical mucus that may be left on it. y The best way to reach in and get a sample of cervical mucus . Examine the consistency and try to stretch the mucus between fingers .If you can stretch it at least three inches with out it breaking then ovulation is about to occur. BASAL BODY TEMPERATURE METHOD Whether women are trying to conceive or avoid pregnancy charting your basal body temperature is a great way to know when they are ovulating .It will also help to give you a better understanding of body. Meaning: Basal body temperature is body s core temperature normally BBT remains roughly around 97f,when ovulate through body temperature raises slightly going up by half a degree to a full degree to 98f or higher and stays elevated for a number of days keeping track of BBT is one of the most popular form of natural birth control used by women today. However to take basal body temperature ,they do need to use a special type of thermometers which is able to record the slight changes in temperature .Basal body thermometers are available in traditional mercury thermometers as well as digital which are faster and easier to read.

SYMPTOTHERMAL METHOD
The method combines several techniques to predict ovulation. It typically includes monitoring and charting cervical mucus and position and temperature changes on daily basis and may include other signs of ovulation such as breast tenderness ,back pain ,abdominal pain or heaviness or light inter menstrual bleeding. To use this method correctly couple must abstain from unprotected sex from the first sign or sensation of wet cervical mucus until the women s body temperature has remained elevated for three days after peak day is observed effectively, the method uses the guidelines of the BBT method to determine its end.

LACTATIONAL AMENORRHOEA METHOD

Research has confirmed that a form of breast feeding to achieve contraception called the lactational amenorrhea method ,is more than 98% effective during the first 6 months following delivery .Based on year of data from thousands of women in more than a dozen countries ,The research also suggests that LAM may be dependable for longer perhaps up to a year after giving birth. During breast feeding ovulation inhibits by a series of physiological responses to nipple stimulation .More frequent or intense sucking sends nerve impulses to the mother hypothalamus that disturb normal signals to the pituitary controlling hormone secretion the resulting abnormal pattern of LH secretion is inhibitory to ovarian activity .When breast feeding diminishes with less frequent breast feeding or more frequent supplemental feeding the chance of ovulation and subsequent supplemental feeding the chance of ovulation and subsequent pregnancy rises.

STANDARD DAYS METHOD The standard days method is a relatively new method of natural family planning .It can be used to help you and your partner avoid unwanted pregnancies developed by the researcher at the institute for reproductive health at George town university school of medicine SDM helps couples to recognize when they are most fertile .This can help to avoid having unprotected sex during fertile periods of your menstrual cycle. How to use the standard days method: y The standard day method is fairly straight for ward to use. All you need to do is keep track of how long your menstrual cycle is in order to determine when days 8 through 19 0ccur . y When first day of your period arrives this is day of your cycle make this is day 1 of your cycle make this on your calendar. y Between day 1 and day 7 it is highly unlikely that you will become pregnant so it is safe to participate in sexual intercourse without using birth control. y Between day 8 and day 19 you are at your most fertile .You and your partner should abstain from sex or you should use an alternate type of birth control such as a condom. y Between day 20 and 32 you are unlikely to get pregnant so you can resume sexual intercourse. Effectiveness: When used regularly and consistently SDM has been shown to be a highly effective birth control method. When used perfectly only five out of every 100 women will get pregnant .This means that the method is 95%effective against pregnancy.

Benefits of using the SDM: y SDM is very easy to learn. y This method requires no calculation ,record keeping or physical exam unlike the rhythm method or the ovulation method. y There are no associated birth control side effects Draw backs to the SDM: y y y y It cannot be used effectively by women with . Irregular periods . Cycles shorter than 26 days. Cycles lasting longer than 32 days.

NEW SIMPLE OBSERVTION BASED METHOD The today method is a new observation based method that relies on a simple algorithm to help women identify when they are fertile. The method is based on monitoring the signs and symptoms of fertility namely the observation of the presence or absence of cervical secretions .Today method is another approach to interpreting the changes in the characteristics of cervical secretions that is easier to teach ,learn and use .The today method requires only that a women monitor the presence and absence of secretions to determine on each day if she is fertile .Each women is taught to consider as secretions anything that the perceives coming from her vagina except menstrual bleeding. The women ask herself two simple questions each day (1).Did I note secretions today .(2).Did I note secretions yesterday. If she notices any secretions she is probably fertile and needs to abstain from unprotected intercourse to avoid pregnancy .If she notices no secretions on both days she is not fertile.

INTRA UTERINE DEVICES

I UD is a old method of contraception this principle was known to the Arabs in middle east who is controlling contraception in camels by introducing a small round stone into the each horn of the uterus .The original device first used is 1999.During the last 3 decades however there has been a significant improvement in its design and content. Types of IUD there are two basic y Non medicated IUD. y Medicated IUD Other wise IUD s are divided into 3 types as y First generation IUD-the non medicated or inert IUD. y Second generationIUD-the IUD comprising copper y Third generation IUD-hormone realizing IUDs are third generation IUDs. y Hormone releasing IUDs either releasing progesterone or levonorgestrel has also been introduced. Now a days the following medicated IUDs are in use: CUT 200 Multiload 250 progestasert types of IUD:

CUT 380A Multiload 375 LNG -IUS. Copper 200: Copper 200 B of fine copper wire wounded round the the T shaped vertical device is made of contains 125mg of copper ,the copper is per 24 hours during a period of 1 year 4years. carries 215 sq mm surface area vertical stem of device .Stem of a polyethylene frame .The device last at the rate of about 50ugm the device is to be removed after

y Copper200 carries 200sqmm surface area of wire containing 120mg of copper and is removed after 3 years. y CU 380 A: CU 380 A carries 380mmz surface area of copper wire wounded around the stem (176mg)and copper sleeves on the horizontal arms(66.5) replacement is every 10 years. Multi load copper CU 250: The device is available in a sterilized sealed packet with an applicator ,the device emits 60-100ug of copper per day during a period of 1 year the device is replaced every 3 years. Multi load 375 : It has 375mmz surface area of copper wire wound stem replacement is every 5years. Levonorgestrel intrauterine system: This is a T shaped device with polydimethyl siloxane membrane around the stem which acts as a steroid reservoir total amount of levonorgestrel is 52mg and is released at the rate of 20ug/ day this device is to be replaced every 5 years. Progestasert: It is a progesterone (38mg) containing IUD that releases progesterone 65ug/day in the uterine cavity it is replaced after 1year. around its vertical

Lippes loop:
It is non medicated open intra uterine device.

