婦產(chǎn)科學(xué)課件：計劃生育(英文版)

1、Family planningFamily planningSummaryFamily planning enables sexually active couples to prepare for their pregnancies, in order to optimize both fetal and maternal outcomes.Fertility control? Avoid unwilling pregnancyUnplanned pregnancies constitute major public health problems.SummaryFamily plannin

2、g enablesThree categories of family planning排 卵受 精著 床卵泡發(fā)育InterceptionContraceptionAbortionThree categories of family plaChapter 1 ContraceptionChapter 1 ContraceptionMethods of contraceptionIntrauterine device, IUDHormonal contraceptionOther contraceptive methodsMethods of contraceptionIntrauIUDConv

3、enience, cost effectiveness and reversibilityFor women who are in stable, mutually monogamous relationships at low risk for sexually transmitted infections (STIs)Most commonly used in China80%IUDConvenience, cost effectiveHistory of IUDUsed in animals at first1909, the first human IUD, designed by a

4、 German doctor named Richard Richter, was made of silkAseptic techniquemodern IUDHistory of IUDUsed in animals Ancient IUDsAncient IUDsCategories of modern IUDsIUDs wound with copper wireDifferent shapesDifferent surface areas of copperThe levonorgestrel-releasing intrauterine system (LNG-IUS, Miren

5、a)左炔諾酮緩釋系統(tǒng)，曼月樂Release levonorgestrel 20ug/dSuitable for women with heavy menses or dysmenorrhealCategories of modern IUDsIUDs Modern IUDsModern IUDsTCu-380TCu-380TCu375 母體樂TCu375 母體樂Mechanisms of contraceptionMechanisms of contraceptionMechanisms of contraceptive action of IUDsKill the sperm or fert

6、ilized ovum byMobilization of leukocytes in response to the presence of the foreign bodyLeukocytes may produce an environment hostile to the fertilized ovumSpermicidal activity with copper devicesPrevent implantation byDisruption of endometrial maturation with the progesterone-releasing deviceAltera

7、tion of normal tubal actionDisruption of normal oocyte maturationMechanisms of contraceptive acIndications to the use of IUDsWomen of childbearing age with no contraindication who accept IUDUterine cavities sound to 6cm-9cmParous women in a mutually monogamous relationship who do not have a current

8、or prior history of STDs or salpingitisWomen desiring a method of high efficacy that is free of daily or coitally related activityIndications to the use of IUDsCurrent pregnancyAcute cervical, uterine, or salpingeal infectionSuspected gynecologic malignancyPolymenorrhea(月經(jīng)頻發(fā)), hypermenorrhea(月經(jīng)過多),

9、or undiagnosed abnormal vaginal bleedingSevere cervical relaxation, laceration or stenosis, or severe uterine prolapseCongenital anomalies of the genital organsUterine cavities sound to 9cmContraindications of IUDsCurrent pregnancyContraindicatContraindications of IUDsSevere acute or chronic general

10、 diseasesHistory of STDsPelvic tuberculosisHigh risk of infection or bleeding after induced abortion or deliveryCopper allergic history Prior ectopic pregnancyMultiple sexual partnersContraindications of IUDsSeverTime of IUD insertion3-7 days after menstrual bleeding stops, without sexual intercours

11、e 42 days after vaginal delivery when perineal wound heal well and the uterus involute to normal size6 months after c-sectionMirena should be inserted on the third day of menstrual bleedingTime of IUD insertion3-7 days Insertion of the round IUDInsertion of the round IUDInsertion of the uterine-shap

12、ed IUDInsertion of the uterine-shapeInsertion of the LNG-IUDInsertion of the LNG-IUDComplications of IUD insertionModerate discomfort or pain when the uterus is sounded or when the IUD is insertedBleedingInfectionPartial or complete perforation of the uterusSyncopal reactionsUterine crampsComplicati

13、ons of IUD insertionFollow-up of IUD by ultrasoundFollow up the IUD 3 months, 6 months, 12 months after insertion and every year afterwardsFollow-up of IUD by ultrasoundIndications to the IUD removalExpiryoftheavailability of an IUDMenopause for 6 months or menstrual disorder during perimenopausal p

