On the Methodological Meeting icon

On the Methodological Meeting




Скачати 73.52 Kb.
НазваOn the Methodological Meeting
Дата16.07.2012
Розмір73.52 Kb.
ТипДокументи

“Approved”

on the Methodological Meeting

of the Department of Obstetrics and Gynecology

with the Course of Juvenile and Adolescent Gynecology

Bukovinian State Medical University

“____” ____________________ 200 .

Minutes No_______

Deputy Chief of the Department,

Doctor of Medical Science O.A.Andriyets


METHODOLOGICAL INSTRUCTIONS

to the practical class on the topic:

Women’s Consulting Centre. Groups of Perinatal Risk”


Educational subject:

Obstetrics and Gynecology

6th course, medical faculty,

number of hours – 7.

The Instructions are compiled by

Associate Professor L.V.Begal


Chernivtsi– 2008

  1. Topic of the Class: Women’s Consulting Centre. Groups of Perinatal Risk.

  2. Duration of the class: 7 hours

  3. Objectives:

The student should

    • know: dyspanserization of the pregnant and methods of their examination in Women’s Consulting Centre (WCC);

    • be able to: work with standard documents.

  1. Advise to the student: the aim of active medical observation is early determination and timely treatment of diseases. An important task of dyspanserization is to conduct certain measures directed to preserve the health of women without any vivid diseases. The system of dyspanserization includes popularization of a healthy way of life, conduction of appropriate sanitary0hygienic measures, participation in the programs of physical culture and sport. Dyspanserization is closely connected with prevention of diseases, it is the basis of primary and secondary prophylaxis, which is very important for obstetrics, gynecology and perinatology. Dyspanserization of the pregnant is the system including active medical observation from the early terms of gestation. It may be reached by: 1) coming of women to WCC at any suspicion of pregnancy; 2) finding the pregnant while performing dyspanserization of all the women of the given district; 3) systemic conducting sanitary-elucidative work on the questions of hygiene of pregnancy. An important component of the dyspansery system is general clinical and obstetrical examination which is conducted at the first and following visits to WCC. Pregnant women should be consulted by an obstetrician-gynecologist and therapist, dentist and other specialist as well.

All the pregnant women are divided into two groups: healthy ones ( the first group) and women with the risk of complications of pregnancy and labour (the second group). The pregnant of this group should undergo special observation which is conducted by an obstetrician-gynecologist and other specialists.

Dyspanserization allows to reveal obstetrical pathology and extragenital diseases (the third group – afflicted pregnant). This group requires special observation and treatment.

With the normal course of pregnancy the woman should visit WCC once a month during the first half of gestation, after 20 weeks – twice, after 30 weeks – 3-4 times a month, thus, 14-15 times during pregnancy. Therapists and dentists examine twice – during the first visit and after 30 weeks.

During dyspanserization the following examinations are performed: clinical blood count – 3 times (at the first visit, after 22 weeks, after 30 weeks); clinical urine analysis – at every visit; bacterial examination of discharge from the vagina and urethra; blood group and rhesus-factor determination (in case of negative rhesus-factor husband’s blood group is also defined); Wassermann’s reaction – at the first visit and after 30 weeks. TORCH-infection is examined on indication.

WCCs have the system to define the risk of perinatal pathology elaborated by O.G.Frolova and O.I. Nikolayeva (1980). To estimate the risk level in the fetus and newborn the total score of unfavourable factors in antenatal and intranatal periods is considered. If the total score is 10 and more there is a high risk of perinatal pathology, 5-9 – an average risk, 4 and less – a low degree of risk development. All the risk factors of perinatal pathology and mortality are divided into factors acting in antenatal (group A) and intranatal (group B) periods. Antenatal and prenatal factors are: 1) social-biological; 2) obstetrical-gynecological anamnesis; 3) extragenital pathology; 4) complications of the present pregnancy; 5) fetus condition. Intranatal risk factors are peculiarities of the mother’s organism, fetus, placenta and umbilical cord. Risk level of newborn period is recommended to define according to Apgar scale: 0-4b – high level; 5-7 – average; 8-10b – low.