Mode of action: y Mechanism of action is not clear the probable factors are :

y Bio chemical and histological changes in the endometrium -There is a non specific inflammatory reaction along with biochemical changes in the endometrium which have got gamato toxic and spermatolytic effect. y There may be increased tubal motility which results in quick migration of the fertilized ovum into the uterine cavity before the endometrium is receptive. y There may be impaired sperm absent probably due to local chemical effect affecting the sperm utility and migration. Copper devices: Ionized copper has got an additional local anti fertility effect by preventing implantation through enzymatic interference .Copper initiates the release of cytokinins which are cytotoxic .Serum copper levels has not increased. Levonorgestrel IUD: It includes strong and uniform suppression of endometrium cervical mucus becomes very scanty an ovulation and insufficient luteal phase activity has also been mentioned. Contraindications: y y y y y y y y y Presence of pelvic infection. DUB Suspected pregnancy Prolapsed uterus. Severe dysmenorrhoea. Suspicious cervix with abnormal cytology. Past history of ectopic pregnancy. Nulli Para With in six weeks following caesarian section

Time of insertion: Interval: It is a preferable to insert 2-3 days after the period is over but it can be inserted any time during the cycle even during menstrual phase. Post abortal: y If the IUD is inserted within 12 days after first or second trimester abortion if no infection is present. y If it is more than 12 days after 1 or 11 trimester, miscarriage and no infection is present .She can have the IUD inserted any time it is reasonably certain she is not pregnant. y If the infection is present treat and refer to choose another method if she still wants the IUD it can be inserted after the infection has completely cleared. Soon after the child birth: y Any time with in 48 hours after giving birth. y If it is more than 48 hours after giving birth delay IUD insertion until 4 weeks or more after giving birth. y No monthly bleeding -Any time it can be determined that she is not pregnant no need for back up method. Method of insertion: Preliminaries: y History taking and examination to exclude any contraindications of insertion. y Mother is informed about the various problems the device is shown to her and consent is obtained.

y The insertion is done in the POD taking aseptic precautions to reduce cramping pain .Ibuprofen may be given 30mnts before insertion. y Placement of the device into the inserter the device is taken out from the sealed packet the thread the vertical stem and the horizontal stem folded to the vertical stem are introduced through the distal end of the inserter. Actual steps: y The mother empties her bladder and is placed in the lithotomy position .Uterine position and size are as curtained by pelvic examination . y Posterior vaginal speculum is introduced and the vagina and cervix are cleared by aseptic lotion. y The anterior lip of the cervix grasped by Allis forceps a sound is passed through the cervical canal to note the position of the uterus and the length of the uterine cavity. y The inserter with the device placed inside is then introduced through the cervical canal right up to the fundus and after positioning it by the guard the inserter is withdrawn keeping the plunger in position. y The excess of the nylon thread beyond 2-3 cm from the external OS is cut then the Allis forceps and the posterior vaginal speculum are taken off. After the procedure: The mother is instructed about the possible symptoms of pain and slight vaginal bleeding and she should be advised to feel the thread periodically by the finger the mother is checked after 1 month and the annually.

Complications: Immediate: y Cramp like pain. y Sync opal attack. y Partial or complete perforation. Remote: y y y y y Pain. Abnormal menstrual bleeding. Pelvic infection. Spontaneous expulsion. Perforation of the uterus.

Management: If the thread is visible through the cervix it is best to remove the device however if the thread is not visible it is better to have a have it alone after counseling with the mother ,the device is expelled spontaneously with the delivery there is no conclusive evidence of increased risk of fetal anomalies with copper devices. Indications for removal of IUDs: y y y y y y y y y Persistent excessive regular / irregular uterine bleeding. Flaring up of the scalpingitis. IUD has come out of the place. Pregnancy occurring with the device in site. Mother desirous of a baby. Missing of thread. One year after menopause . When effective life span of the device is over. IUD removal is safe and can be done at any time it is done by pulling the strings gently and slowly with a forceps.

Advantages of third generation IUDs over others: y y y y y y y y y Higher efficiency with lowest pregnancy rate. Longer duration of action ( 5-10years) . Non contraceptive benefits. Risk of ectopic pregnancy is significantly reduced. Risk of PID is reduced, anemia is improved. Significant reduction in menstrual blood loss. It can used in the treatment endometrial hyperplasia. Can be used as an alternative to hysterectomy . It provides excellent benefits of hormone replacement therapy.

Disadvantages: y Expensive. y LNG, IUD ,not available through government channel in India . y Deposition of calcium salts over the device on prolonged use may prevent the diffusion of the active agent.

