1. Emergency Contraceptive Pills (ECPs)
Method of Contraception that is used within 72 Hrs of unprotected intercourse to prevent pregnancy also called "Morning after" or post-coital contraception.
Reasons for Using Emergency Contraception
A Woman who had an unprotected sex, and she wants to prevent pregnancy. For example:
- She did not expect to have sex and was not using any contraception.
- Sex was forced.
- A condom broke or slipped.
- She ran out of contraceptives, started a new packet of pills several days late, or missed three or more active pills in a row, and she did not use condoms or spermicidal.
- She is late for contraceptive injection-more than 2 weeks late for DMPA, more than 2 week for Norethindrome enanthate.
The Government of India guidelines for Emergency Contraception recommend use of Levonorgestrel (progestogen only) NG 0.75 mg as a "dedicated product" for effective emergency contraception. The Drug Controller of India has approved only Levonorgestrel for use as ECP.
How do ECP [Emergency Contraceptive Pill] Work
Prevents pregnancy by inhibiting or delaying ovulation, altering the survival mucosa, altering the endometrial leading to impair endometrial receptivity to implantation of fertilizing egg. Alternating the transportation of embryo, sperms & egg.
Medical Eligibility Criteria for Emergency Oral Contraception.
Any Woman can use emergency oral contraception if she is not already pregnant.
When Should ECPs be taken?
The ECPs should be taken as soon as possible after unprotected intercourse. Only one tab of 1.5 mg or two tabs of 0.75 mg stat should be taken within 72 hours after intercourse.
2. In Tra Uterine Devices(IUDs)
Mechanism of action
Prevent sperms and egg from meeting.
Perhaps makes movement of sperm difficult, reduces the ability of sperm to fertilize egg.
Possibly prevents egg from being emplaned in wall of uterus.
- A single decision leads to effective long-term prevention of pregnancy.
- Long-lasting .Cut-380 A, lasts at least 10 years. Inert IUDs never need replacement.
- Little to remember for clients.
- No interference with sex.
- Increased sexual enjoyment, no need to worry about pregnancy.
- No hormonal side-effects of copper-bearing or inert IUDs.
- Immediately reversible.
- No effect on quality or quantity of breast milk.
- Can be inserted immediately after childbirth (except hormonal IUDs) or after induced abortion (if no evidence of infection)
- Menstrual Changes common in early months but lessen after 3 months.
- Longer and heavy menstrual periods.
- Bleeding or spotting between periods.
- More cramps or pain during periods.
- Does not protect against sexually transmitted diseases or HIV/AIDS
Many Women can use Copper-bearing IUDs can be safely used by Women who:
- Have just had an abortion or miscarriage (if no evidence of infection or risk of infection)
- Take antibiotics or anticonvulsants
- Are fat or thin
- Are breastfeeding
At routine follow-up visit (3 –weeks)
Conduct pelvic examination as appropriate.
Definitely conduct pelvic examination if you suspect:
Pelvic inflammatory disease
Sexually transmitted infection
IUD is out of place.
3. Male Sterilization –Vasectomy
Introduction Vasectomy is:
One of the safest and most effective family planning methods.
One of the few contraceptive options available to men
How does it Work?
A small opening made in the man's scrotum and the Vas deferens on either side are closed off.
This keeps sperms out of his semen. The man can still have erections and ejaculate semen.
His semen, however, no longer makes a woman pregnant because it has no sperms in it.
- Very effective
- Permanent. A small, quick procedure leads to lifelong, safe and very effective family planning.
- Nothing to remember except to use condoms or another family planning method for at least 3 months.
- No interference with sex.Does not affects the man's ability to have sex.
- Increased sexual enjoyment because no need to worry about pregnancy.
- No supplies to get, no repeated clinic visits required.
- No apparent long –term health risks.
- Compared with voluntary female sterilization
Probably slightly more effective
Easier to perform
If there is a charge, often less expensive
Can be tested for effectiveness at any time.
If pregnant occurs in the man's partner, less likely to be ectopic than a pregnancy in a woman who has been sterilized.
Types of female Sterilization Two broad categories: LAPROSCOPY & LAPROTOMY
- Very effective method of contraception.
- Nothing to remember
- No supplies needed
- No repeated clinic visits required
- No interference with sex.
- Increased sexual enjoyment
- No effect on breast feeding
- No known side effects or health risks
- Minilaparotomy can be performed just after a woman gives birth.
- Helps protect against ovarian cancer
Most Women can have Sterilization
Including those Who:
Have just given birth (24 hrs to 7 days)
The Minilaparato my procedure
A small incision (2-5 cm) is made
Uterus raised and turned to bring the 2 fallopian tubes under the incision.
Each tube is tied and cut, or else with clip or ring.
Incision is closed with stitches and covered with adhesive bandages.
The Woman receives instructions on what to do after she leaves the clinic or hospital. She usually can leave in few hours (observed for 4 hours postop.)
The Laparoscopy procedure
Local aesthetics injected under woman's navel.
Abdomen is inflamed with gas or air.
Small incision (about 2 cm) made and laparoscope inserted.
The Laparoscopy Procedure
Each tube is closed with
The gas or air islet out of woman's abdomen
Incision is closed and covered with adhesive bandages
The Woman receives instructions on what to do after she leaves the clinic or hospital. She usually can leave in few hours (observed for 4 hours post-op.)
After the procedure, the woman should
- Rest for 2 or 3 days and avoid heavy lifting for a week
- Keep the incision clean and dry for 2-3 days.
- Be careful not to rub or irritate the incision for 1 week
- Take paracetamol or another safe, pain killer as needed. She should not take aspirin or ibuprofen which slow blood clotting.
- Not have sex for at least one week, or until all pain is gone.
Five Common causes of female sterilization failure
- An undetected luteal-phase pregnancy that was present at the time of Sterilization.
- Surgical "Occlusion" of a structure other than the fallopian tube (most often, the round ligament)
- In complete or inadequate occlusion of the fallopian tube.
- Miss placement of the mechanical device.
How to prevent failures of female Sterilization: Two Methods
Schedule procedure should bedone within 7 days following the menstrual period.
Fallopian tubes should be identifying properly by tracing them right up to the finbrial end prior to occlusion.