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1、Family planningSummarylFamily planningenablessexuallyactivecouplestopreparefortheirpregnancies,inordertooptimizebothfetalandmaternaloutcomes.lFertility control?AvoidunwillingpregnancylUnplannedpregnanciesconstitutemajorpublichealthproblems.Three categories of family planningThree categories of famil
2、y planning排排 卵卵受受 精精着着 床床卵泡发育卵泡发育InterceptionContraceptionAbortionChapter 1 ContraceptionMethods of contraceptionlIntrauterinedevice,IUDlHormonalcontraceptionlOthercontraceptivemethodsIUDlConvenience,costeffectivenessandreversibilitylForwomenwhoareinstable,mutuallymonogamousrelationshipsatlowriskfor
3、sexuallytransmittedinfections(STIs)lMostcommonlyusedinChina80%History of IUDlUsedinanimalsatfirstl1909,thefirsthumanIUD,designedbyaGermandoctornamedRichardRichter,wasmadeofsilklAseptictechniquemodernIUDAncient IUDsCategories of modern IUDslIUDs wound with copper wirelDifferentshapeslDifferentsurface
4、areasofcopperlThelevonorgestrel-releasingintrauterinesystem(LNG-IUS, Mirena)lReleaselevonorgestrel20ug/dlSuitableforwomenwithheavymensesordysmenorrhealModern IUDsTCu-380TCu375 母体乐母体乐Mechanisms of contraceptionMechanisms of contraceptive action of IUDslKill the sperm or fertilized ovum bylMobilizatio
5、nofleukocytesinresponsetothepresenceoftheforeignbodylLeukocytesmayproduceanenvironmenthostiletothefertilizedovumlSpermicidalactivitywithcopperdeviceslPrevent implantation bylDisruptionofendometrialmaturationwiththeprogesterone-releasingdevicelAlterationofnormaltubalactionlDisruptionofnormaloocytemat
6、urationIndications to the use of IUDslWomen of childbearing age with no contraindication who accept IUDlUterinecavitiessoundto6cm-9cmlParouswomeninamutuallymonogamousrelationshipwhodonothaveacurrentorpriorhistoryofSTDsorsalpingitislWomendesiringamethodofhighefficacythatisfreeofdailyorcoitallyrelated
7、activitylCurrentpregnancylAcutecervical,uterine,orsalpingealinfectionlSuspectedgynecologicmalignancylPolymenorrhea(月经频发),hypermenorrhea(月经过多),orundiagnosedabnormalvaginalbleedinglSeverecervicalrelaxation,lacerationorstenosis,orsevereuterineprolapselCongenitalanomaliesofthegenitalorganslUterinecaviti
8、essoundto9cmContraindications of IUDsContraindications of IUDslSevereacuteorchronicgeneraldiseaseslHistoryofSTDslPelvictuberculosislHighriskofinfectionorbleedingafterinducedabortionordeliverylCopperallergichistorylPriorectopicpregnancylMultiplesexualpartnersTime of IUD insertionl3-7daysaftermenstrua
9、lbleedingstops,withoutsexualintercoursel42daysaftervaginaldeliverywhenperinealwoundhealwellandtheuterusinvolutetonormalsizel6monthsafterc-sectionlMirenashouldbeinsertedonthethirddayofmenstrualbleedingInsertion of the round IUDInsertion of the uterine-shaped IUDInsertion of the LNG-IUDComplications o
10、f IUD insertionlModeratediscomfortorpainwhentheuterusissoundedorwhentheIUDisinsertedlBleedinglInfectionlPartialorcompleteperforationoftheuteruslSyncopalreactionslUterinecrampsFollow-up of IUD by ultrasoundFollowuptheIUD3months,6months,12monthsafterinsertionandeveryyearafterwardsIndications to the IU
11、D removallExpiryoftheavailabilityofanIUDlMenopausefor6monthsormenstrualdisorderduringperimenopausalperiodlNomoreneedforcontraceptionlAskingforothercontraceptivemethodsorsterilizationlSeveresideeffectsorcomplicationslPregnancylAcutegenitalorpelvicinfectionlPoorsystemicconditionsoracutestageofgenerald
12、iseasesTime of IUD removal:l3-7daysaftermenstrualbleedingstopslAnytimewhenthereisseverevaginalbleedingContraindications to the IUD removalIUD removalSide effects of IUDslMenstrualdisordersorabnormalvaginalbleedinglLowerabdominalorlumbosacralpainlIncreasedvaginalsecretionsComplications of IUDslPregna