Developmental abnormalities of the fetus under unfavourable factors appear in the following terms of gestation: cerebral abnormalities – 2-11 weeks; eyes – 3-7 weeks; heart – 3-7; extremities – 2-8; teeth – 6-10; ears – 6-11; digestive system – 1-11 weeks.

S.G.Babson et al (1979)give the following risk factors of perinatal morbidity and mortality which refer to intrauteral development :

1. Congenital and family abnormalities in anamnesis.

2. Preterm birth or very small birth weight of mother herself at her borth, and in case the previous labour had the same outcome.

3. Serious congenital abnormalities afflicting the CNS, osseous and blood systems etc.

4. Social problems.

5. Absence of late observation in the perinatal period.

6. Age less than 18 or older than 35.

7. Height less 152,4 cm and body weight 20% lower or higher from the standard norm at this height.

8. The 5th and following pregnancies, especially after 35.

9. Pregnancy 3 months after the previous one.

10. Long-term infertility in anamnesis and treatment by hormones.

11. Teratogenic viral diseases in the first 3 months of pregnancy.

12. Stressful conditions.

13. Smoking.

14. Complications of pregnancy.

15. Multiple pregnancy.

16. Retarded fetus development.

17. Absence of low increase of the body weight.

18. Wrong fetus presentations.

19. The term of gestation more than 42 weeks.

Dyspanserization and primary prevention of the complications of pregnancy belong to the main work of the WCC. This work includes registration in the early terms of gestation, systemic observation of the woman’s condition and development of pregnancy, careful examination of a pregnant woman, recommendations concerning her general regimen, individual hygiene, diet, physical activity. The doctor must answer all possible questions.

^ Medical-genetic consultation is indicated in case of:

  1. previous childbirth (one or more) with abnormalities of the nervous, cardio-vascular, muscular-skeletal and other systems or inborn diseases (Down syndrome, phenylketonuria);

  2. abnormalities of development and psychic diseases not only in parents, brothers, sisters, but also uncles, aunts, grandparents;

  3. habitual abortions, especially in early terms of gestation;

  4. birth of a dead baby without clear etiology.


Abnormalities of the fetus development may be caused by:

  1. Chromosome and genetic disorders.

  2. Unfavourable environmental conditions, especially in early terms of gestation.

  3. Genetic disorders revealed only under the influence of unfavourable environmental factors.


5. Review Questions:

1. What does the system of dyspanserization include?

2. What groups of perinatal risk do you know?

3. How often should the woman visit the WCC?

4. What is the system to determine perinatal risk?

5. What examinations are performed during dyspanserization observation of the pregnant?

6. What abnormalities of the fetus development under the influence of external factors do you know?

7. When is medical-genetical consultation indicated?

6. References:


1. Dutta D.C. Textbook of Obstetrics. – Calcutta (India), “New Central Book Agency (P)LTD”, 2004. – 666 p.

“Approved”

on the Methodological Meeting

of the Department of Obstetrics and Gynecology

with the Course of Juvenile and Adolescent Gynecology

Bukovinian State Medical University

“____” ____________________ 200 .

Minutes No_______

Chief of the Department,


^ METHODOLOGICAL INSTRUCTIONS

to the practical class on the topic:

Women’s Consulting Centre. Family Planning. Modern Contraceptive Methods.”


Educational subject:

Obstetrics and Gynecology

6th course, medical faculty,

number of hours – 7.