HORMONAL CONTRACEPTIVES
Hormonal contraceptives when properly used are the most effective spacing methods of contraception .Oral contraception of the combined type are almost 100 percent effective in preventing pregnancy. ORAL CONTRACEPTIVES: Since the 1960s oral contraceptives have been available to women through a prescription .More commonly known as the birth control pill or the pill it is an extremely popular choice of contraceptive because it is easy to use and efficient .There are two types of birth control pills the combination pill and progestin pill. COMBINED ORAL CONTRACEPTIVES: The combined oral contraceptives is the most effective reversible method of contraception. Combined oral contraceptives also called the pill. Pills that contain low doses of 2hormones a progestin and estrogen like the natural hormones progesterone and estrogen in the body. Progesterone are either: Levonogestrel Nore thisterone Desogestrel Estrogens are: Ethinyl estrediol Mestronol Depending on the amount of ethinyl estradiol and the type progesterine used pills are defined as

1.Generation-With E50 ug or more 11.Generation- E 30-35 ug and P as levonorgestrol 111.Generation- E 20-30ug and P as Desogestrel or gestodin Low dose pill have E <50 uG

Mechanism of action The contraception action of steroidal medications are multiple ,but the most important effect is to prevent ovulation by suppression of gonadotropin hormone realsing factors this prevents pituitary secretion of follicle stimulating and luteinizing hormones .Estrogen also inhibits implantation by altering normal endometrial maturation. The combined effect of estrogen and progestin with respect to the contraception is extremely effective ovulation suppression ,sperm penetration blockage by cervical mucus and unfavorable endometrium for implantation if the first two mechanism fails. Beneficial effects: y Most important benefit is prevention of unwanted pregnancy. Non contraceptive benefits: y y y y y y Improvement of menstrual abnormalities Regulation of menstrual cycle Reduction of dysmenorrhoea (40%) Reduction of menorrhagia (50%) Reduction of premenstrual tension syndrome Protective against iron deficiency anemia

Protection against health disorders: y y y y y y y Pelvic inflammatory disease Ectopic pregnancy Endometriosis Fibroid uterus Functional ovarian cysts Benign breast disease Auto immune disorders of thyroid

Prevention of malignancies: y Endometrial cancer(50%)this protection continuous for 15 or more years after stopping use. y Ovarian cancer(40%) y Colorectal cancer(40%) Adverse effects; The minor complications or aliments are; Nausea ,Vomiting, Headache and leg cramps these are transient and often subside following continues use for 2-3cycles Mastalgia- Heaviness or even tenderness in the breast is often transient. Weight gain- The progestin have got an anabolic effect due to his chemical relation to testosterone which results in a positive nitrogen balance and fat deposition. Cholasma and ache: is prevented or relieved which suppress the activity of the sebaceous glands . Menstrual abnormalities Break through bleeding :Is commonly due to sub threshold blood level hormones usually it settles 3-4 cycles Libido: Libido may be diminished probably due to dryness of the vagina

y y y

y y y y

y Leucorrhoea: It may be excessive cervical mucus secretion or due to increased preponderancy of mouilial infection.

The major complications are: y Depression, change of manifestations y Hypertension y Vascular complications Effects on reproduction: y Ovulation returns within 3 months of withdrawal of the drug in 90% cases. y Risk to fetus: When coc is taken during early pregnancy inadvertently there is no greater risk of significant congenital anomaly. y Lactation (OGN+PGN): Lactation is probably affected by a reduction in the milk production and also by alteration of the quality of milk mini pills is a better alteration for the breast feeders. mood ,sleep disturbances and psychotic

Nurses role:
Complete assessing the mother considering the criteria to use the COCs: Explaining how to use: y Give pills -give as many packs as possible even as much as a year supply(13). y Explain pill pack: Show which kind of pack 21 or 28 with 28 pills pack point that the last . y Pills are a different color ,show how to take the first pill from the pack and then how to follow the directions or arrows on the pack to take the rest of the pills.

y Give key instructions :Take on pill each day discus the cues for taking a pill every day linking pill taking with daily activity. y Explain starting next pack: 28 pills pack when she finishes one pack she should take the first pill from the next pack on the every next day .21 pill packs after she takes the last pill from one pack she should wait 7 days and then take the first pill from the next day. y Provide backup method and explain the use. Come back any time: y Assure every mother that she is welcome to come back any time ,any one who suddenly feels that something is seriously wrong with her health should be advised to come immediately. Helping continuing users: y Ask how the mother is doing with this method and whether she is satisfied. y Ask if she often has problems remembering to take a pill every day. y Give her more pill packs a full year supply . y Every year or so check blood pressure if possible. y Ask a long term mother if she has had any new health problems. Irregular bleeding: y Reassure her that many women using COCs experience irregular bleeding. y Urge her to take a pill each day and at the same time each day . y Teach her to make up for missed pill properly including after vomiting or diarrhea. y No monthly bleeding y Reassure the mother y Ask if she has been taken a pill every day.

Breast tenderness: y y y y y y y y Recommended that she wear a supportive bra Try hot or cold compress Suggest aspirin, paracetamol Weight change. Review diet or counsel as needed. Mood changes or changes in sex devices Ask about changes in her life that could effect her mood. Mothers who have serious mood changes such as major depression should be referred for care.

PROGESTIN ONLY PILL OR MINI PILL: y Pills that contain only low doses of progestin the natural hormone progesterone is called as progestin only pill. y Mini pill is devoid of any estrogen compound it contain very low doses of progestin in any of the following form: y Levonorgestrel 75ug y Norethisterone 350ug y Desogestrel 75ug y Lynestrenol 500ug y Norgestrel 30 ug

Mechanism of action: It works mainly by making cervical mucus there by prevents sperm, penetration, implantation, endometrium becomes atrophic .So blast cyst implantation also hindered .In about 2% of cases ovulation is inhibited.

Advantages: y Side effects contributed to estrogen in the combined pill are totally eliminated. y No adverse effect on the lactation and hence can be suitably prescribed in the lactating women and as such it is often called as lactation pill. y Easy to take as there is no on and off regimen y It may be prescribed in patient having hypertension ,fibroid ,diabetes ,and epilepsy. y Reduces risk of PID and endometrial cancer. Draw backs; y There may be acne break through bleeding. y All the side effects attributed to the progestins may be evident. y Failure rate may be about 0.5-2%. NURSES ROLE Explain how to use: y Give pills give as many as packs as possible even as much as years supply. y Explain pill pack: Show which kind of pack 28 pill or 35 pill .Explain that all pills in POP packs are the same colour.Show how to take the first pill from the pack and then how to follow the directions or arrows on the pack. y Give key instructions :Take the pill each day discuss the cues for taking pill every day. y Explain starting next pill : When she finishes one pack ,she should take the first pill from the next pack on the every next day. y Provide back up method when necessary. y Explain that effectiveness decreases when breast feeding stops.

