facts about pakistan one birth every 7 seconds 3 mothers die in childbirth every hour 12 million...
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Facts about Pakistan• One birth every 7 seconds• 3 mothers die in childbirth every hour• 12 million children under 5 years are malnourished• 50% of population are lacking safe drinking water.• 60% lack safe sanitary facilities• One doctor per 2008 persons• One nurse per 6500 persons• One hospital bed per 1506 persons• Unemployment, law and order problems and social
unrest increasing.
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Population Profile
• 3.2 million 1947
• 128 million 1995
• 235 million By year 2015
• Population below poverty line 33.1%
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Surgical Contraception
Female Sterilization• Laparoscopic• Minilap• Vaginal tubectomy
Male sterilization• vasectomy
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Non surgical Tubal Occlusion
• Quinacrine pellets
• Tetracycline methyl cyanoacrylate
• Oviduct plugs
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Barrier methods of C.C
Male condom• Advantages
• Simple
• Responsibility on male
• Protects against the transfer of venereal diseases
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Male condom
Disadvantages
• Expensive
• Less satisfying sex
• Allergic reactions
Failure rate - 6-18 per HWY
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Diaphram
• Functions1. Retainer of the spermicide2. To keep sperms away from alkaline
receptive cervical mucus3. Prevent the cervical mucus reaching the
vagina4. Prevents the aspiration of the sperms into
the cx & the uterus
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Diaphram
Advantages– Safe,cheap,easy– Orgasm Does not influence the
orgasm of either partner.
DisadvantageLess effective in case of prolapse and retroversion
Failure Rate
2-15/100 women years
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Intrauterine Devices
• Multiload Cu 250 and 375. These come preloaded and doesn't require to be loaded in the inserter.
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Contraceptive prevalence rate (CPR)
Iran 23%
Bangladesh 40%
Indonesia 48%
Malaysia 51%
Turkey 72%
Pakistan 12%
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CONTRACEPTION
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Contraception Saves Lives
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Contraception means prevention of conception by any method with out abstinence from sexual intercourse.
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MOTIVATION
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Counselling
Is the process of helping clients to make informed and voluntary decisions about choice of contraception.
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Methods of Contraception • Physiological methods
– Rhythm method– Incomplete method
• Chemical methods
• Barrier methods
• Intrauterine contraceptive devices
• Hormones
• Sterilization
• Early abortion
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Natural Family Planning
Abstaining from sexual intercourse during fertile phase of menstrual cycle.
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Fertility Cycle
Phase I: Relatively infertile phase
(approx first 7 days)
Phase II: Fertile phase
(approx 8 to 16th day)
Phase III: Absolutely infertile phase
(approx 17th to 28th day)
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Rhythm Method
• Advantage
• No expensive involved
• No side effects
• Disadvantage
• Planning of coitus
• Dependence on regularity of the cycle
• Suitable for educated,intelligent & cooperative women
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Advantage Safe,easy,cheap
Orgasm doest not interfer with the orgasm of either partner.
Disadvantage
Less effective in case of prolaspe and retroversion
Failure Rate 2 – 15 /100 women years.
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Intrauterine C.C device• Copper 250 and 375• Multiload
• Hormone releasing IUCDs
Progestasert
Levonorgesrel (Mirena)
levonova
Preloaded doesn't require to be loaded in the inserter.
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Method
Pass uterine sound to measure the length of uterine cavity
Introduce the multiload with the inserter until it touches the fundus
Then withdraw the inserter.
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Mode of action
• Immobilize the sperm and prevent it from fertlizing the ovum.
• Inflammatory reaction in the Endometrium prevents embedding of fertilzed ovum.
• Hormonal Effects.
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Contradictions
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Complications
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Hormonal Contracption
• COC pills
• Progesterone only pill
• Long acting pill
• Intectables
• Vaginal rings
• implants
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Contraindications oral contraception
• Absolute – Cholestatic jaundice of pregnancy– Porphyria– Pruritis of pregnancy– Herpes gestationalis – Cancer of breast.
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Contraindications oral contraception
• Relative– Thromboembolism– Blood dyscrasias– Diabetes– Obesity– Chorea– Migraine– Varicose veins– Asthma– Depressive psychosis– Elective surgery
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SEQUENTIAL PILL
• Two types of pill
• First 14 containj only oestrogen
• And last seven a combination of oestrogen and progestrogen
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PROGESTRONE ONLY PILL
• Mini pell
• 28 or 35 packet
- femules - 500ug 28
- Moridey - 250ug 28
- Microval- 30ug 35
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ADVANTAGES - POP
• Do not treduce breast milk
• Suitable for women with contraindication of oestrogens
• Minimal side effects
• No risk of circulatory or malignant disease
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LONG ACTING PILLS
• Once a month
• Quinestrel + Levonorgestrel
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INJECTABLES
• DEPOPROVERA (DMPA)– 150mg every 12 wks
• NORIGEST (NET-EN)• 200 mg ever 08 wks
• CYCLOPROVERA• Once a month
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ADVANTAGES INJECTABLES
• Highly effective
• Easy to deliver
• Use independent of sexual intercourse
• Do not reduce breast milk
• May reduce anaemia
• Less dysmenorrhoea & PMT
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DISADVANTAGES INJECTABLES
• Requires regulkar visits to the clinica for injections
• Not retrievable• Return to fertility is delayed for months• Menstrual irregularities• Galactorrhoea• Mild androgenic affects• Enuresis
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VAGINAL RINGS
• Shell type
• Core type
• Contain Oestrogen + Progesterone or only Progesterone
• Rings changed every 03 months
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CONTRACEPTIVE IMPLANTS
• NON – Biodegradable– Norplant – 1 - 5 yrs– Norplant – 2- 3 yrs– Implnon - 3yrs
• Biodegradable• Capronor - one year
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POST COITAL CONTRACEPTION
• Immediate insertion of copper- T
• The YUZPE method– 2 tabs of COC at once and 02 tabs after 12
hours
• Ethinyl Oestradiol- 2.5 mg bd * 05 days
• Conjugated equine oestrogens- 10 mg tds * 05 days
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MECHANISM OF ACTION POST COITAL CONTRACEPTION
• Block implantation
• Uterine fluid / genital tract mucus rendered hostile to sperm or blastocyst
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RISK OF PREGNANCY POST COITAL CONTRACEPTION
• 20 %
• 30 % on the day of maximum risk