The Instructions are compiled by

Associate Professor L.V.Begal


Chernivtsi – 2008

  1. Topic of the Class: Women’s Consulting Centre. Family Planning. Modern Contraceptive Methods.

  2. Duration of the class: 7 hours

  3. Objectives:

The student should know:

    1. Kinds of contraceptive methods.

    2. Efficacy, indications and contraindications of use of various contraceptives.

    3. Mechanism of action, principles of use, possible complications in various kinds of contraception.

    4. What is the aim of family planning and how is it performed?

The student should be able to:

  1. Choose contraceptives individually in each case.

  2. Determine contraindications.

  3. Estimate the condition of the woman who uses contraceptives.

  4. Define the time to remove intrauterine contraceptive devices (IUCD).

  5. Determine negative influence of hormonal contraceptives on the woman’s organism.

  6. Conduct dyspanserization observation over the women using contraceptives.

Master the following practical skills:

  1. Methods of examination of gynecological patients.

  2. Ontogenesis and regulation of the function of the reproductive system.

  3. Methods of functional diagnostics, norms of hormonal content in the blood and urine.


^ 4. Advises to the student.

Organization, structure and tasks of the family planning service (FPS). Under conditions of worsening demographic situation in the country, lowering life standards of the major part of the population, worsening of reproductive health of the population the questions concerning family planning (FP) are of special importance. This is the basis to lower maternal and children mortality, prevention of diseases, transmitted sexually, and to preserve the health of population.

Family planning, as an important element of primary medical aid in many countries of the world, includes the following main kinds of work in Ukraine:

    • to inform and consult the population on the questions of FPS;

    • to organize FPS;

    • to supply the population with contraceptives;

    • to treat infertility and sexual disorders;

    • to form public opinion in the process of work, directed to the changing of stereotype concerning FPS as purely medical or family problem;

    • to improve the level of knowledge and qualification not only obstetrician-gynecologists but other specialists;

    • to spread knowledge concerning sexual education of children and teenagers, to prepare teachers and parents on the questions of sexual education of their children;

    • to enlist cooperation of mass-media to elucidation of the problems of FPS, sexual culture, family-marital relations;

    • to make medical service in FPS accessible to everyone.

Contraception is used to prevent spermatozoon from penetration into the ovum, that is, to prevent fertilization. Systematic or planned regulation of birth does not mean refuse from sexual life, it means reasonable termination of pregnancy. This termination must be reliable. Both, the husband and wife must take part in choosing contraceptives and be responsible for their use.

  1. Intrauterine Contraceptive Devices (IUCD)

    • influence upon the ability of spermatozoa to penetrate into the uterine cavity (copper);

    • influence upon the reproductive process before the ovum reaches the uterine cavity (copper);

    • thicken the cervical mucus (progestine);

    • change endometrial condition (progestine).

Advantages

Contraceptive:

    • high efficacy (0,5-1,0 pregnancy per 100 women during the first year of use);

    • immediate efficacy;

    • long period of action (10 years);

    • the method is not connected with coitus;

    • the method does not influence upon breast feeding;

    • immediate restoration of fertility after removal of intrauterine contraceptive devices (IUCD);

    • few side effects;

    • after introduction of IUCD the patient should come to the doctor in case of problem only;

    • cheap method.

Non-contraceptive:

-diminish menstrual pains (only progestine);

- decrease menstrual bleeding (only progestine).

Disadvantages:

    • before introduction gynaecological examination and examination for urogenital infection must be performed;

    • the women should examine herself threads of IUCD after menstruation if it is accompanied by pains, spasms or bloody discharge;

    • the woman can interrupt the method herself;

    • increase menstrual bleeding and pains in the first months (only for copper IUCD);

    • possible spontaneous expulsion of IUCD;

    • rare (< 1/100- cases) uterine perforation during IUCD introduction;

    • increase the risk of extrauterine pregnancy and further infertility.

Contraindications for use of UICD:

    • pregnant women;

    • women without clear vaginal bleeding (till the cause is established);

    • women with active infection of the reproductive organs (vaginitis, cervitis);

    • women after recent abortion (3 months);

    • women with inborn abnormalities of the uterus or benign tumours (fibroma);

    • women with diseases of the valves of the heart in an active phase;

    • women with malignant trophoblastic tumours;

    • women with pelvic TB;

    • women with cancer of the reproductive organs;

    • women with the risk of infection (having more than one sexual partner).