Managing missed pills: y Taka a missed pill as soon as possible. y Keep taking pills as usual one each day. y If she has regular monthly bleeding .She also should use a back up method and if she had sex in the past 5 days can consider ECPs. y When a mother had vomiting within 2 hours next dose has to be given as early as possible. Come back any time: y Assure the mother to come problem. Planning the next visit: y Encourage her to come back more pills before she uses up her supply of pills y Contacting women after the 3 months of POP use recommended. Helping continuing users: y y y y Ask mother how she is following and whether she is satisfied. Ask especially if she is concerned about bleeding changes Give her more pill packs Ask the mother she had any new health problems since her last visits back any at time if she had any

DEPO- PROVERA
Women who are looking for a long term ,highly effective method of birth control may want to use depo - provera also known as DMPA or the short depo provera is a type of birth control that only need to be administered four times a year

Depo provera is a progestin injection that is given for every three months like the mini pill and Norplant this injection works to suppress ovulation ,may thicken cervical mucus to create a hostile environment for sperm and thins the uterine lining to make Implantation of a fertilized egg difficult . Many women prefer Depo-Provera because they do no have to worry about taking a pill every day. Women who breast feeding can use Dpo -provera but only the after the sixth week post partum .Additional Depo- provera offers some protection against endometrial cancer. However it offers no protection against sexual transmitted diseases. Side effects: y Unlike the birth control pill which provides women with a small doses of hormones on a daily basis. Depo-Provera gives a women large doses of progestin at one time as a result side effects of this contraceptive tend to be more pronounced . y Change in menstruation. y Increase in spotting and break through bleeding. y Weight gain. y Dizziness. y Nervousness. y Change in libido. y Rash or skin discoloration . y Breast tenderness. y Depression. y Increase or decrease in facial and body hair. y Hair loss. Complications: y There are some serious health complications the use of Depo-Provera. that can occur with

y y y y

Breast cancer and cervical cancer. Jaundice. Blood clots. Severe allergic reactions and infertility.

Effectiveness: y Depo-Provera is one of the most effective forms of hormonal birth control on average the failure rate is only 0.5% women who become pregnant while taking Depo- Provera have higher neonatal and infant mortality rates. y Women who are hoping to become pregnant with in the next year should not begin taking Depo- Provera. y It can take as much as a year before your menstrual system returns to normal after discontinuing the short.

NORPLANT
This progestin only contraceptive is actually an implant that is worn for up to five years .Availability of this hormonal birth control varies according to where you live in the united states . Norplant is no longer available. Action: Norplant is a made of six tiny silicon rods that contain progestin .These rods are implanted under the skin of upper arm where they are left for as long as five years .The implant procedure can be done in the doctor s office and takes about 10 minutes. Norplant is becomes effective within 24 hours of menstruation .While have the implants progestin is slowly released into the body .The progestin works to thicken cervical mucus there by creating a barrier for sperm. It may also suppress ovulation as well as thin the lining of uterus .Which will hinder the implantation of the fertilized egg.

Benefits of Norplant: Norplant offers continuous protection against pregnancy for as much as five years .Women who are breast feeding can safely use Norplant. Side effects and complications: y While side effects of Norplant are generally the same as other types of hormonal contraceptives. y Menstrual disturbance and irregularities. y Headache/Migraines. y Increase in acne. y Weight gain. y Nausea. y Anxiety. y Unwanted hair growth or loss . y Ovarian cysts. Effectiveness: When Norplant was first introduced in1990.Norplant is no longer available in many countries including the united states due to the severity of side effects experienced by some women. Women who are currently have Norplant implant may continue to use this form of birth control but will need to use a different forms of contraception once the implant are removed.

COTRACEPTIVE PATCH
One of the newest form of hormonal birth control to come onto the market is the patch which is sold under the brand name ortoevra .it is available through a prescription

Action of the patch: The patch operates on the some premise as the combination birth control pill .It uses estrogen and progesterone to suppress ovulation ,thickness cervical mucus and possibly thin the uterine linning.However instead of taking these hormones orally this contraceptives allows the hormones to be continuously delivered directly into the blood stream through the skin via a thin patch. On the same day every week ,users of ortho evra .Place a new patch on the buttocks abdomen or the upper outer arm for three consecutive which patch offers effective protection against pregnancy for one month. It does not offer any protection against sexually transmitted diseases.

Advantages of the patch: Many women find the patch more convenient to use than pill because they only need to worry about it once a week use of the patch can help to regulate a women s periods to be lighter, shorter and with fewer menstrual cramps . others reported benefits of the patch are similar to the birth control pill and include: y Decrease PMS symptoms. y Decreased in the appearance of acne. y Some protection against pelvic inflammatory diseases and ectopic pregnancy. y Decreased risk of endometrial and ovarian cancers. Side effects: y y y y Side effects of ortoevra are similar to birth control pill and include: Breast tenderness. Headaches. Nausea.

y y y y y y y y y

Mood swings. Weight gain Spotting and break through bleeding. Irritation at the site of application. Although rare more serious side effects of the patch include: Blood clots. Stroke. Heart attacks Possibly an increased risk of cervical cancer .The risk of these serious health complications is increased for smokers and especially smokers over the age of 35.

