Family Planning

 

 Family Planning  • • • • •

The concep conceptt of enha enhanci ncing ng the the qual quality ity of of familie familiess w/c w/c includ includes: es: Regu Regula lati ting ng & sp spac acin ing g chil childb dbir irth th Help Helpin ing g subf subfert ertile ile co coup uple less bege begett chil childr dren en Coun Counse selin ling g pare parent ntss and and woul wouldd-be be pare parent ntss The privileg privilegee and the obligatio obligation n of the (married) (married) couple couple exclusively exclusively to decide decide w/ w/ love love when and how many children provided: the motive is justified and the means are moral.

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Involves Involves perso personal nal decision decisionss based based on on each individual’ individual’ss backgroun background, d, experiences experiences and sociocultural beliefs. It involves thorough planning to be certain that the method chosen is acceptable and can be used effectively.

Function of the Health Professional in Family Planning  To counsel, reassure, give information and a nd allow an individual/couple to decide his/her/their course of  action according to what he/she think is appropriate for them and in accordance to their own personal, societal, religious beliefs & values FAMILY AMILY PLANNING PLANNI NG SERVICES 

Temporary conception control • Meth Method odss use used d to pr prev even entt con conce cept ptio ion n

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Meth Me ods used ed prev even ent ov ovul ulati ation on Meth Method thod odsss us use used d to to to pr pre preve vent ntt impla imp lant ntati ation on

Sterilization/ Permanent conception control • Tub ubal al Occl Occlus usio ion n / Bilate Bilateral ral Tub Tubal al Lig Ligati ation on • Vasec asecto tomy my or Vas Lig Ligat atio ion n (never advice a permanent method of planning)

METHODS USE TO PREVENT CONCEPTION   Natural methods ( The only method accepted by the catholic church) Coitus interruptus (least effective method) • Ol Olde dest st type type of of birth birth con contr trol ol pra practi cticed ced by man man.. • The premature premature withdra withdrawal wal of of the penis before before ejaculation ejaculation during during sexual sexual intercourse intercourse • Reliability Reliability is is low because because sperms sperms are emitted in varying varying quantit quantities ies in the normal normal lubricati lubricating ng fluid fluid

secreted throughout intercourse • Ps Psy ych chol olog ogic ical al di disa sadv dvan anta tage ge • Not Not acce accept pted ed by th thee Cath Cathol olic ic Chur Church ch   Coitus reservatus • Male Male does does not not reach reach org orgasm asm and therefo therefore re no ejaculat ejaculation ion occurs occurs • Require Requiress cons conside iderab rable le cont control rol over over the the sexu sexual al urg urgee   Coitus interfemora – “ipit” (kaskas lang)  Rhythmic abstinence • Identificatio Identification n of the the periods periods of fertility and the the periods periods of sterility sterility in the menstrual menstrual cycle cycle of a woman woman and the restriction of sexual intercourse to the sterile periods or the time when the pregnancy is unlikely  because the woman is biologically unprepared to conceive. • Also known as “safe or infertile period” technique and “natural birth control” or NFP because there is nothing artificial used to prevent conception. • Thes Thesee metho methods ds are are bas based ed on on the the ff. ff. prin princip ciple les: s: • The human human ovum is susceptib susceptible le to fertilization fertilization for approx approx.. 18-24 18-24 hours hours after ovulat ovulation ion

 