Period of Introduction:

    • in any day of menstrual cycle if the patient is not pregnant;

    • from the 1st to the 7th day of menstrual cycle;

    • after labour (immediately; in the first 48 hours or in 4-6 weeks; in 6 months);

    • after abortion – immediately or during 7 days if there are no signs of infection of the minor pelvis.

  1. Barrier Methods of Contraception and Spermicidal Agents.

Barrier methods of contraception prevent sperms to penetrate the vagina or uterine cervix by chemical or mechanical ways or combination of both. They are male (condoms) and female (diaphragms, cervical caps, spermicidal foam, spermicidal suppositoria and foamy tablets, spermicidal pastes, jellies, sponges).

^ Male Condoms.

Types. Condoms are made of latex, plastic or natural (animal) products.

Mechanism of action. Prevent sperms to penetrate into the female reproductive tract.

Advantages

Contraceptive: immediate efficiency; don’t influence upon breast feeding, can be used along with other contraceptive methods to enhance the contraceptive efficiency; no risk for health; no systemic side-effects; easy availability; sold without prescription, don’t require medical examination; cheap.

Non-contraceptive: the only contraceptive method ensuring safety from infection including AIDS (only latex and plastic); promotes low morbidity of cervical cancer; can be used in the treatment of immunological forms of infertility (during 3-6 months); prevents sperm antigens penetration into the vagina; prevents sperm allergy; can be used to improve erection after operations on the abdominal organs (condom ring plays the role of a tight).

Disadvantages: partially reliable having a pregnancy rate of 2-12 per 100 women during the first year of use; the method depends on the user and his motivation; it may decrease sensitivity of the penis; irritation to the rubber may develop both in men and women.

^ Occlusive Diaphragm and Caps.

Types. Occlusive diaphragms are differentiated by their size which is determined by the diameter of the rim in milimeters, and there are four main types depending on the peculiarities of the rim structure: diaphragms with the rim which may be watch spring, spiral spring, arch-like spring, membrane spring.

^ Mechanism of action. These provide a barrier in the vagina against direct insemination and serve as a unit for spermicidal agent.

Advantages.

Contraceptive: immediate efficiency; don’t influence upon breast feeding; the method is not connected with coitus (may be inserted at any convenient time 6 hours before coitus); no risk for health and systemic side effects.

Non-contraceptive: prevents transmission of STDs especially when used in conjunction with a chemical spermicidal agent; keeps menstrual blood when used during menstrual cycle.

Disadvantages: an average efficiency (6-18 pregnancies per 100 women if used with a chemical spermicidal agent); efficiency depends on the woman and her desire to use it; may cause urinary infection because it must be washed, dried and kept properly after each use; should not be removed during 6 hours after coitus; it may be large and uncomfortable, difficult to insert and remove; occasionally vaginal irritation may develop.

Side effects: allergic reaction to rubber or spermicidal agent; when it is left in the position for a long time (not recommended more than 24 hours) an unpleasant smell and discharge from the vagina may appear; candidose colpitis and cystitis may develop.

Contraindications for use: for women with especially undesirable pregnancy, with repeated urogenital infections; women have some difficulties to use them; women with uteroptosis, syndrome of toxic shock in anamnesis, vaginal stenosis, genital abnormalities.

^ Spermicidal Agents

Spermicidal agents are chemical elements inactivating or killing sperms before the latter gain access to the cervical canal. Spermicidal agents are: sprays, foams, pastes, jellies, creams, vaginal foamy tablets, vaginal foamy suppositoria, soluble films, substances for condoms, sponges.

^ Mechanism of action: ruin the membrane of spermatozoa lowering their mobility and ability to fertilize.

Advantages.

Contraceptive: immediate efficiency; don’t influence upon breast feeding; can be used along with other methods; easy for use; don’t require medical examination before it.

Non-contraceptive: partial defence against infections of the urogenital tract.

Disadvantages: if used along, failure rate is high, approximately 30 per 100 women; depends on the desire of a woman to insert it 10-15 minutes before coitus; is effective only 1-2 hours; comparatively expensive.


