familyplanning計劃生育Section1

ContraceptionContraception

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HormonalContraception

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IntrauterineDevice(IUD)

●OthersHormonalContraceptionHormonalContraceptionOralcontraception,OCContraceptiveinjectionContraceptivedeliverysystem

OralcontraceptionShort-actingoralcontraceptivesMonophasicBiphasicTriphasic:moreandmorewidespread

●VacationpillsOralcontraceptionShort-actingoralcontraceptivesMonophasicBiphasicTriphasic:moreandmorewidespread

●VacationpillsContraceptiveinjectionLong-actingSingleprogesterone;combinedtypeOnemonth;threemonthsContraceptivedeliverysystemImplantationVaginalringMicrospheresandmicrocapsulesinjectionContraceptivepatchMechanismofhormonalcontraception

MechanismofhormonalcontraceptionMechanismofhormonalcontraceptionPreventingovulationAlteringthecervicalmucusAlteringtheendometriumAlterthefunctionofoviductsIndicationofhormonalcontraceptionChild-bearingageNocontraindictionHealthywomen

ContraindicationofhormonalcontraceptionSeriouscardiovasculardiseasesAcuteandchronichepatitis,ornephritisBlooddiseaseorthromboticdiseasesEndocrinediseaseCancer,precancerouslesions,uterineorbreastlumpsLactationperiodMenstrualrareorolderthan45yearsoldUnexplainedvaginalbleedingMentaldiseaseSideeffectsofhormonalcontraceptionNausea,dizziness,fatigue,drowsiness,lossofappetiteBreakthroughbleedingMissedmenstrualperiodsoramenorrheaWeightgainPigmentationHeadache,breasttenderness,increasedappetite,itchingSideeffectsofhormonalcontraceptionEndometrialcancer,cervicalcancer,breastcancer,epithelialovariancancerFertility—80%ovulationin3months,95%~98%ovulationinayearOffspringhealthImpairedglucosetolerance;increaseofHDL,triglyceride&totalcholesterol;totalproteindecreasedThromboembolicdisease

IntrauterineDevice(IUD)

IntrauterineDevice(IUD)InertintrauterinedevicesActivityIUD---withcopperwithdrugsprogesterone(Mirena)indomethacinothers

MirenaT形塑料支架放置直徑4.8mm19mm32mm縱形管內(nèi)含52mg左炔諾孕酮取出用尾絲Mechanism---IUDMobilizationofleukocytes→produceanenvironmenthostile+influencethemovementoftheoviductsInterferenceofendometrialmaturationCopperdevice→killsperm+interruptionofcellmetabolismProgesterone-releasingdevice→alterationofnormaltubalcilialaction+disruptionofnormaloocytematurationMechanism---MirenaIndication---IUDWomenofchildbearingageNocontraindictionWithVoluntaryrequirements

Contraindication---IUDPregnancyorpregnancysuspectedInflammationofgenitaltractTumorofgenitaltractMenorrhagia,frequentmenstruation,irregularvaginalbleedingUterineinjurydiseasesGenitalmalformations

Contraindication---IUDAbnormaluterinecavitySeveresystemicdiseasevenerealdiseasePelvictuberculosisPooruterinecontraction,residual,inflammationafterabortion,deliveryorcesareansectionCopperallergyInsertiontime---IUD3~7daysaftermenstruationDelayedmenstruation,lactationamenorrhea---ruleoutpregnancy42dayspostpartumDuringabortionorcesareansection▼Insertionsteps---

MirenaSideeffects&complication---IUDDuringinsertion---bleeding,uterineperforationAfterinsertion---infection;ectopic,crack,deformationofIUD;menstrualabnormalities;vaginaldischargeincreased;pelvicinfection;ectopicpregnancy

OthercontraceptionTopicalcontraceptives---condom;femalcondom;contraceptivediaphragm;vaginalspermicidesNaturalfamilyplanning---20%failurerateBiotechnologycontraception---LHRHa;immunocontraception;anti-fertilityvaccineSection2

SterilizationTubalsterilizationoperationSafe,permanentHighreversibilitySurgicalapproach---laparotomy(tuballigation);laparoscopy;transvaginal

Indication---tuballigationVoluntaryNocontraindictionTherapeuticsterilization

Contraindication---

tuballigationPelvicinflammatorydisesesAbdominalskininflammation2timesofT>37.5℃in24hrsCannottoleratesurgeryduetosystematicdiseasesSeverneurosisPreparation---tuballigationTimechoice---3~7daysaftermenstruation;duringabortion,deliveryorcesareansectionGoodexplanationHistory,physicalexamination,bloodandurinelaboratoryexaminationGynecologicalabdominalsurgerypreparationAnesthesia---

tuballigation

localinfiltrationanesthesiaIntravenousanesthesiaEpiduralanesthesiaEndotrachealintubationanesthesia

Steps---

tuballigation

Emptyingthebladder→disinfectionofSurgicalfieldIncitionExtracttubeExtinguishtubeLigatetube---UchidamethodCheck,closeabdomenComplication---tuballigation

BleedingorhematomaInfectionOrgandamageSterilizationfailureSection3

RemedialmeasuresforcontraceptionfailureInducedabortionInducedabortionearlymid-pregnancymedicalabortionartificialabortionVacuumsuctionCurettageVacuumsuctionIndication---pregnanciesof10weeks,durationorless

---WithVoluntaryrequirementswithoutcontraindiction

---CannotcontinuethepregnancyduotodiseaseContraindiction---emergencystageofalldiseases

---Inflammationofgenitaltract

---2timesofT>37.5℃beforeoperation

---PoorhealthysituationSteps---

VacuumsuctionPreparationDetectuterinecavityDilatecervixVacuumsuctionCheck

Steps---

VacuumsuctionCurettage10~14pregnancygestationSufficientlydilatecervixGraduallydisplacedbymedicalabortionComplication---artificialabortionUterineperforationInte