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The sperms sperms deposited deposited in the the vagina vagina are ordinarily ordinarily capable of fertilizin fertilizing g the ovum for no no more more than 72 hours • Present Present methods methods of determini determining ng ovulatio ovulation n time time are inexact inexact and and seldom seldom sufficiently sufficiently predictive predictive (by (by at least 48 hours) so that in practice, it is necessary to avoid intercourse for a far longer period of  time than 72 hours before ovulation and 24 hours after ovulation Calendar method  • The use of mathemat mathematical ical calculati calculations ons to predict predict the probab probable le time time of ovulation. ovulation. “Ovulation most often takes place 14 days before the onset of the next menstruation .” • Ogino-knaus formula: 1. Determi Determine ne the the shortes shortestt and long longest est cycle cycle ex. Shortest cycle = 28 days Longest cycle = 36 days 2. If the cycle cycle is irregular irregular,, subtract subtract 18 from from the shortest shortest and and 11 11 from the the longest longest ex. 28-18=10 ex. 25-18=7 36-11=25 29-11=18 3. The difference between the shortest cycle and 18 determines the earliest time when ovulation ovulation occur. 4. The difference between the longest cycle and 11 determines the last day when ovulation can occur  5. OVULATION CAN OCCUR ANYTIME IN BETWEEN. 6. In a regular 28 day cycle, abstinence should be observed from day 9 to day 17. (count 5 days before the earliest ovulation and 3 days after the last day)  Basal Body Temperature • • • • • •

This relies relies on on slight slight changes changes (0.3 (0.3 to 0.6ºC 0.6ºC)) in basal basal body temp. that may occur just just before before ovulation ovulation Pre-ov Pre-ovulat ulatory ory temp temperat erature ure is is low becaus becausee of high high estro estrogen gen leve levels ls Post-o Post-ovul vulato atory ry temp. temp. rise rise is due to high high proges progester terone one The temperat temperature ure is taken every morning morning at the same same time time with the same same thermom thermometer eter just just before before arising arising and after at least 4-6 hours of continuous sleep. 3 days days of eleva elevatio tion n indicat indicatee temperat temperature ure chan change ge is due due to ovul ovulatio ation n Abstinence Abstinence should should be be observe observed d 5 days before and 3 days days after tempera temperature ture rise. rise.

 Billings or CERVICAL MUCUS METHOD

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A pa parti rticu cular lar type type of cervi cervical cal mucu mucuss felt felt  by the woman at the vaginal opening is a signal of ovulation • Rese Resear arch ch sho shows ws this this ty type pe of of muc mucus us appears conception. Withoutnecessary the mucus,for sperm transport is impeded. •

This This type type of mucu mucuss is is des descr cribe ibed d as as “clear  and transluscent and about the consistency of raw egg white.”

Phases of Wetness/Dryness 1. Wet – mens menstru truati ation on 2. Dry – basi basicc infer infertil tilee patt pattern ern - sequence sequence of dry dry days days (or days days of unchang unchanging ing mucus) mucus) indicat indicating ing low low level of estrogen estrogen and present present infertility

- duration duration is invariable, invariable, could be days, days, weeks,mon weeks,months ths or zero zero (if (if cycle cycle is short) short) 3. Wet – days days of of poss possibl iblee fertili fertility ty

 

-changing mucus; non-slippery at first later becoming slippery o -peak: last day of slippery mucus -days 1-3 after the peak are part of fertile period o 4. Dry Dry – infe infert rtil ilee day dayss -day 4 after the peak till the end of the cycle o -ends about 2 weeks after the peak  o o

 Lactational Amenorrhea Method 

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LAM is based based on on scientific scientific evidence evidence that a woman woman is not fertile fertile and and unlikely unlikely to become become pregnan pregnantt during during full lactation or exclusive breastfeeding. Full lactation describes breastfeeding when no regular  supplemental feeding of any type is given (not even water) and the infant is feeding both day and night with little separation from the mother. LAM – lactation amenorrheal method –  LAM LAM prov provid ides es max maxim imum um pro prote tecti ction on as as long long as: as: hormone that inhibits ovulation is prolactin.  Mens Menstr trua uati tion on has has not not resu resume med d and and • breas breastt feed feedin ingg- men menst stru ruat atio ion n will will com comee ou outt Bottle Bottle feeds feeds or or regula regularr food food suppl suppleme ements nts are are not not introd introduce uced d and 4 – 6 months • bottle fed 2 – 3 months Baby Baby is les less ttha han n 6 mon month thss of of age. age. •

 Symptothermal method ( combination combination of BBT & cervical. Best method )