^ Sponges (Today)

Mechanism of action: a sponge prevents penetration of semen into the upper portions of the female reproductive tract (the uterus and Fallopian tubes) and serves as a reservoir for spermicidal agent. It is a mushroom-shaped polyurethane disposal sponge, 2 inches in diameter, 1.25 inches thick and contains 1g of nonoxynol-9. It is provided with a loop for its easy removal. Efficiency of contraceptive action of sponges is from 10 to 20% during the first year of use.

Advantages

Contraceptive: immediate efficiency; don’t influence upon breast feeding; the method is not connected with coitus (may be inserted at any convenient time 6 hours before coitus); no risk for health and systemic side effects.

Non-contraceptive: partial defence against infections of the urogenital tract, especially used with spermicidal agent; keeps menstrual blood when used during menstrual cycle; defends from uterine dysplasia.

Drawbacks: sometimes sponges cause irritation; some women may forget to remove the sponge; manipulations in the vagina may be unpleasant for some women; there is no certain link found between sponge use and development of toxic syndrome; sponges may cause dryness of the vagina due to secretion absorption.

Contraindications for use: women whose age, number of labours in anamnesis or problems with health are very dangerous for the next pregnancy; women with repeated infections of the urogenital tract; women with uteroptosis or toxic shock syndrome in anamnesis, with vaginal stenosis, genital abnormalities; couples requiring highly effective contraceptive method not connected with coitus and not willing to keep to the instructions or use contraceptives every time.

  1. ^ Method of Lactational Amenorrhoea.

The method of lactational amenorrhoea (MLA) is the use of breast feeding as the method to prevent pregnancy. It is based on physiological effect when ovulation is inhibited due to the process of lactation.

Mechanism of action: prevent ovulation.

Advantages.

Contraceptive: effective (1-2 pregnancies per 100 women in the first 6 months); immediate efficiency; not used with coitus; no systemic side effects; no need in special medical examination; no need to buy contraceptives.

Non-contraceptive. For the child: passive immunization (giving antibodies with milk); the best source for nutritive antibodies; less contact with possible infection through other liquids for baby feeding or kitchen utensils. For the mother: decrease of blood loss after childbirth.

Drawbacks: depends on the woman herself (her desire to keep to the rules of breastfeeding); fails due to social circumstances; effective only during 6 months till menstruation appears; the method does not prevent from urogenital infections.

The method is effective only women during the period of breastfeeding up to 6 months without renewed menstrual cycle.

  1. ^ Natural Methods of Family Planning (NFP)

NFP are based on “fertility awareness”, that is, the woman learns to know when the fertile time starts and when it ends. The fertile phase of the menstrual cycle can be predicted in various ways: the calendar or the rhythm method, mucus method, temperature method, symptothermal method.

While using this method the couple avoids sexual intercourse during the fertile phase of the menstrual cycle when the woman can become pregnant.

Efficiency of the method: nowadays about 5-8% of family couples use this method. It is too low, but the method itself is not much reliable – 20% of pregnancies.

Advantages.

Contraceptive: may be used both for termination of pregnancy and for becoming pregnant; no risk for health or systemic side effects; no financial expenses.

Non-contraceptive: it gives possibility for the woman to understand better physiology of her organism, reproductive system and menstrual cycle; promotes enlisting the husband to family planning and better family relations; is used for the diagnostics and treatment of infertility and premenstrual syndrome.

Drawbacks: an average efficiency (9-20 pregnancies per 100 women during the first year of use); a careful learning should be performed for its correct use and achieving the results; a specially trained specialist can assist; the couple should avoid sexual intercourse during the fertile phase to terminate pregnancy; it requires making everyday notes; possible vaginal infection can complicate interpretation of the cervical mucus; a special basal thermometer is needed for some of the methods; it does not prevent from all possible infections.

Who can use this method: women whose age, number of labours in anamnesis or problems with health are very dangerous for the next pregnancy; women with disordered menstrual cycle (breast feeding or after abortion); those who don’t want to use it for personal reasons.

