計(jì)劃生育課件

計(jì)劃生育Contraception&FamilyPlanning

意義

控制人口數(shù)量

提高人口質(zhì)量

計(jì)劃生育內(nèi)容

⑴

晚婚：按法定年齡推遲3年以上結(jié)婚為晚婚。⑵晚育：按法定年齡推遲3年以上生育為晚育。⑶節(jié)育：包括避孕、絕育⑷優(yōu)生優(yōu)育：提高人口素質(zhì)受孕必備條件⑴正常精子

輸卵管壺腹部受精卵著床

⑵成熟卵子（孕卵）

⑶通暢的生殖管腔⑷子宮內(nèi)膜同步改變避孕

激素避孕hormonalcontraceptives

：口服短效、長(zhǎng)效、長(zhǎng)效避孕針、緩釋系統(tǒng)

非激素避孕：non-hormonalcontraceptives宮內(nèi)節(jié)育器、外用避孕藥具、自然避孕法、免疫避孕、黃體生成激素釋放激素類似物避孕。緊急避孕

Emergencycontraceptives第一節(jié)激素避孕

hormonalcontraceptives

一、激素避孕機(jī)制

1.抑制排卵

Preventovulationbyinhibitinggonadotropinsecretion.

抑制下丘腦的促性腺激素釋放激素因而使垂體的促卵泡素和促黃體素分泌受抑制而不發(fā)生排卵。2.對(duì)生殖器官的直接作用（1）改變宮頸粘液性狀：Theprogestincomponentthickenthecervicalmucus,retardingspermpenetration

宮頸粘液變粘稠量減少、不利于精子穿透。（2）改變子宮內(nèi)膜形態(tài)與功能：Theendometriumchangesbothinfunctionandinmorphology.It’snotsuitableforthefertilizedeggtoimbed.避孕藥中孕激素干擾了雌激素效應(yīng)，子宮內(nèi)膜增殖受抑制；腺體及間質(zhì)提早發(fā)生類分泌期變化，不適于孕卵著床。（3）改變輸卵管的功能Changethefunctionofthetube二、激素避孕遠(yuǎn)期安全性1.長(zhǎng)期服用甾體激素避孕藥與生殖器腫瘤2.長(zhǎng)期服用甾體激素避孕藥與日后生育3.長(zhǎng)期服用甾體激素避孕藥與子代發(fā)育4.長(zhǎng)期服用甾體激素避孕藥與人體三大代謝

三、IndicationandcontraindicationsofOCIndications:

Anyreproductive-agedwomanContraindicationsPatientswithseverediseasesofimportantorgans,suchashepatitis,cardiovasculardisease.Patientswithendocrinediseaseorblooddisease(thromboembolicdisease).Patientswithmalignanttumor,uterinediseasePatientsolderthan45yearsorwithhypomenorrhea.Smokingandolderthan35years.Maycauseprematureovarianfailure,myocardialinfarctionLactatingwomanlessthanhalfyearafterdelivery.四、OCSideEffectsandmanagementNauseaBreasttendernessMenstrualchangesWeightgainHeadache五、激素避孕臨床應(yīng)用種類類型：復(fù)方短效口服復(fù)方長(zhǎng)效口服復(fù)方或單方長(zhǎng)效針劑緩釋系統(tǒng)透皮貼劑NEWMETHODS“ThePatch”

第二節(jié)非激素避孕

non-hormonalcontraceptives一、宮內(nèi)節(jié)育器（IUD）避孕機(jī)制----殺精毒胚、干擾著床非細(xì)菌性炎性反應(yīng)、前列腺素作用、溶黃體作用、纖溶作用、免疫作用、銅離子作用、孕酮的作用（多環(huán)節(jié)抗生育作用）HowIUDsacttopreventconceptionisnotknown.ThemostwidelyobservedphenomenonismobilizationofleukocytesinresponsetothepresenceoftheforeignbodyclassificationCopperIUDsMedicine-releasingIUDs副作用：出血、腰酸腹脹并發(fā)癥：子宮穿孔、節(jié)育器異位、節(jié)育器嵌頓、感染二、外用避孕藥具