Signs of Ovulation: • Mitlelschmerz • Spinbarkheit • Chang hanges es in vagin aginal al mucu mucuss • Goodell’s si sign • Mood changes • Breast tteenderness • Incr Increa ease sed d leve levels ls of of prog proges este tero rone ne • Chang hangee in in bas basal al bod ody y ttem emp. p.

di disa sadv dvan antag tagee o off llam am – migh mightt g get et preg pregna nant nt

 

Successful use of natural methods to prevent pregnancy depends upon: • • •

The accur accuracy acy of of the metho method d in identi identify fying ing the the woman' woman'ss actual actual fertile fertile days days A cou couple' ple'ss abilit ability y to correct correctly ly iden identify tify the fertile fertile time The coup couple' le'ss ability ability to to follow follow the the rules rules of of the meth method od they they are are using using

Advantages of natural family planning method m ethod • Sa Safe fe an and d has has no si side de-e -eff ffec ects ts • Inexpensive • Acceptable Acceptable to to religiou religiouss affiliatio affiliations ns that do do not not accept accept artificial artificial methods methods of contracep contraception tion • Helpfu Helpfull for for plann planning ing pregna pregnancy ncy and avoidi avoiding ng pregna pregnancy ncy • Promotes Promotes communicati communication on about family planning planning and contraception contraception between between couples couples.. Disadvantages • Involv Involves es long long preparat preparation ion and and intensi intensive ve record recording ing befo before re it can be be used. used. • There is a need to to abstain abstain on on certain certain days days which which may may be inconvenien inconvenientt for the couple. couple. • Not Not ideal ideal to wome women n with with ir irreg regula ularr cycle cycles. s. • Not very very reliab reliable le becaus becausee of menstr menstrual ual cycle cycle variati variations ons that that may occur occur anyti anytime. me.

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Test kits kits that that measur measures es the the leve levell of LH and predic predictt ovulation are now available in USA and other countries. These These kits kits det detect ect the the leve levell of LH in the the urine urine w/c su surg rges es 12-24 hours before ovulation. It is 98 tto o 100 100% % ef effe fect ctiv ive. e. When When a woma woman n sees sees that that her LH leve levell is hig high, h, she she shou should ld avoid coitus.

LOCAL BARRIER METHODS   CONDOM  • •

A th thin in stre stretc tcha habl blee rubb rubber er she sheat ath h worn worn ove over  r  the penis by the man during intercourse. Preg regnanc nancy y rate rate is 77-2 28%

Adv; gives highest protection against STD – female condom

Disadvantages: • Self Self-lu -lubr bric icate ated d ty type pe br brea eaks ks ea easi sily ly • Peni Peniss must must be be with withdr draw awn n from from the the vag vagin inaa befo before re \it becomes flaccid • Less Lessen en sexu sexual al en enjoy joymen mentt b by y th thee male male

 

Female Condoms

How to use the female condoms

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 package Open the Female condom  condom package carefully; tear at the notch on the top right of the package. Do not use scissors or a knife to open.

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The The out outer er ring ring cov cover erss tthe he are areaa aro aroun und d the opening of the vagina. The inner  ring is used for insertion and to help hold the sheath in place during intercourse

While ho holding th the Female condom condom  at the closed end, grasp the flexible inner ring and squeeze it with the thumb and second or  middle finger so it becomes long and narrow

 

Choose a position that is comfortable for insertion – squat, raise one leg, sit or lie down.

 

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Gent Gently ly ins insert ert th thee inne innerr ring ring int into o the the vagi vagina na.. Feel the inner ring go up and move into  place.

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Place, Place, the index index finger finger on the inside inside of the condom condom,, and push the inner ring up as far as it will go. Be sure the sheath is not twisted. The outer ring should remain on the outside of the vagina.

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The female condom is now in place and ready for  use with your partner.

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When When yo you u are are ready ready,, g gen ently tly gu guid idee your partner’s penis into the condom's opening with your hand to make sure that it enters properly – be sure that the penis is not entering on the side, between the sheath and the vaginal wall.

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Wrap the the con condo dom m in the the pack packag agee or in in tiss tissue ue,, and and throw it in the garbage. Do not put it into the toilet.