13、ncylExpulsionlPelvicinfectionHealth benefits of IUDslTheLNG-IUSresultsina70%to90%reductioninmenstrualbloodlosslTheLNG-IUScanreleasedysmenorrhealHormonal contraceptionlInventedbyanAmericandoctornamedGregoryGoodwinPincusin1954lCategories:lOralhormonalcontraceptives(OCs)lHormonalcontraceptionbyinjectio
14、n,implantationortransdermalroutesMechanisms of contraceptive actionlSuppressionoftheLHsurgepreventovulationlThickeningofthecervicalmucuspreventspermpenetrationlAltermotilityofthemuscleoftheuterusandoviductsSlowingoftubaltransportlAtrophyoftheendometriumpreventimplantationlSeverecardiovasculardisease
15、slAcuteorchronichepatitisornephritislThromboticdiseaseslEndocrinedisorderslMalignanttumor,precancerouslesion,massofuterusorbreastlLactationperiodlOligomenorrhoea(月经稀少)orage45lUndiagnosedabnormalvaginalbleedinglMentaldisordersContraindications of OCsUsage of OCslSyntheticsteroidssimilartotheestrogena
16、ndprogestinlCommonlyuseddrugs:lMarvelon(妈富隆)=炔雌醇30g+去氧孕烯0.15mglYasmin(优思明)=炔雌醇30g+屈螺酮3.0mglDiane-35(达英-35)=炔雌醇35g+醋酸环丙孕酮2mglCombinedregimen(21tablets)isbegunlwiththeonsetofthemenstrualcyclelstopfor1weekandthenstartthenextcycleAdvantagesofOCslOvarianandendometrialcancerlMenorrhagia(月经过多)anddysmenorrh
17、ea(痛经)lPID,endometriosis,benignbreastchanges,andectopicpregnancylIron-deficiencyanemiaandacnelImprovementsinhirsutism(多毛症)andsymptomaticendometriosisDisadvantages of OCslTheriskofthromboembolicdiseaselPulmonaryembolismlCerebralthrombosislGreaterriskofdevelopingcoronarythrombosislconfinedtoolderusers
18、whosmokeoneormorepacksofcigarettesperdayDisadvantages of OCslBreastcancer?NoriskorunclearlCervicalintraepithelialneoplasia slightlyhigherrisklOtherinfrequentproblemslHypertensionlCholelithiasis(胆石症)lBenignlivertumorsSide effects of OCslBreakthroughspottingandbleeding resolveafter1to3monthsofuselMiss
19、edmenstrualperiodsoramenorrhealNausealHeadacheslWeightgainOther contraceptive methodslMalecondomlFemalecondomlNaturalfamilyplanning,NFPlVaginalspermicidesMale condomlDefinition:lThelatexrubberoranimalintestinecondomservesasacoverforthepenisduringcoitusandpreventsthedepositionofsemeninthevagina.Male
20、condomlFailurerates:2%-15%inthefirstyearofuselUsedinconjunctionwithcontraceptivevaginaljellyorfoamcanreducethechancesforcondomfailureduetomechanicalortechnicaldeficienciesAdvantages of condomlProvideshighlyeffectiveandinexpensivecontraceptionlProvidesprotectionagainstsexuallytransmitteddiseases(STDs
21、)lSomecondomscontainaspermicide,whichmayofferfurtherprotectionagainstfailureFemale condom(vaginal pouch)阴道隔膜阴道隔膜宫颈帽宫颈帽NaturalfamilyplanningmethodlWomenarefertileforonlyafewdaysofthemenstrualcyclelThefertileperiodisfromthetimeofovulationto2-3daysthereafterlCouplesavoidintercourseduringtheat-riskdays,
22、oruseanothermethod(usuallycondom)duringthewomansfertiledays.NaturalfamilyplanningmethodlAvarietyofmethodsareusedtocalculateawomansfertiledayseachcycle.lCalendarmethodlBasalbodytemperaturelCervicalmucuschangeslFertilitymonitors月经的周期型变化月经的周期型变化卵巢周期卵巢周期子宫内膜子宫内膜阴道涂片阴道涂片宫颈粘液结晶宫颈粘液结晶基础体温基础体温月经周期月经周期171421
23、28 8 天天4 6 8 10 12 14 16 18 20 22 24 26 28 天天基基 础础 体体 温（双相型）温（双相型）阴道鳞状上皮组织学与细胞学对照模式图阴道鳞状上皮组织学与细胞学对照模式图内底层内底层外底层外底层中层（小）中层（小）中层（大）中层（大）表层表层表层表层浅棘层浅棘层深棘层深棘层生发层生发层宫颈粘液的周期性变化宫颈粘液的周期性变化羊齿状结晶羊齿状结晶椭圆体椭圆体NaturalfamilyplanningmethodlNotreliableandsafeenoughlNotrecommended!PostcoitaloremergencycontraceptionlT