VAGINAL CONTRACEPTIVE RING

One of the newest development in hormonal contraceptives is the vaginal contraceptive ring also known as the ring and sold under the brand name Nuva ring each ring provides continuous protection against pregnancy for up to one month .It is available through a prescription. Action of the vaginal contraceptive ring: The nuva ring is a small transparent ring that is inserted into the vagina ,near the cervix and worm for three weeks. During this time it slowly releases estrogen and progesterone into the body like the combination birth control pill, the hormones works suppress ovulation and thicken cervical mucus like the birth control pill the vaginal ring may also change the uterine lining there by impending the implantation of a fertilized egg. Anew vaginal needs to be inserted every month .Once inserted the ring is worn for three consecutive weeks before it is removed for one week .During the week that the ring is not worn menstruation occurs each ring provides one month worth of birth

control .However the ring does not protect against any sexually transmitted diseases. First time users of the ring will start this method of birth control during the first five days of their menstrual period .Because it takes seven days for the ring to become effective it will be necessary to use an additional form of birth control during the first week .However if women have already been using another form of hormonal birth control then the ring should be effective as soon as they swith.

Benefits of using the ring: Many women like the convenience of only having to worry about their contraception once a month women also like the fact that using a vaginal ring can cause their menstrual periods to be lighter and shorter with fewer cramps .other benefits of the ring are similar to the birth control pill and include: y Decreased PMS symptoms. y Decreased in the appearance of acne. y Some protection against pelvic inflammatory diseases and ectopic pregnancy. y Decreased risk of endometrial and ovarian cancers. Complications and side effects of the ring: As with all hormonal birth control methods there a variety of side effects associated with the use of vaginal contraceptive rings .The most common ones include: y Yeast infection. y Increased vaginal discharge or irritation. y Upper respiratory infection.

Sinus infection. Weight gain. Nausea. Spouting or break through bleeding. Headaches. Tender breasts. Mood swings. There are also a number of more serious health complications associated with the use of the ring .These include an increased risk of : y Stroke. y Heart attack. y Gall bladder disease. y y y y y y y y

EMERGENCY CONTRACEPTIVE METHODS Emergency contraception or emergency post coital contraception refers to contraceptive measures that if taken after sex ,may prevent pregnancy. Emergency contraception or emergency birth control is used to help keep a women from getting pregnant after she had has sex with out using birth control or if birth control method failed , if are already pregnant emergency contraception will not work. Forms of EC include: Emergency contraceptive pills: Sometimes simply referred to as emergency contraception or morning after pill are drugs that act both to prevent ovulation or fertilization and possibly post fertilization implantation of a blast cyst .ECPs are distinct from medical abortion methods that act after implantation. Intrauterine devices: y Usually used as a primary contraception method but some times used as emergency contraception. y As its name implies EC is intended for occasional use. When primary means of contraception fails .Since EC methods act before implantation they are medically and legally considered forms of contraception . Some scientists believe that EC may possibly act after fertilization a possibility that leads some to consider EC an abortifacient. y Emergency contraceptive pills may contain higher doses of the some hormones found in irregular combined oral contraceptive pills taken after unprotected sexual intercourse ,such higher doses may present pregnancy from occurring .Mifepristone can be used as EC but is an anti hormonal drug and does not contain estrogen or progestin s.

y The phase morning after pill is a misnomer ECPs are effective when used shortly before intercourse and are licensed for use up to 72 hours after sexual intercourse and the WHO says they can be used for up to 5 days after contraceptive failure TYPES OF ECPs The progestin-only method uses the progestin levenorgestrel in a doses of 1.5 mg either as two 750mg doses 12 hours apart or more recently as a single dose progestin only EC is available as a dedicated emergency contraceptive product under many names world wide including in the U.S Canada and Honduras plan B. The combined or yuzpe regimen users large doses of the both estrogen and progestin taken two doses at a 12 hours interval .This method is now believed to be less effective and less well tolerated than the progestin only method. It is possible to obtain the same effect by taking sexual regular combined oral contraceptive pill. Morning after pills (ECPs) are not to be confused with imferistone used as an abortion pill according to the international federation of gynecology and obstetrics. EC is not an abortifacient because it has its effect prior to the earliest time of implantation . Since ECPs out before implantation they are considered medically and legally to be form of contraception EFFECTIVENESS OF ECPs: The effectiveness of emergency contraception is presented difficulty from the effectiveness of ongoing methods of birth control it is expressed as a percentage reduction in pregnancy rate of a single use of EC . Different ECP regimens have different effectiveness level . For both the progestin only and yuzpe regimens the effectiveness of emergency contraception is highest when taken with in 12 hours of intercourse and declines over time .While most studies of emergency contraception have only enrolled women within 72 hours of unprotected intercourse a 2002 study

by the world health organization suggested that reasonable effectiveness may continue for up to 12 hours after intercourse. SAFETY: Existing pregnancy is not a contra indication in terms safety as there is no known harm to the women the course of her pregnancy or the fetus if progestin only or combined emergency contraception pills are accidentally used but EC is not indicated for a women with a known or suspected pregnancy because it is not effective in women who are already pregnant. SIDE EFFECTS: The most common side effects reported by users of emergency contraceptive pill was nausea, vomiting. Other common side effects were abdominal pain , fatigue, headache, dizziness and breast tenderness .Side effects do not occur for more than a few days after treatment and they generally resolve within 24 hours.

PERMANENT FAMILY PLANNING METHODS

Voluntary sterilization is a well established contraceptive procedure for couples desiring no more children currently female sterilization accounts for 85 percent and male sterilization for 10-15 percent of all sterilization in India (Government of India year book 198384) voluntary sterilization is a surgical method where by the reproductive function of an individual male or female is destroyed purposefully and permanently .The operation done in males is vasectomy and that on female is tubal ligation or tubal occlusion. Sterilization offers many advantages over other contraceptive methods.

y It is a one time method. y It does not require sustained motivation of the user for its effectiveness. y It provides the most effective protection against pregnancy. y The risk of complications is small if the procedure is according to the accepted medical standards. y It is most cost effective.