To remove the Female condom condom,, twist the outer ring and gently pull the condom c ondom out

 

Vaginal Diaphragm • A shallow shallow,dome-shap ,dome-shaped ed rubber rubber device device with a flexible flexible wire rim that covers the cervix; cervix; maybe maybe inserted inserted several hours before intercourse and left in place for at least 6 hours after the last intercourse • Init Initial ially ly fitt fitted ed by a healt health h pro profe fess ssio ional nal • Weight eight loss/g loss/gain ain of 15 15 lbs lbs may may requ require ire re-fitti re-fitting ng • Inserted Inserted before before intercours intercoursee with the the woman woman in squatt squatting ing or supine supine position, position, or with with one leg elevated elevated on a chair  • May cause cause cerv cervic iciti itiss if left left in in place place for for too too lon long g • Washed ashed with with mild mild soap soap & water water, lasts lasts for 2-3 years years   • 97% efficiency

Ht: 1. 1.)) prop proper er h hy ygi gien enee 2. 2.)) chec check k for hol holes es bef befor oree use 3. 3.)) must must sstay tay in pla place ce 6 – 8 hrs after sex 4. 4.)) must must be ref refit itte ted d especially if without wt change 15 lbs 5. 5.)) sper spermi mici cide de – ch chem em.. Barrier ex. Foam (most effective), jellies, creams S/effect: Toxic shock  syndrome Alerts: Should be kept in place for about 6 – 8 hours

Cervical Cap

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Come Comess in 2 type types: s: p pre resi size zed d (S (S-M-M-L) L) aand nd ccus usto tom m fitted (a plastic cap fitted to conform to the individual woman’s cervix made after making a mold of cervix with non-toxic substance used to make contact lenses) • Cont Contra rain indi dica cati tion ons: s: hx hx of TSS, TSS, PID, PID, cer cervi vici citi tis, s, cervical Ca, vaginal bleeding, an allergy to latex/spermicide • most durable than diaphragm no need to apply spermicide C/I: abnorm abnormal al a sme smear  ar 

Advantages   • • • • •

Can Can be iins nser erte ted d many many hou hours rs b bef efore ore sex sex pl play ay.. Easy Easy to ccar arry ry aaro roun und, d, ccom omfo fort rtab able le.. Do Does es not not aalt lter er tthe he me mens nstr trua uall cy cycl cle. e. Do Does es no nott affe affect ct futu future re fert fertil ility ity.. May May hel help p you you b bet ette terr know know your your b bod ody y.

Disadvantages • • • • • •

Does Does not not p pro rote tect ct aga again inst st H HIV IV/A /AID IDS. S. Requ Requir ires es a ffit itti ting ng in a ccli lini nic. c. So Some me wome women n ca cann nnot ot be fi fitt tted ed.. Ca Can n be be dif diffi ficu cult lt to in inse sert rt or re remo move ve.. Ca Can n be be dis dislo lodge dged dd dur urin ing g int interc ercou ours rse. e. Po Poss ssib ible le al alle lerrgi gicc rrea eact ctio ions ns..

 

Intravaginal contraceptives (spermicides)

Side-Effects of Spermicides • You or you yourr part partne nerr may may be be aller allergi gicc to materials in spermicide. This can cause genital irritation, rash, or itchiness. If  this happens and your spermicide has nonoxynol-9, try a spermicide without this chemical. Advantages • Ava vail ilab able le wi with thou outt a pr pres escri cript ptio ion. n. • Lubr Lubric icati ation on may in incre creas asee pl pleas easur ure. e. • Use Use can can be pa part rt of se sex x pl play ay.. • Does Does no nott aff affect ect fu futu ture re ferti fertilit lity y. Disadvantages • Does Does no nott pro protec tectt aga again inst st HIV/ HIV/AI AIDS DS.. • Must Must be rea readi dily ly av avai aila labl blee and and use used d  prior to penetration. • Can be messy. • Can Can hav havee a ba bad d tas taste te du durin ring g oral oral se sex. x. • Poss Possib ible le ge geni nita tall irr irrit itat atio ion. n.

