Professional Documents
Culture Documents
TECHNI QUES
By
E. Ejiro Emuveyan
Associate Professor of Obstetrics &
gynaecology
Department of Obstetrics & Gynaecology
College of Medicine, University of Lagos
P.M.B. 12003
Lagos
MALTHUS IAN C ONCE RNS
●
Worl d Po pu lat ion Pro file 1
Beginning of last century 2b
1970 4b
2000 6b
Rate of increase 1.2%
Estimated doubling time 42 yrs
10 Largest Countries in Population
China 1304
India 1104
USA 296
Indonesia 222
Brazil 184
Worl d Po pu lat ion Pro file 2
● 1/3 under 15 years of age
● Spacers
● Limiters
● Demographic Shift
more women aged 30-44 years than
those aged 15-29 years.
needs of women with divergent social
or economic circumstances.
NIG ERI AN POP UL AT ION PR OF IL E
❁ Mid 2005 131.5 PRB
❁ Fertility rate: 5.9 per woman
❁ Pop. Growth rate 2.4
❁ Living below USS2 per day 91%
❁ women using all methods 12 %
modern methods 8%
❑ Age Profile
Women in reproductive age (15-44 yrs. -22.8%
Children Under 15 years 43.0%
CONT RACE PTIVE P REV ALE NCE
Worldwide (2005)-38.1m (53%) use effective
methods
Nigeria (1998) 6%
Ghana 19%
Benin 7%
Guinea-Conakry 4%
Kenya 32%
Tanzania 20%
HIST ORY OF FA MI LY P LA NNING
❑ Religious and Moral Issues
❑ Natural Family-Planning
✦ Coitus interruptus - Oldest method (17th
century)
✦ Abstinence - Total/Periodic
❆ METHOD(S),
❆ BENEFITS
❆ RISKS,
❆ SIDE EFFECTS
CONSE NT AN D SER VIC E
● Documentation Of Discussion with client and
her understanding of what has been said is of
legal importance.
● When using methods that require
instrumentation or some type of surgical
approach use of consent forms that outline
information discussed and the patient’s
understanding is important.
● Consent form serves as evidence if needed
that:
(I) Counselling about use of particular
birth control method was given
(II) Patient appeared to be competent to
understand what was said to her
ME THODS
CLASSIFICATION
TRADITIONAL OR FOLK
- Coitus Interruptus
- Post coital Douche
- Lactational Amenorrhoea
- Periodic Abstinence (Rhythm, Natural
Family Planning)
BARRIER
- Condom(Male and Female)
- Diaphragm
- Cervical Cap
- Vaginal Sponge
ME THODS
HORMONAL
- Oral
- Injectable
- Implantable Long-Acting Progestins
OTHER CONTRACEPTIVES
- IUCD
- Sterilisation
- Tubal Ligation
- Vasectomy
NA TU RAL C ONTRA CEP TION
A. PERIODIC ABSTINENCE/RHYTHM METHOD
● LONG AND CHEQUERED HISTORY
● FERTIILE PERIOD 2-3 days after ovulation
2 days before no less than 2 days after
● PROMOTED BY CATHOLICS
Types of periodic abstinence
- Calendar method
- Combined temperature/calendar method
- Cervical mucus (Billings) method
- Symptothermal method
HISTORY
19th Century- Lack of follicular development in
pregnancy
1921 - Ludwig Haberlandt
1929 - Oestrogen Synthesized
1934 - Progesterone synthesized
1959 - First OC (Norethynodrel -
Menstranol)
1960 - Progressive lower dose pills.
TYPE S
(A) Combined Oral Contraceptives (COCS).
Sequential - E Pill 15-16 days followed
E/P for 5 days
Problem: Than normal incidence of endometrial
cancer
Phasic - Monophasic, Biphasic, Triphasic
28 days regimen (last 7 days placebo)
❑ FAILURE RATES
● COC 0.2 - 1 per 100 woman years
● POP 0.3 - 5 per 100 woman years
PCC varies with types
HORM ONAL CONT RACEP TION
HISTORY: 19TH CENTURY TO 1934
1921 - Ludwig
Harberlandt First proposed Hormonal
Sterilisation
1929 - Molecular
structure of Oestrogen determined
1934 - Molecular
structure of Progesterone determined
HORM ONAL CONT RACEP TION
HISTORY: 1952 - 1960
2. Oestrogen only
3. Progestogen only
4. Danazol
- Recent
(a) CU DEVICES
1st Generation - Cu 7
- Cu T
2nd Generation - Multiload 250
Nova T
3rd Generation - Multiload 375
Cu T 380 A
Flexigard 330
Cu Fix PP 330
Eficacy - 1.5 per 100 woman years
CYDCLOPROVERA
ME CH ANISM OF ACT IO N
100% Effective
3. Weight gain
Result of an increase appetite rather than
fluid retention
1. Dihydroxyprogesterone
acetophenide (acetophenide 150mg and
estradiol enanthate 10mg).