  1. ^ Withdrawal Method (Coitus Interruptus).

Coitus interruptus is a common practice. Coitus takes place in a normal manner but the penis is withdrawn immediately before ejaculation.

Mechanism of Action: the penis is withdrawn before ejaculation and sperm is not ejaculated into the vagina and fertilization fails.

Advantages.

Contraceptive: immediate efficiency; no effect on lactation; may be used as additional method for other contraceptive methods at any time; no cost.

Non-contraceptive: promotes enlisting the husband to family planning and better family relations.

Drawbacks: depends on the desire of the couple to use it every time of sexual intercourse (4-18 pregnancies per 100 women during one year of use); efficiency can be lower if some semen is left after recent coitus (less than 24 hours); sexual senses may be low; does not prevent from infection.

Who cannot use this method: men with premature ejaculation, those who have some difficulty with self-control, or those who have some physical or psychological disorders; couples that can not take the risk of pregnancy for the woman and those who need a highly effective method of contraception; those who want to use the method not connected with sexual intercourse or those who don’t want to use it every time, those who want to enjoy intercourse fully. The main cause of failure is that prostatic fluid secreted prior to ejaculation frequently contains active spermatozoa.

  1. ^ Surgical Sterilization

Today surgical sterilization (SS) is the most spread contraceptive method in the developed countries of the world. It is the most effective both for men and women, and at the same time it is the safest.

Female sterilization. Most of the data from developing countries are indicative of the fact that mortality rate during SS is 10 per 100 000 cases, at the same time maternal mortality in these countries constitutes 300-800 cases per 100 000 childbirths. Thus, SS is 80 times as safe as repeated pregnancy.

^ Tubal ligation – the fallopian tubes are blocked surgically with the aim to prevent fertilization. It is the method of permanent interruption of the female reproductive function.

Methods: minilaparotomy and laparoscopy.

Mechanism of action: after the fallopian tubes are blocked (ligation, escision, applying silastic Falope ring or clip, electrocoagulation) fertilization becomes impossible.

Advantages.

Contraceptive: high efficiency (0,2-4 pregnancies per 100 women during the first year of use); immediate efficiency; constant irreversible method; does not influence upon breast feeding; is not connected with sexual intercourse; very suitable for those women who have contraindications for pregnancy; it is uncomplicated surgical procedure performed with local anaesthesia; no long side effects; no changes of sexual function (does not influence upon hormonal secretion of the ovaries).

Non-contraceptive: diminishes the risk of ovarian cancer development.

Drawbacks: the method is irreversible; the patient may regret her decision later; little risk of complications; little pain after the operation; it requires a highly qualified specialist and expensive equipment; does not prevent from infection.

Contraindications: pregnancy or suspected pregnancy; vaginal bleeding or unknown etiology; acute or systemic infection (till the moment it is cured); women with contraindications for operation; those who are not sure in their desire concerning fertility in future; no individual agreement.

Time of operation: any day of menstrual cycle if there is no pregnancy; from 6 to 13 day of menstrual cycle (better in a proliferating phase); after labour – minilaparotomy during the first 2 days or 6 weeks later; laparoscopy is not suitable for the women after labour. After abortion – I trimester: immediately or during 7 days if there is no pelvic infection (minilaparotomy or laparoscopy); II trimester: immediately or during 7 days. If there is no pelvic infection – only minilaparotomy.

^ Male Sterilization

Vasectomy is male sterilization, performed by means of a standard method (one or two small incisions) or scalpel-free technology (more preferable now).

Mechanism of action: the deferent duct is blocked (vas deferens) and spermatozoa are absent during ejaculation.

Advantages.

Contraceptive: high efficiency (0.1-0.15 pregnancy per 100 women during the first year of use); constant method; does not influence on the period of lactation and is not connected with sexual intercourse; the best for those couples when tubal ligation or pregnancy are of a high risk for the woman; simple operation under local anaesthesia; no long side effects; does not change sexual function (no influence upon hormonal secretion of the testes).