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When When use used d freq fr eque uent ntly ly spe smaking perm rmic icid ides may irritate the vagina ites easier to catch HIV/STI

PREVENTION OF OVULATION • Use of co cont ntra race cep pti tiv ves: es: • Pills • Injectable • Implant Contraceptive pills Contraceptive • Estrogen Estrogen & proges progesterone terone prevent prevent pregnancy pregnancy by inhibitin inhibiting g the hypothala hypothalamus mus and and anterior anterior pituitary pituitary so that that ovulation does not occur. They also inhibit fertility by: 1. Alterin Altering g the the motilit motility y of the the fallo fallopia pian n tubes tubes

2. Inadeq Inadequat uately ely devel developi oping ng the the endomet endometrium rium 3. Keeping Keeping cervical cervical mucus mucus unreceptive unreceptive and and unsupp unsupportive ortive of sperm sperm

 

Types of Pills • Combination pills – contain both progesterone & estrogen; taken from day 5 to day 25 of the menstrual cycle • Sequential 21 day pill- start 5th day of mens • 2 tty ypes pes of of pil pills ls ar aree ttak aken en:: 28day pill- start 1st day of mens 1. Contain Containss estrog estrogen en alone alone – taken taken from from day 5-19 5-19 missed 1 pill – take 2 next day 2. Contain Containss proges progestin tin-tak -taken en from from day 20-2 20-25 5 • All-progestin (minipill) – taken everyday • Does not necessarily necessarily inhibit inhibit ovulati ovulation; on; prevents prevents implant implantation ation of the the zygote zygote Client Instructions on taking CPs • Before startin starting g CP, CP, the woman woman must must undergo undergo physical physical examinati examination, on, pelvic pelvic exam and Pap smear to rule rule out contraindications. CP should be prescribed by a physician. • Must be be taken on a Sunday Sunday following following menses menses and and abortion abortion or the the first Sunday Sunday 2 weeks after delivery delivery,she ,she is to use condom on the first 7 days of pill taking. They should be taken at the same time everyday. everyday. • If she is taking taking 28 day pills, pills, there there is no rest rest day or or interval. interval. If she she is taking taking a 21 day day pill, pill, she ends ends on on a Saturday and begin a new pack on the next Sunday Sunday.. Bleeding will occur around 4 days after stopping  pills. If she expected bleeding did not come, she should consult the doctor before starting a new packet of pill. • Minor side effects: effects: nausea, nausea, weight weight gain, gain, headache, headache, breast breast tendern tenderness, ess, breakthrough breakthrough bleeding, bleeding, yeast yeast infections, mild hypertension, potential depression • If a woman woman forgets forgets one one pill, pill, take one one now and then then the next on on the regular regular schedu schedule le of pill pill taking. taking. If two

 pills, take two pills now and two pills tomorrow and use back-up method for the next 7 days. If 3 pills, discard the remaining pack and start a new pack, use back-up method for the next 7 days. • OC users users should should have have a check-up check-up after 4 months months then annual annual check-ups check-ups to to have have pelvic exam, breast exam and Papsmear. Papsmear. • Another Another contraceptiv contraceptivee method method should should be used until a woman has had had 2 regular regular menstru menstruations ations or wait for  three months after stopping taking OC before attempting pregnancy. There is usually a 1-2 month delay in the resumption of menstruation after discontinuing OC. • Folic acid acid deficiency deficiency is common common in long term user user so that that it is advisable advisable to take folic folic acid supplement supplement • If used used by adolescen adolescent, t, they should should have have a regular regular menstrua menstruation tion for for at least least two years years before before beginning beginning OC use. Contraceptive Contracept ive pills • If accidentally accidentally taken by a child, child, side-ef side-effect fect is increas increased ed blood blood clotting clotting,, stimulate stimulate vomiting vomiting by giving giving child syrup of ipecac • Danger si signs: if forgotten for one day, immediately take the forgotten tablet plus the tablet scheduled that day. If forgotten for two consecutive days , or more days, use • A- abdominal pain another method for the rest of the cycle and the start again. • C-ch -chest est p pai ain n and and dy dysp spne neaa • H- headache • E-eye problems • S- severe leg pain Implant (Norplant) •

6 tiny tiny si sili lico cone ne rub rubbe berr caps capsul ules es or 2 ro rods ds containing progestin (evonorgestiel), surgically implanted under the skin of  the upper arm; removed surgically in about 5 years or when the woman wishes to discontinue the method.