DHPA/E2-EN “Deladroxate” or
Perlutal
2. Deposit-Medroxyprogesterone acetate
25mg and estraldiol cypionate 5mg
DMPA/E2C; HRP11Z “Cyclofem” or
“Cycloprovera.
3. Norethisterone enanthate 50mg and
estraldiol valerate 5mg NET-EN/E2V;
HRP102 “Mesigyna”
4. 17 & Hydroxyprogesterone caproate 250mg
andestraldiol valerate 5mg Chinese
injectible No. 1
REFERENCES
Impl ants
In rings problems of
erosion/vaginal/cervix/vaginal infection and
inconvenience during S.I
Advantages
As for injectables
Disadvantages
As for injectibles
Requires surgical procedure
CO NTRACEP TIVE I MPLAN TS
Organon International
Simple 30 mm silastic rod
Release the progestin 3 keto
-desogestrel at a rate of 30 ug per day
Effective for two to three years
Removal is quick and relatively simple
3 keto-Desogestrel may inhibit
ovulation more than levonogestrel.
Norplan t 6
❊ Norplant subdermal contraceptive the first
represents the efforts of scientists of
the Population Council who licensed Leiras of
Finland in 1983 to manufacture and
distribute Norplant.
❊ Norplant is a safe, effective method of
reversible fertility regulation.
❊ Despite this, the apparent major
shortcoming is menstrual disorders
which cause about half of all discontinuations.
❊ The observed menstrual changes though
not associated with a adverse alteration
of haematological indices encouraged further
research at the local mechanism underlying
contraceptive induced endometrial
bleeding.
❊ In view of observed undesirable side
Norplan t II
❊ Also from Population Council
Advantages
- Under patient’s control
- not coitus related
- no daily administration
- greater contraceptive effect
- milder adverse effects.
DESIG N OF VAGI NA L CONT RACE PT IV E RING S
- homogenous ring
- shell ring
- core ring
TYP ES OF VAGINAL CONTRAC EP TIVE RIN GS
(c) Sponge
(i) Today sponge - polyurethane and
Nonoxynol-9
Toxic to Spermatozoa
(ii) Protected
(i) Latex
Teat ended
Plain
FEMALE STERILISATION
SURGICAL
Commonest Approaches
(a) Minilap
(b) Laparoscopy
(c) Laparotomy
(d) Vaginal
TUBA L LIG AT ION T ECH NIQUES
(a) Pomeroy
(b) Madlener
(c) Fimbriectomy
(d) Salpingectomy
(e) Uchinda
(f) Irvine
E and F more effective
(i) Occlusive bands or rings: Falope
(ii) Occlusive clips - Filshie or Hulka - Clemems
(iii) Tubal diathermy (Thermocoagulation)
(iv) Hysterectomy
COMPLICATIONS
- immediate
- delayed
- long term
NON-SURGICA L
- via hysteroscopy
- by use of chemicals
- phenols
- quinacrine
(I) SURGICAL
16% of contraceptive use
(i) Vasectomy
(a) Scalpel
(b) Non-scalpel - 1974: China,
Ligation
Excision (segmental)
Coagulation
(ii) Clips
(iii) Silicone rods
MA LE S TE RILISA TION
NON SURGICAL
Percutaneous Intravasal Injection of
Sclerosants viz
(a) Carbolic Acid
(b)N Butyl-cyno-acrylate
TYPES
(a) Androgens
(b) Progestogens + Androgens
(c) Danazol + Androgens
(d) Gonadotrophin Releasing Hormone
(GnRH).
(e) Anti Progestogens
Problems
- continued sperm production
- histamine like effects - GnRH
Antagonists
- Testosterone use viz lipoprotein
changes, acne
ME THODS B EING DE VE LOP ED
CONTRACEPTIVE VACCINES
Research has been on for a few decades
PRINCIPLES OF ACTION
TYPES
E: OTHERS: - Anti-Sperm
- Anti-Ovum
- Anti-Zona Pellucida
- Recombinant Zona
Pellucida Antigens
F: MALE VACCINES
- Passive/Active
Immunisation against FSH
- Gn-RH Vaccine
CONCLUS ION