Guide lines for sterilization: y Sterilization services are provided free of charge in government institutions. y The age of husband should not ordinarily be less than 25 years or more than 45 years. y The age of wife should not be less than 20 years or more than 45 years. y The motivated couples must have two living children at the time of operation. y The couples knows that for all practical purposes.

VASECTOMY
Vasectomy is a permanent sterilization operation done in the male where a segment of vas deference of both the sides are resected and the cut ends are ligated. ADVANTAGES: y The operative technique is simple and can be performed by one with minimal training. y The operation can be done as an outdoor procedure or in a mass camp even in remote villages. y Complications- immediate or late complications are few. y Failure rate is minimal 0.5% and there is a fear. Chance of success of reversal anastomosis operation. y The overall expenditure is minimal in terms of equipment, hospital stay and doctor s training. DISADVANTAGES: y Additional contraceptive protection is needed for about 2-3 months following operations i.e. till the semen becomes free of sperm. y Frigidity or impotency when occurs is mostly psychological. TECHNIQUE: y Written consent of the person is a must and the surgeon should be convinced about the family structure of the couples. y Premedication is usually not necessary. y The local area shaved and an antiseptic dressing is given with savlon. y The vas is palpated at the base of the scrotum and is lifted up by the thumb and index finger of the left hand. y The area over the vas and the adiposing part are in filtered with it lignocaine

y Small vertical incision is given -3/4 over the vas. y After dissecting the dertus muscle and cutting the sheath ,the vas is reached and separated from the surrounding structure and lifted up by an Allis forceps. y Homeostasis is secured and the skin is sutured by inteupted catgut. y The same procedure is repeated on the opposite side. y A scrotal suspensary bandage is worn. y The patient is allowed to go home after an hour. ADVICES: y Antibiotics and analgesics are administered. y Weight lifting ,heavy work or cycling is restricted for about 2 weeks ,while usual activities can be resumed forthwith. y Additional contraceptives should be used for 2-3 months. COMPLICATIONS: Immediate: y Wound sepsis ,which may lead to scrotal cellulites or abscess. y Scrotal haematoma. Remote: y Frigidity or impotency -it is most psychological in origion. y Sperm granuloma is due to inflammatory reaction leakage. y Increase in sperm agglutination in circulation. y Spontaneous recannulisation.

to sperm

NOSCALPEL VASECTOMY: No scalpel vasectomy is a new technique that is safe ,convenient and acceptable to males .This method is performed under local anesthesia ,stretched skin over the vas is punctured with one blade of a sharp pointed dissecting scissors instead of using a scalpel .Then the hole is increased and the vas is dissecting out by using the tip of the scissors. OPEN ENDED VASECTOMY: The testicular abdominal end of the end is open .This will resected vas is prevent congestive

coagulated .The epididymitis. NURSES ROLE:

y Assess the client and consider the medical criteria for client selection. y Educate thoroughly about the procedure and take informed consent. y Explain the self care for vasectomy. y Before the procedure the should wear clean ,loose clothing to the health facility. y After the procedure the man should rest for 2 days if possible . y If possible put cold compress on the scrotum for the first 4 hours ,which may decrease pain and bleeding. y Wear snug under wear or pants for 2-3 days to help support the scrotum ,this will lessen swelling ,bleeding and pain. y Keep the puncture / incision site clean and dry for 2-3 days. y Use condoms or another effective family planning methods for 3 months after the procedure. Plan for follow up visit: y Ask him to return in 3 months for semen analysis.

y Assure every client to come back at any time if he has bleeding ,pain ,pus , heat , swelling or redness.

FEMALE STERILIZATION
Occlusion of the fallopian tubes in some form is the underlying principle to achieve female sterilization. It is the most popular method of terminal contraception. INDICATIONS: Family planning purposes: This is the principle indication in most of the developing countries .India in particular intensive education and even cash incentives are provided to boost up the programme. Socioeconomic: An individual is adopted to desired number of children Medico surgical indications: Medical disease such as heart diseases ,diabetes ,chronic renal diseases and hypertension are likely to worsen ,if repeated pregnancy occur and hence sterilization is advisable .During the third time repeat cesarean section or repair of prolapsed operation to avoid risks involved in the future child birth process sterilization operation should be considered. TIME OF INSERTION: The operation can be performed During puerperium: If the women is otherwise healthy the operation can be done 24-48 hours following delivery ,hospital stay and at rest home following accept the method after having the

delivery are enough to help the women recover simultaneously the two events i.e. delivery and operation. Interval procedure:

from

The operation is done beyond three months following delivery or abortion .The ideal time of operation is following menstrual period in proliferative phase. Concurrent phase: Sterilization is done along with termination of pregnancy.

METHODS OF FEMALE STERILIZATION Occlusion by resection of a segment of both fallopian tubes is the widely accepted procedure . During the recent years ,occlusion of the tubes with rings or clips using a laparoscope is gaining popularity. TUBECTOMY It is an operation where a resection of a segment of fallopian tubes is done to achieve permanent sterilization. The approval may be y Abdominal /vaginal y Abdominal -conventional y Minilaparoscopy CONVENTIONAL /LAPAROTOMY STEPS Anesthesia: the operation can be done under local /spinal /general anesthesia .In mass camp local anesthesia is preferred. In case of local anesthesia premedication with inj :Morphine 15 mg/ both the

inj : pethidine 100mg with inj: phenargon 50 mg is given at least 30-40 mts prior to surgery the incision area is infiltrated with 1% lignocaine. Incision : In puerperial cases ,where the uterus is felt per abdomen ,the incision is made 2 fingers breadth , below the fundal height and in interval cases ,the incision is made 2 fingers breadth above the symphysis pubis , the incision is done either midline / paramedian /transverse. Delivery of the tube: The induction finger is introduced through the incision, the finger is passed across the posterior surface of the uterus and then to the posterior leaf of the broad ligament from where the tube is hooked out. TCCHNIQUE POMEROYS METHOD