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disadvantage if keloid skin as soon as removed – can become pregnant

 

Advantages: • Long Long term term reve revers rsib ible le co cont ntrac racep epti tion on • Do not not inte interf rfer eree wit with h coit coitus us • Has Has no no est estro roge gen n rela relate ted d sid side-e e-eff ffect ectss • Can Can be be use used d duri during ng br brea east stfe feed edin ing g • Can be us used by ad ado oles lescent centss • Rapid Rapid retu return rn of of fertil fertility ity w/c occurs occurs 3 month monthss after after remo removal val Disadvantages: • Expensive • Scarr carrin ing g at at iins nser erti tio on sit sitee Contraindications: • Pregnancy • Desi Desire re to ge gett p preg regna nant nt wi with thin in 2 year yearss • Undi Undiag agno nose sed d vag vagin inal al bl blee eedi ding ng Injectable contraceptive (Depo-provera, Noristerat, etc.) • Synthetic Synthetic proges progestin tin hormon hormones es injecte injected d into into muscle: muscle: administere administered d every every 3 months months - never massage injected site, it will shorten duration

They exert their contraceptive effect by inhibiting ovulation, altering cervical mucus and preventing endometrial growth. The woman does not menstruate with this contraception. It has the same advantages, disadv., disadv ., and contraindications contrai ndications as implants. Disadvantages: • Fe Fert rtili ility ty retu return rn is is usua usually lly del delay ayed ed by 6 mont months hs • Higher Higher risk for for osteopo osteoporosis rosis so advise advise to increase increase calcium intake and engage engage in weight weight bearing bearing exercise exercise • Impai Impairr gluc glucos osee tole toleran rance ce in wome women n at ris risk k for for DM Client instructions: instructions: • Advise Advise client client to have annual annual PE that includes includes breast breast exam,pelvic exam,pelvic exam, and Papsmear  Papsmear  • Report Report signs of leg pain pain or swelling swelling,, chest pain pain & dyspne dyspnea,tingl a,tingling ing and numbness numbness of of extremities, extremities, loss loss of  vision, severe headache, dizziness & fainting. Side-effects: 1. Thrombo-em Thrombo-embolic bolic disorder disorderss and other vascular vascular problems problems including including CVA CVA & MI • Oral Oral pills shou should ld be disco discontin ntinued ued for for 4-8 weeks weeks befor beforee anticipa anticipated ted surg surgery ery 2. Alterations Alterations in metaboli metabolism,esp sm,esp.. of CHOs and and B-vitamins B-vitamins (pyridoxi (pyridoxine ne & folic acid) acid) 3. Fetal effects effects after discont discontinuin inuing g the pill-eviden pill-evidence ce of increased increased of chromosom chromosomal al changes changes 4. Amenor Amenorrhe rheaa after after discon discontin tinuin uing g the pill pill 5. Neoplastic Neoplastic disease disease (breast (breast,, liver-h liver-hepato epatocellular cellular adenoma) adenoma) 6. Hype Hypert rten ensi sio on 7. Adve Advers rsee drug drug int intera eracti ction onss

 

Estrogen deficiency & excess

Estrogen excess • Nausea & vomiting • Dizziness • Edema • Leg cramps • Incr Increa easse in br brea easst si size ze • • • •

Estrogen deficiency • Earl Early y sp spot otti ting ng (d (day ayss 11-14 14)) • Hypomenorrhea • Nervousness • At Atro roph phic ic va vagi gini niti tiss lea leadi ding ng to  painful intercourse