barrierContraceptivesCondomsMalelatex,polyurethane,animalskinFemalepolyurethaneDiaphragmsCervicalcapSpermicidesMalecondomTheFemaleCondomTheDiaphragmTheCervicalCapSpermicides三、自然避孕法四、免疫避孕法五、黃體生成激素釋放激素類似物避孕第三節(jié)緊急避孕Postcoital/emergencycontraception(EC)（一）避孕機(jī)制①阻止或延遲排卵②干擾受精或阻止著床（二）方法1、緊急避孕藥甾體激素類和非甾體激素類。一般應(yīng)在無(wú)保護(hù)性生活后3日內(nèi)口服緊急避孕藥。

Drugs:Takinghormonal/non-hormonalcontraceptiveswithin3daysafterunprotectedsexualintercourse.2、緊急安放帶銅宮內(nèi)節(jié)育器一般應(yīng)在無(wú)保護(hù)性生活后5日內(nèi)放入帶銅宮內(nèi)節(jié)育器。

IUDs:IUDinsertionwithin5daysafterunprotectedsexualintercourse.第四節(jié)輸卵管絕育術(shù)Tubalsterilization

方法：結(jié)扎切斷、電凝、鉗夾、環(huán)套、

藥物粘堵輸卵管管腔。

途徑：可經(jīng)腹、經(jīng)腹腔鏡或經(jīng)陰道術(shù)后并發(fā)癥：腹腔內(nèi)積血或血腫、感染、臟器損傷、絕育失敗第五節(jié)人工流產(chǎn)INDUCEDABORTION定義：避孕失敗的補(bǔ)救措施，采用人工或藥物方法終止妊娠。

Inducedabortionisthedeliberateterminationofpregnancyinamannerthatensuresthattheembryoorfetuswillnotsurvive.

SurgicalabortionMedicalabortion方法及對(duì)象

1）medicalabortion：adoptedto7weeksgestationRU-486(mifepristone)givenorallyinconjunctionwithaprostaglandin,Comlplicationsincludefailuretoterminateapregnancy,incompleteabortion.

2）負(fù)壓吸宮術(shù)Vacuumaspiration：Earlyabortionadoptedto6to10weeksgestation.3）鉗刮術(shù)Embryulcia

：Toterminatepregnancy11~14weeksofgestation.4）中期引產(chǎn)InductionofLaborbyIntra-amnioticinstillation(forinitiatingmid-trimesterabortion)5）剖宮取胎術(shù)ceaserian：引產(chǎn)禁忌或同時(shí)要絕育。并發(fā)癥Complicationsandmanagementsofartificialabortion

子宮穿孔

人工流產(chǎn)綜合反應(yīng)吸宮不全近期并發(fā)癥：漏吸術(shù)中出血術(shù)后感染栓塞宮頸裂傷ArtificialabortionsyndromeSymptoms-bradycardia,arrhythmia,dropinBP,heavysweat,etal.Preventionandmanagement-injectingatropine0.5~1mgpreoperation.Usetheappropriatevacuumpressureandoperatetenderlyduringoperation.IncompleteabortionPartofplacentaand/orfetuscanberemainedintheuterinecavity,mainlyduetotheunskilledoperator.Symptoms-vaginalbleedingformorethan10days.Management-ifthereisnoinfection,scrapingtheuterinecavityASAP;ifthereisinfection,usingantibioticsthenscraping.infectionSymptoms-acuteendometritis,pelvicinflammation.Management-usingprophylacticantibioticsUterineperforationOneofseverestcomplicationsofartificialabortion.Itcanbecausedbytheprobe,sucker,cervicaldilatororforceps.Managements-onceitoccurs,operationshouldbestoppedatonce.Antibiotics/oxytocinshouldbeusedandthepatientshouldbehospitalizedandbeatclosedobservation.Ifwearenotsurewhetherthereareinternalinjuries,laparotomyshouldbeperformed.IntrauterineadhesionMainlyoccursatthecervix.Managements-Dilatingthecervixusingaprobeordilatoranddissolutetheadhesion.Afterthe