14、eriodNo more need for contraceptionAsking for other contraceptive methods or sterilizationSevere side effects or complicationsPregnancyIndications to the IUD removalAcute genital or pelvic infectionPoor systemic conditions or acute stage of general diseasesTime of IUD removal:3-7 days after menstrua

15、l bleeding stops Any time when there is severe vaginal bleedingContraindications to the IUD removalAcute genital or pelvic infectIUD removalIUD removalSide effects of IUDsMenstrual disorders or abnormal vaginal bleedingLower abdominal or lumbosacral pain（腰骶部疼痛）IncreasedvaginalsecretionsSide effects

16、of IUDsMenstrual Complications of IUDsPregnancyExpulsion（移位）Pelvic infectionComplications of IUDsPregnancy婦產(chǎn)科學(xué)課件：計劃生育(英文版)Health benefits of IUDsThe LNG-IUS（曼月樂） results in a 70% to 90% reduction in menstrual blood lossThe LNG-IUS can release dysmenorrhealHealth benefits of IUDsThe LNGHormonal contr

17、aceptionInvented by an American doctor named Gregory Goodwin Pincus in 1954Categories:Oral hormonal contraceptives (OCs)Hormonal contraception by injection, implantation or transdermal routesHormonal contraceptionInvented婦產(chǎn)科學(xué)課件：計劃生育(英文版)Mechanisms of contraceptive actionSuppression of the LH surge p

18、revent ovulation Thickening of the cervical mucus prevent sperm penetrationAlter motility of the muscle of the uterus and oviducts Slowing of tubal transportAtrophy of the endometrium prevent implantationMechanisms of contraceptive acSevere cardiovascular diseasesAcute or chronic hepatitis or nephri

19、tisThrombotic diseasesEndocrine disordersMalignant tumor, precancerous lesion, mass of uterus or breastLactation period（哺乳期）Oligomenorrhoea (月經(jīng)稀少) or age 45Undiagnosed abnormal vaginal bleedingMental disordersContraindications of OCsSevere cardiovascular diseasesUsage of OCsSynthetic steroids simila

20、r to the estrogen and progestinCommonly used drugs:Marvelon (媽富隆)=炔雌醇30g+去氧孕烯0.15mgYasmin (優(yōu)思明)=炔雌醇30g+屈螺酮3.0mgDiane-35 (達(dá)英-35)=炔雌醇35g+醋酸環(huán)丙孕酮2mgCombined regimen (21 tablets) is begunwith the onset of the menstrual cyclestop for 1 week and then start the next cycleUsage of OCsSynthetic steroidsAdvant

21、ages of OCsOvarian and endometrial cancer Menorrhagia(月經(jīng)過多) and dysmenorrhea(痛經(jīng)) PID, endometriosis, benign breast changes, and ectopic pregnancy Iron-deficiency anemia and acne Improvements in hirsutism(多毛癥) and symptomatic endometriosisAdvantages of OCsOvarian and eDisadvantages of OCsThe risk of

22、thromboembolic diseasePulmonary embolismCerebral thrombosisGreater risk of developing coronary thrombosisconfined to older users who smoke one or more packs of cigarettes per dayDisadvantages of OCsThe risk oDisadvantages of OCsBreast cancer? No risk or unclear Cervical intraepithelial neoplasia sli

23、ghtly higher riskOther infrequent problemsHypertensionCholelithiasis(膽石癥)Benign liver tumorsDisadvantages of OCsBreast canSide effects of OCsBreakthrough spotting and bleeding resolve after 1 to 3 months of useMissed menstrual periods or amenorrheaNauseaHeadachesWeight gainSide effects of OCsBreakth

24、rougOther contraceptive methodsMale condomFemale condomNatural family planning, NFPVaginal spermicidesOther contraceptive methodsMalMale condomDefinition:The latex rubber or animal intestine condom serves as a cover for the penis during coitus and prevents the deposition of semen in the vagina.Male

25、condomDefinition:Male condomFailure rates: 2%-15% in the first year of useUsed in conjunction with contraceptive vaginal jelly or foam can reduce the chances for condom failure due to mechanical or technical deficienciesMale condomFailure rates: 2%-1Advantages of condomProvides highly effective and