Drawbacks: the method is irreversible, the patient may regret his decision later; the sperms are stored in the reproductive tract up to 3 months. The couple must therefore abstain from intercourse during this period or use other methods of contraception. Approximately 12-20 ejaculations clear the semen of all sperms. There is some risk and side effects connected with a small operation especially when general anaesthesia is performed; local pain and discomfort after operation; haematoma and infection sometimes occur; experienced personnel is required; does not prevent from HIV, STD infections.

Indications: men of a reproductive age who want to use a highly effective contraceptive method; those whose wives are under high risk of undesirable pregnancy that can be dangerous for them; those who think they have enough children in their families and only on individual agreement.

  1. ^ Postcoital Contraception

Postcoital contraceptive agents interfere with postovulatory events leading to pregnancy and are therefore known as interceptives. It is also known as “emergency contraception” method used to prevent pregnancy after an unprotected intercourse.

The method of postcoital contraception is used following rape, unprotected intercourse or accidental ruptures of condom during coitus taking place around ovulation. It is used in misplaced IUCD and missed pill. These postcoital pills should be used mainly as “back-up” methods in these conditions, and not as a regular contraceptive technique as an ongoing method following every act of sexual intercourse. The efficiency of the method is rather high – 96% - if no more than 72 hours passed after unprotected intercourse.

The mechanism of action of the steroid preparations is directed on the various parts of the reproductive system: the hormones may delay ovulation if taken soon after intercourse, cause corpus luteolysis, and bring about cervical mucus changes and endometrial atrophy.

Types of preparations: combined oestrogen-progestogen oral contraceptives (OC); progestogens; Danazol; Miphepristone (Ru-486); IUCD.

Advantages: all the types are very effective (less 3% of women may become pregnant in this cycle); PC ensures also prolonged contraceptive defence.

Disadvantages: combined oral contraceptives are effective only in that case when the time after unprotected intercourse is no more than 72 hours. They may cause nausea, vomiting or pain of the mammary glands. The first dose should be taken during 48 hours after coitus; it should be taken during 5 days after unprotected intercourse.

^ F. Contraception in the Postnatal Period (Postnatal Contraception)

Lactational Amenorrhoea: a high efficiency during first 6 months in case of breast feeding and absent menstrual cycle (amenorrhoea); breast feeding must be started at once after delivery which is very beneficial both for the mother and her child; it acts till another contraceptive method is chosen.

^ Intrauterine Contraceptive Devices: may be inserted after caesarean section or after childbirth (48 hours after). If it is not done in this time, the insertion should be postponed to 4-6 weeks after delivery; if menstrual cycle is renewed IUCD may be inserted at any day of the menstrual cycle if the patient is not pregnant; it does not influence upon the amount of milk, its quality and health of the baby. Side effects such as pains or bleeding are very few.

Precautions: mothers in the period of lactation have less frequency of IUCD expulsion (6-10%); the best time IUCD for insertion is 10 minutes after the placenta is delivered.

^ Barrier methods: condoms, occlusive diaphragms, spermicidal agents as foams, suppositoria, creams, pills, films, TODAY sponges.

Precautions: while using barrier methods the end of postnatal period (6 weeks after delivery) should be waited for; spermicidal agents help to prevent dryness of the vagina during sexual intercourse (especially in women during lactation period).

^ Natural Family Planning: it is not recommended to complete renewal of the menstrual cycle. The patient can write the registration card 6 weeks after labour but she must continue the method of LA; it does not influence upon the quality and quantity of milk and the health of the baby.

Surgical Sterilization: may be performed at once 48 hours after labour or caesarean section; if it is not done it is postponed till 6 weeks after labour; the ideal time is when the women is completely healthy after labour and the baby is in good health; it does not influence upon the amount and quality of breast milk.