Chloasma Visual ch changes Hypertension vascular h heeadache

 Progesterone deficiency & excess Progesterone excess • Increa eassed ap app peti titte • Tiredness • Depression • Breast ten tenderness • Vagin aginal al yea yeast st in infect fectio ion n

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Progesterone deficiency • Late Late sspo pott ttin ing g and and brea breakk-th thro roug ugh h  bleeding (days 15-21) • Hea eavy vy flow wi with clo clotts • Dec ecrreas aseed br breas astt ssiz izee

Oiirly and d scalp H sustkisin man Postp tpiill ame amenorrhea

Safety measures in the use of pills • Careful Careful scree screenin ning g to detect detect women women who who are at at risk of of develo developin ping g problem problemss • Use Use of of lo lowe west st po poss ssib ible le dos dosee for for each each wo wome men n • Careful follow-up follow-up should should be done done every 6-12 months months to detect detect problems problems —complete —complete health health assessmen assessment: t: should include history, history, PE, Pap smear & lab studies Family history • • Vascu ascula larr acc accid iden entt ((st stro roke ke)) • DM • Breast Ca Contraindications: Medical history • • Hepa Hepatit titis is or he hepa patic tic in insu suff ffic icien iency cy • Throm hromb bo-em o-embo boli licc dis diseas ease • Sick ckle le--ce cell ll disease • Mode Modera rate te/s /sev ever eree hype hypert rten ensi sion on • Smok Smokin ing g more more th than an 15 ci ciga garet rettes tes a day day • Psyc sychic dep deprress ession •

History of conditions that can be aggravated by fluid retention • Migraine • Convulsive d/ d/o • Asthma • Card Cardia iacc & rena renall iins nsuf uffi fici cien ency cy

 

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PE findings  Pregnancy & Lactation  30 years old or older   Presence of hormonal-dependent tumors  Breast nodules  Fibrocystic disease  Abnormal mammogram 

Varicose veins

PREVENTION OF IMPLANTATION IUD (Intra-Uterine Device)  An object made of plastic or non-reactive metal (nickel-chromium alloy) that fits inside the uterine cavity  Manufactured in several shapes (loop, coil, spiral)  Causes a chronic inflammatory response in the endometrium, discouraging implantation of a fertilized ovum  Conception may occur; if implantation takes place, it causes early abortion  Usually inserted during the menstrual phase  IUDs come with increased risk of ectopic pregnancy and perforation of the uterus and do not protect against sexually transmitted disease. IUDs are prescribed and placed by health care providers.

Types of IUD • Non-medicated 1. Lippes-Loo Lippes-Loopp- available available in 4 sizes (A-small (A-small to D-large D-large); ); has been withdraw withdrawn n from the market market 2. Saf-T-coil Saf-T-coil – available available in 2 sizes sizes (small (small & large) large) • Medicated 1. Copper Copper 7 (Cu 200) 200) – copper has direct direct spermicida spermicidall effect; has been been withdrawn withdrawn from from the market market 2. Copper-T Copper-T (T (T-Cu -Cu 200, 200, tatum tatum copper copper-bearin -bearing g IUD) IUD) 3. Prog rogesta estassertert-T T HT 1. 1.)) Chec Check k for sstr tring ing dai daily ly 2. 2.)) Month Monthly ly ch chec ecku kup p 3. 3.)) Regu Regula larr p pap ap smea smear  r 

primary indication for use of IUD parity or # of children, if 1 kid only don’t use IUD

 

Contraindications of IUD Contraindications • Any infl inflamm ammator atory y conditi condition on or infec infectio tion n of the the reprodu reproductiv ctivee tract tract or PID • Abno Abnorm rmal alit itie iess of the the ut uter erus us • Sev eveere dy dyssmenorrhea • Ut Uter erin inee ble bleed edin ing g of un unkn know own n or orig igin in • Suspected preg egn nancy Complications / Adverse reactions reactions • Syn Syncope cope du duri rin ng inse insert rtio ion n • Incr Increas eased ed ris risk k of of PID PID w/ w/cc may may resul resultt iin n • Ste teri rili lity ty or inf infer erti tili lity ty • Medical-sur Medical-surgical gical intervention intervention for complicat complications ions such as twisted twisted ovary, ovary, bowel bowel obstructi obstruction, on, unilateral tubo-ovarial abscess • Perfo erfora rati tion on of th the ute uteru russ • Dysmenorrhea • Incr Increa ease sed d blo blood od loss loss (a (ane nemi mia) a) • Ectopic pr pregnancy • expulsion IUD Danger Signs P eriod late (pregnancy suspected) Abnormal spotting or bleeding A bdominal pain or pain with intercourse I nfection (abnormal vaginal discharge) N ot feeling well, fever, chills S trings lost, shorter or longer 