A loop is made by holding the tube by an Allis forceps in such a way that the major part of the loop consists mainly of isthmus and the part of the ampullary part of the tube ,about 1-1.5 cm of the segmented of the tube distal to the ligature is exercised as to leave about 1.5 cm of intact tube adjacent uterus. MADLENERS TECHNIQUE Is the earliest method ,but failure rate is 3% ,the loop of the tube is crushed with an artery forceps ,the crushed area is tied with black silk , the loop is not excised. The abdomen is sutured in layers, Antibiotics are given mother is normal ,discharge after 48 hours. routinely ,if the

MINILAPAROTOMY When tubectomy is done through a small abdominal with some device ,the procedure is called minilap. STEPS y Anesthesia- always under local anesthesia y Plan of incision -1/2 -3/4 inch y Specially recognized retractor may be introduced after the abdomen is opened. y The uterus is elevated or pushed to one side by the elevator that has already been introduced trans vaginally into the uterine cavity. y The appropriate technique of tubectomy is performed on the side and then repeated on the other side. y The peritoneum is closed by purse string suture. y Usually the mother is discharged within 24-48 hours. VAGINAL LIGATION Tubectomy through the vaginal route may be done along with vaginal plastic operation or in isolation .when done in isolation , the approach to the tube is through the posterior colpotomy. LAPAROSCOPIC STERILIZATION Laparoscopy is the commonly employed method of endoscopic sterilization ,the procedure is commonly done under local anesthesia ,the operation is done in the interval period ,concurrent with vaginal termination of pregnancy or 6 weeks following delivery. The procedure can be done either with single puncture or double puncture technique the tubes are occluded either by a silastic ring. incision along

PRINCIPLE STEPS
PRE -MEDICATION -Pethidine hydrochloride 75-100mg with phenorgon 25 mg and Atropine sulphate 0.65 mg are given intramuscularly about hour before operation. LOCAL ANAESTHESIA Taking usual aseptic precautions about 10 ml of 1% lignocaine hydrochloride is to be infiltrated at the puncture site down up on the peritoneum. POSITION The mother is placed in lithotomy position .The operating table is tilted to approximately 15 degree of trendellenburg position ,the bladder should be emptied . pelvic examination is done methodically ,an uterine manipulator is introduced through the cervical for manipulation for visualization of tubes and uterus at a later step. PRODUCING PNEUMOPERITONIUM is just below the the incision with ,the abdomen is

A small skin incision 1.25cm umbilicus. the verres needle is introduced through 45 degree angulation into the peritoneal cavity inflated with about 2 Its of gas. INTRODUCTION OF TROCHAR APPLICATOR

AND LAPAROSCOPIC WITH RING LOADED

2 silastic rings are loaded one after the applicator with the help of a loader and pusher.

the other on

The ring loaded applicator approaches one side of the tube and grasps at about 2-3 cm from the utero placental junction . a loop of the tube (2.5 cm )I lifted up, down into the cylinder of the

applicator and the ring is slipped direct vision. REMOVAL OF THE LAPAROSCOPE

into the base of the loop

under

After viewing that the rings are properly placed in position, the tubal loops looking white and there is no intraperitoneal bleeding, the laparoscopic is removed .The gas or air is deflated from the abdominal cavity, the abdominal wound is sutured by single chromic catgut suture. HAZARDS OF TUBAL STERILIZATION Immediate -related to anesthesia RemoteGeneral complications- Occasional obesity ,psychological upset.

Gynecological -Chronic pelvic pain , congestive dysmenorrheal , menstrual abnormalities , alteration in libido Failure rate -The 0.7% overall failure rate in tubal sterilization is about

Mortality -Is estimated to be about 72 per 1,00,000 Reversibility Pregnancy rate after reversal are high (80%) following use of clips and rings .reversal of vasectomy of vas potency is possible up to 90% of cases. NURSES ROLE y Assess the mother and concise whether the mother is eligible for the sterilization or not y Listen to a women s concerns ,answer to her questions and give clear information y Involving her partner can be helpful but is required

y Take consent -to give informed consent to sterilization the following points should be known to mother y Voluntary sterilization is a surgical procedure. y There are certain risks of the procedure as well as the benefits. y If successful , the procedure will prevent the mother from ever having any more children y The procedure is considered permanent and probably can not be reversed. y The mother can decide against the procedure at any time before it takes place . y Support the user before the procedure ,the women should, y Use another contraceptive until the procedure. y Not eat anything for 8 hours before surgery .She can drink clear fluids until 2 hours before surgery. y Wear clean ,loose fitting clothing to the health facility if possible y Not wear nail polish or jewellary. y If possible ,being friend or relative to help her to go house after wards . y After the procedure ,the women shouldy Rest for 2 days and avoid vigorous work and heavy lifting for a week . y Keep incision clean clean and dry for 1-2 days. y Avoid rubbing the incision for 1 week. y Not have sex at least for 1 week ,if pain lasts for more than 1 week, Avoid sex until all pain is gone. Plan for follow up visit; Plan the follow up visit: y Following up with 7 days or at least with in 2 weeks is strongy recommended y The nurse will check the site of the incision , look for signs of infection and remove.

Come back any time; Assure every mother - That she is welcome back at any time, Whenever any problem arises like bleeding, pain ,high fever ,fainting ,persistent cough.