^ Combined Hormonal Contraceptive Agents (CHCA): is not recommended for the women during the period of lactation 6-8 weeks after labour. CHCA use must be postponed till interruption of breast feeding (after 6 months in rare cases); if the woman does not feed CHCA can be used 3 weeks after labour; the use of CHCA in the first 6-8 months after childbirth can have a negative influence upon the quantity of breast milk and normal baby growth; the use of CHCA increase the risk of thrombphlebitis due to hi9gh level of oestrogens.

^ 5.Review Questions.

1. What is IUCD? Mechanism of action and contraindications.

2. What is hormonal contraception?

3. Combined Hormonal Contraceptive Agents.

4. Mechanism of action of CHCA, their side effects.

5. Contraindications for CHCA use.

6. Combined two-phase CHCA.

7. Combined three-phase CHCA, mechanism of action.

8. Preparations with gestogen microdoses.

9. Postcoital medicines.

10. Prolonged contraceptives.

11. Traditional methods of contraception.

12. Vaccines against fertilization.

13. Contraception for Adolescents.

14. Complications in case of IUCD and prolonged contraceptives.

15. Dyspansery observation over the women who use IUCD and hormonal contraceptives.

16. Natural methods of termination of pregnancy considering basal temperature, hygienic factors, time of ovulation.

17. The main principles of family planning.

6.References:

1. Howkins & Bourne. Shaw’s Textbook of Gynaecology, 14th edition. – Thomson Press. Chennai, India. – 483 p.

Схожі:

On the Methodological Meeting iconOn methodological meeting

On the Methodological Meeting icon«confirm» on methodical meeting of endocrinology department a chief of endocrinology department, prof. Vlasenko M. V. “ 31 ” august 2012 y methodological recommendations

On the Methodological Meeting icon«confirm» on methodical meeting of endocrinology department a chief of endocrinology department, prof. Vlasenko M. V. “ 31 ” august 2012 y methodological recommendations
Тopic №10: Thyroididtis. Classification. Clinics. Diagnostics. Differential diagnosis. Treatment
On the Methodological Meeting icon«confirm» on methodical meeting of endocrinology department a chief of endocrinology department, prof. Vlasenko M. V. “ 31 ” august 2012 y methodological recomмendations
Тopic №11: Thyrotoxicosis syndrome. Diffuse toxic goiter. Classification. Clinics. Laboratory and instrumental diagnostics. Differential...
On the Methodological Meeting icon«confirm» on methodical meeting of endocrinology department a chief of endocrinology department, prof. Vlasenko M. V. “ 31 ” august 2012 y methodological recommendations
Тopic №3: Diabetic angyopathy. Classification. Rethynopathy. Nephropathy. Diabetic foot. Diagnostics. Treatment dispensary supervision...
On the Methodological Meeting icon«confirm» on methodical meeting of endocrinology department a chief of endocrinology department, prof. Vlasenko M. V. “ 31 ” august 2012 y methodological recomмendations
Тopic №13: Iodine deficiency disease of thyroid gland. Signs of the endemic region. Clinics, diagnostics, prophylactic, treatment....
On the Methodological Meeting icon«confirm» on methodical meeting of endocrinology department a chief of endocrinology department, prof. Vlasenko M. V. “ 31 ” august 2012 y methodological recommendations
Тopic №1: Diabetes mellitus. Prevalence. Classification. Pathogenesis of main clinical symptoms. Clinics. Laboratory and instrumental...
On the Methodological Meeting icon«confirm» on methodical meeting of endocrinology department a chief of endocrinology department, prof. Vlasenko M. V. “ 31 ” august 2012 y methodological recomмendations
Тopic №12: Treatment of diffuse toxic goiter. Thyrostatics, surgical treatment. Postoperative conplication. Tyrotoxic crisis: clinics,...
On the Methodological Meeting iconActivity first coordination meeting in zhytomyr

On the Methodological Meeting iconSample of Board Meeting Minutes Name of Organization

Додайте кнопку на своєму сайті:
Документи


База даних захищена авторським правом ©zavantag.com 2000-2013
При копіюванні матеріалу обов'язкове зазначення активного посилання відкритою для індексації.
звернутися до адміністрації
Документи