STERILIZATION/ PERMANENT CONCEPTION CONTROL Tubal Occlusion / Bilateral Tubal Ligation - Involv Involves es tying tying,, cuttin cutting g or cauteri cauterizin zing g the the fallop fallopian ian tbes tbes - Usually Usually done done immediate immediately ly after after delivery delivery (within (within 24-48 24-48 hours) hours) when when the the incidence incidence of of morbidity morbidity & failure are lowest - May also also be be done done in aany ny phase phase of of the the mens menstrua truall cycle cycle methods: Mini-laparotomy o Laparoscopy or “band-aid surgery” o o

 

Vaginal tubal sterilization

HT:: avo HT avoid id lift liftin in heav heav ob ec ects ts

 

Vasectomy / Vas ligation

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Acco Accomp mplis lishe hed d wit witho hout ut en entry try in into to th thee abdominal cavity; twin incisions are made in the area where the scrotum joins the body, just over the vas deferens

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The The tube tubess are are tied tied and and sep sepera erated ted;; porti portion onss maybe excised Foll Follow ow-u -up p sperm sperm cou count ntss mayb maybee done done afte afterr.

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 After vas ligation, the man is considered sterile:  After 20 or more ejaculation, zero sperm count- safe 2 outstanding needs of couples who come to the fertility f ertility clinic 1. Education Education about about reproduct reproduction ion & procedu procedures res used used to evaluate evaluate fertility fertility 2. Counselin Counseling g to help help them them maximize maximize their potential potential for for conception conception Stages on evaluating infertile couples: 1. Complete Complete physical physical assessme assessment nt to rule out endocri endocrine ne or emotional emotional problems problems and diseas diseasee entities 2. Evalua Evaluation tion of of the reprod reproduct uctive ive capaci capacity ty of the male male • Semen analysis • Hormone an analysis • Testicular biopsy • X-ray X-ray stud studies ies to iden identify tify blocka blockage ge of of sper sperm m path pathway way 3. Evaluation Evaluation of the the reproduc reproductive tive capacity capacity of the the female female • Abilit ity y to ovulate • Endometrial ial biopsy • Test for for cervical cervical mucu mucuss viscos viscosity ity/an /analy alysis sis of of cervical cervical secre secretio tions ns • Pa Pate tenc ncy y of of tthe he fall fallop opia ian n ttub ubes es • Analy Analysi siss of en endo dome metri trial al secre secreti tion onss Possible managemen m anagementt: • • • 

Hormonal therapy Su Surg rgic ical al iint nter erve vent ntio ion n fo forr ob obst stru ruct ctiv ivee ca case sess Medical th therapy for P PIID Success of treatment depends on:  Ages of the couple  Continued interest  Cooperation

 

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Financial resources

Other Family Planning Services • Sex Ed Education • It is a bro broad ad term term used used to desc descri ribe be education about human sexual anatomy, anatomy, sexual reproduction, reproduction, sexual sexu al intercourse intercourse,, and other aspects of  human sexual behavior . Common avenues for sex education are parents or caregivers, school programs, and public health campaigns. • Gen enet etic ic Counselli lin ng • Help Helpin ing g peop people le face faced d wi with th a di diag agno nosi siss of ge gene neti ticc di dise seas asee to un unde ders rsta tand nd bo both th th thee fa fact ctua uall information about the disease and the effect it will have on their lives, so that they can reach their  own decisions about the future. • Research