24、wohormonalproductsareavailableforEC:lHigh-doselevonorgestrellHighdosecombinedestrogen/progestinpillslStartingassoonaspossibleafterexposurelRecommendedtobestartedwithinthefirst72hourslMorningafterIUD(Copper)insertionwithin120hoursChapter 2 SterilizationFemale SterilizationlAchievesterilizationbyocclu
25、dingtheuterinetubeslApermanentmethodofcontraceptionlRequiringanintraperitoneal(腹膜内的)incisionandgeneralanesthesialLigationoftheoviductsisusuallyperformedlthroughacolpotomyincisionlthroughanabdominalincisionlbylaparoscopyComplications of female sterilizationlIntraperitonealhematoceleorhematomalInfecti
26、onlInjuryofureter,bladderorrectumlPostbilateraltuballigationsyndrome:lPainlMenstrualdisturbances(prospectivecontrolledstudiesshownostatisticalsignificantdifference)lFailureofsterilizationlEctopicpregnancyTechniquelUchidamethodofsterilizationlPomeroytypeoftuballigationlChoosethetechniquemostcomfortab
27、leforthephysicianChapter 3 Induced abortionDefinitionslAbortionistheinterruption(spontaneousorinduced)ofanestablishedpregnancybefore20weeksgestationalagelMiscarriageisusedbythelaypublictodescribethespontaneouslossl“Elective”or“therapeutic”abortionaretermsusedtodescribeinducedpregnancytermination.Ind
28、uced abortionlDefinition:ldeliberateterminationofpregnancyinamannerthatensuresthattheembryoorfetuswillnotsurvivelMethods(forthefirsttrimester):lSuctioncurettagelDilatationandevacuationlMedicalabortionSuctioncurettagelSafestandmosteffectivemethodtoterminatepregnanciesof10 weeksdurationorlesslAdvantag
29、es:lEmptiestheuterusmorerapidly,minimizesbloodlosslReducesthelikelihoodofperforationoftheuterusSuction method for induced abortionComplicationslInfection1%lExcessivebleeding2%lUterineperforation1%lSyncopalreactionslRetainedtissuelLeakagesucklMajorcomplicaitons0.2%0.6%lpersistentfeverlhemorrhagerequi
30、ringtransfusionlunintendedmajorsurgeryUterine perforationDilatation and evacuationlForinducingmidtrimesterabortion(pregnanciesof10-14 weeksduration)lAmodificationofsuctioncurettagelSerialplacementofcervicaldilatationsticksisusedtoeffectlydilatatecervicalcanalwithlesslikelihoodofinjurylLargersuctionc
31、annulasandspeciallydesignedforcepsareusedtoextracttissueComplicationslHemorrhage(usuallyduetoatonyorlaceration)lPerforationlInfectionlRetainedtissuelAmnioticfluidembolismLate complicationslUterinecavityorcervicaladhesionlChronicpelvicinflammatorydiseaselMenstrualdisorderslSecondaryinfertilityMifepri
32、stonelEffectsfirst-trimesterabortion49 dayslAsyntheticdrugdevelopedbyFrenchpharmacologists,whichactsatleastpartiallyasanantiprogestationalagent.lGivenorallyinconjunctionwithaprostaglandinsuchasmisoprostolComplicationslFailuretoterminateapregnancylIncompleteabortionlSignificantuterinecrampingFollow-u
33、p of patients after induced abortionlTaketemperatureseveraltimesdailyandreportfeverorunusualbleedingatoncelAvoidintercourseortheuseoftamponsforatleast2weekslDiscussthepossibilityofemotionaldepressionFollow-up of patients after induced abortionlPelvicexaminationtoruleoutendo-andparametritis,salpingit
34、is,failureofinvolution,orcontinueduterinegrowthlEffectivecontraceptionshouldbemadeavailableaccordingtothepatientsneedsanddesiresChapter 4 Family planning methods choiceFamily planning methods choicelFornewlyweddedcouplelSuggested:malecondom,femalecondomorspermicidaljellylNotsuggested:IUDorOCslForcouplewithonechild:IUD,malecondom,OCs,NorplantandspermicidaljellylForcouplewithtwoormorechildren:operationforsterilizationofwomenormenFamily planning methods choicelForwomenduringbreastfeedinglSuggested:IUDorcondomlNotsuggested:OCslForwomeninclimacteric:anymethodsexcepthormonalcontraceptivesThank you!