26、inexpensive contraceptionProvides protection against sexually transmitted diseases (STDs)Some condoms contain a spermicide, which may offer further protection against failureAdvantages of condomProvides hFemale condom(vaginal pouch)Female condom(vaginal pouch)陰道隔膜陰道隔膜宮頸帽宮頸帽Natural family planning me

27、thodWomen are fertile for only a few days of the menstrual cycleThe fertile period is from the time of ovulation to 2-3 days thereafterCouples avoid intercourse during the at-risk days, or use another method (usually condom) during the womans fertile days.Natural family planning methodNatural family

28、 planning methodA variety of methods are used to calculate a womans fertile days each cycle.Calendar methodBasal body temperatureCervical mucus changesFertility monitorsNatural family planning methodNatural family planning methodNot reliable and safe enoughNot recommended!Natural family planning met

29、hodPostcoital or emergency contraceptionTwo hormonal products are available for EC:High-dose levonorgestrelHighdose combined estrogen/progestin pillsStarting as soon as possible after exposureRecommended to be started within the first 72 hoursMorning after IUD (Copper) insertion within 120 hours Pos

30、tcoital or emergency contraChapter 2 SterilizationChapter 2 SterilizationFemale SterilizationAchieve sterilization by occluding the uterine tubesA permanent method of contraceptionRequiring an intraperitoneal(腹膜內(nèi)的) incision and general anesthesiaLigation of the oviducts is usually performedthrough a

31、 colpotomy incisionthrough an abdominal incisionby laparoscopyFemale SterilizationAchieve stComplications of female sterilizationIntraperitoneal hematocele or hematomaInfectionInjury of ureter, bladder or rectumPostbilateral tubal ligation syndrome:PainMenstrual disturbances (prospective controlled

32、studies show no statistical significant difference)Failure of sterilizationEctopic pregnancyComplications of female sterilTechniqueUchida method of sterilizationPomeroy type of tubal ligationChoose the technique most comfortable for the physicianTechniqueUchida method of sterChapter 3 Induced aborti

33、onChapter 3 Induced abortionDefinitionsAbortion is the interruption (spontaneous or induced) of an established pregnancy before 20 weeks gestational ageMiscarriage is used by the lay public to describe the spontaneous loss“Elective” or “therapeutic” abortion are terms used to describe induced pregna

34、ncy termination.DefinitionsAbortion is the intInduced abortionDefinition:deliberate termination of pregnancy in a manner that ensures that the embryo or fetus will not surviveMethods (for the first trimester):Suction curettageDilatation and evacuationMedical abortionInduced abortionDefinition:Suctio

35、n curettageSafest and most effective method to terminate pregnancies of 10 weeks duration or lessAdvantages:Empties the uterus more rapidly, minimizes blood lossReduces the likelihood of perforation of the uterusSuction curettageSafest and moSuction method for induced abortionSuction method for indu

36、ced aboComplicationsInfection 1%Excessive bleeding 2%Uterine perforation 1%Syncopal reactionsRetained tissueLeakagesuckMajor complicaitons 0.2%0.6%persistent feverhemorrhage requiring transfusionunintended major surgeryComplicationsInfection 1%Uterine perforationUterine perforationDilatation and eva

37、cuationFor inducing midtrimester abortion (pregnancies of 10-14 weeks duration)A modification of suction curettageSerial placement of cervical dilatation sticks is used to effectly dilatate cervical canal with less likelihood of injuryLarger suction cannulas and specially designed forceps are used t

38、o extract tissueDilatation and evacuationFor iComplicationsHemorrhage (usually due to atony or laceration)Perforation Infection Retained tissueAmniotic fluid embolismComplicationsHemorrhage (usualLate complicationsUterine cavity or cervical adhesionChronic pelvic inflammatory diseaseMenstrual disordersSecondary infertilityLate complicationsUterine caviMifepristoneEffects first-trimester abortion 49 daysA synthetic drug developed by French pharmacologists, which acts at least partially as an antiprogestational agent.Given orally in conjunction with a prostaglandin such as misop