RESEARCH STUDIES
Use of family planning methods in Kassala, Eastern Sudan Abstract
Background Investigating use and determinants of family planning methods may be instructive in the design of interventions to improve reproductive health services. Findings Across sectional community-based study was conducted during the period February-April 2010 to investigate the use of family planning in Kassala, eastern Sudan. Structured questionnaires were used to gather socio-demographic data and use of family planning. The mean SD of the age and parity of 613 enrolled women was 31.1 7 years and 3.4 1.9, respectively. Only 44.0% of these women had previously or currently used one or more of the family planning methods. Combined pills (46.7%) and progesterone injection (17.8%) were the predominant method used by the investigated women. While age, residence were not associated with the use of family planning, parity (> five), couple education ( secondary level) were significantly associated with the use of family planning. Husband objection and religious beliefs were the main reasons of non-use of family planning. Conclusion Education, encouragement of health education programs and involvement of the religious persons might promote family planning in eastern Sudan.

Family planning services quality as a determinant of use of IUD in Egypt Abstract

Background Both availability and quality of family planning services are believed to have contributed to increasing contraceptive use and declining fertility rates in developing countries. Yet, there is limited empirical evidence to show the relationship between the quality of family planning services and the population based prevalence of contraceptive methods. This

study examined the relationship between quality of family planning services and use of intrauterine devices (IUD) in Egypt. Provision Assessment (ESPA) survey that included 602 facilities offering family planning services. The EIDHS collected latitude and longitude coordinates of all sampled clusters, and the ESPA collected these coordinates for all sampled facilities. Using Geographic Information System (GIS) methods, individual women were linked to a facility located within 10 km of their community. A facility-level index was constructed to reflect the quality of family planning services. Four dimensions of quality of care were examined: counseling, examination room, supply of contraceptive methods, and management. Effects of quality of family planning services on the use of IUD and other contraceptive methods were estimated using multinomial logistic regression. Results are presented as relative risk ratios (RRR) with significance levels (p-values). Results IUD use among women who obtained their method from public sources was significantly positively associated with quality of family planning services (RRR = 1.36, p < 0.01), independent of distance to the facility, facility type, age, number of living children, education level, household wealth status, and residence. Quality of services related to counseling and examination room had strong positive effects on use of IUD (RRR = 1.61 for counseling and RRR = 1.46 for examination room). Obtaining IUD from a private source or using other contraceptive methods was not associated with quality of services. Conclusion This study is one among the few that used geographic information to link data from a population-based survey with an independently sampled health facility survey. The findings demonstrate that service quality is an important determinant of use of clinical contraceptive methods in Egypt. Improving quality of family planning services may help further increase use of clinical contraceptive methods and reduce fertility

SUMMARY

Women health is the health of the entire family when women is suffering with some problems entire community will be affected. There may types of methods are available to follow like barrier methods ,the male condom ,the female condom ,the cervical cap ,the diaphragm ,the contraceptive sponge ,spermicide ,hormonal methods such as ,birth control pills ,contraceptive patch ,the vaginal ring ,injections ,implants ,intra uterine devices ,natural family planning methods ,abstinence., with drawl methods ,rhythm method .basal body temperature method, ovulation method, symptothermal method lactational amenorrhea method ,standard days method, two day method ,emergency contraceptives ,permanent family planning methods ,tubectomy for women vasectomy for men.

CONCLUSION India s population is increasing very explosively population expulsion is found to be the main reason for shortages of resources and neutralization of impact of progress made in various developmental sectors, husbands and millions of people still are very poor ,illiterate and unhealthy it is because resources are limited ,population is large and every year around 17 million new mouths are added ,It is there for very important to control and stabilize the population for this family planning and birth control is one of the most desirable solutions for controlling population growth.

BIBLIOGRAPHY 1. DC dutta text book of obstetrics 7th edition ,new central book agency. 2. Myles text book for midwives 15th edition ,Churchill living stone publishers 3. BT Basavanthappa text book of midwifery and reproductive health nursing. 4. Annamma Jacob text book of midwifery 5. www.google.com 6. www.pubmed.com. 7. www.ask.com .

SEMINAR
CONTRACEPTIVE TECHNOLOY
SUBMITTED TO MRS . RADHA RAMANA SREE LECTURER SUBMITTED BY D. REDDAMMA

ON

M SC NURSING 1 ST YEAR

GOVERNMENT COLLEGE OF NURSING OBSTETRICAL AND GYNAECOLOGICAL NURSING SEMINAR ON :C ONTRACEPTIVE TECHNOLOGY

INTRODUCTION

DEFINITION OF CONTRACEPTION.

A process or technique for the prevention of pregnancy by a medication, devices or method that blocks or alters one or more of the processes of reproduction in such a way that sexual union can occur without impregnation. __Mosby s___ Contraception (birth control) prevents pregnancy by interfering with the normal process of ovulation ,fertilization and implantation. There are different kinds of birth control that acts at different points in the process.

___Encyclopedia TYPES OF CONTRACEPTIVE METHODS. BARRIER METHODS. Male condom Female condom Cervical cap Diaphragm Contraceptive sponge

Lea s shield Spermicides NATURAL CONTRACEPTIVE METHODS. Abstinence With drawl method Rhythm method Ovulation method Basal body temperature method Symptothermal method Lactational amenorrhoea method Standard day method To day method INTRA UTERINE CONTRACEPTIVE DEVICES. HORMANAL METHODS. Combined oral contraceptives Progestin only contraception or mini pill Injections Norplant Contraceptive patch Vaginal contraceptive ring EMERGENCY CONTRACEPTIVE METHODS PERMANENT FAMILY PLANNING METHODS VASECTOMY Define vasectomy Types of vasectomy Advantages Draw backs Complications

Nurses role. FEMALE STERILIZATION Indications Time of operation Methods of female sterilization Theatre preparation steps Complications Nurses role RESEARCH STUDIES SUMMARY CONCLUSION BIBLIOGRAPHY

INVITATION

Respected madam I would like to invite you to attemd my seminar on contraceptive technology which is to be held at seminar hall in Government modern maternity hospital on 14th June 2011 from 2pm to 4pm, your presence and valuable suggestions are most precious to me.

Thanking you madam