ROSHNI PERERA; GROUP 11

Contraception.
 Contraception is a way to prevent prgnancy using medications, devices, or abstinence.
Contraceptives can be used regularly prior to intercourse, at the time of intercourse, or after
intercourse. A patient’s choice of contraceptive method will be influenced by personal
considerations, noncontraceptive benefits, efficacy, safety, cost, and contraceptive method
 barrier methods.

Contents
hormonal agents.
intraunterine device.
postcoital/ emergency
contraception.

vasectomy.
bilateral tubal occlusion.
other methods of
sterilization.

continuous abstinence.
natural family planning.
 Barrier.
diaphragm;
A flexible ring with a rubber dome that must be fi tted by a gynecologist. It cre ates a barrier
between the cervix and the lower portion of the vagina. It must be inserted with spermicide and
left in place after intercourse for 6–8 hr.
cervical caps A smaller version of a diaphragm that fi ts directly over the cervix.
condoms female condom; male condom;
rarely used, expense and inconvenience, labial types; latex , polyurethane, animal skins.,
protection, 79% efficacy. efficacy 86-97%

mechanical obstruction.

not desiring hormones, reduce STIs.

 DISADVANTAGES AND CONTRAINDICATIONS;
Must be placed properly before genital contact. ↓ sensation. May rupture (condom)

If left in for too long, may result in Staphylococcus aureus infection (which may cause toxic shock
syndrome). May ↑ risk of urinary tract infection (UTI) (diaphragm)

Pelvic organ prolapse Patient discomfort with placing devices on genitals Lack of spontaneity
Allergies to materials Diaphragm may be associated with more UTIs
 hormonal
agents. Inhibits ovulation
Thickens cervical mucus to inhibit sperm
Combined hormonal (estrogen and progestin)Combined oral contraceptives penetration
Contraception patch Alters motility of uterus and fallopian
Vaginal ring tubes
Thins endometrium
Thickens cervical mucous to inhibit sperm
Progestin-only oral Minipill penetration
Alters motility of uterus and fallopian tubes
Thins endometrium

Injectables depo-medroxy progesterone

Inhibits ovulation
acetate Thins endometrium
Implants (subdermal in arm) Etonorgestrel (progestin) Alters cervical mucous to inhibit sperm penetration
 DISADVANTAGES AND CONTRAINDICATIONS

Implants (subdermal in arm)

Combined hormonal (estrogen and progestin)
Current or past history of
Progestin-only oral thrombosis or thromboembolic
Known thrombogenic mutations
disorders
Prior thromboembolic event dependent on taking pill each day Hepatic tumors (benign or
Cerebrovascular or coronary artery disease at same time malignant),
Cigarette smoker over age of 35 Patient needs to remember to take active liver disease
Uncontrolled hypertension pill Undiagnosed abnormal
Diabetic retinopathy, nephropathy,
vaginal bleeding
peripheral vascular disease
Injectables Known or suspected
Undiagnosed vaginal bleeding
carcinoma of the breast or
Migraines with aura
↑ Depression personal history of breast
Benign or malignant liver tumors,
↑ Osteopenia/ osteoporosis cancer
active liver disease,
Weight gain Hypersensitivity to any of the
liver failure
components
Known or suspected pregnancy
May ↑ irregular vaginal
bleeding
IUD
Levonorgestrel IUD

Thickens cervical mucous

Thins endometrium Desires long-term reversible contraception (5 yr)
Stable, mutually monogamous relationship
Copper-T
Menorrhagia
Inhibits sperm migration and viability Dysmenorrhea
Changes transport speed of ovum Desires long-term reversible contraception (10
Damages ovum yr)
Stable, mutually monogamous relationship
Contraindication to contraceptive steroids
 DISADVANTAGES AND CONTRAINDICATIONS
Copper-T

Current STI
Current PID within past 2 months
Unexplained vaginal bleeding
Levonorgestrel IUD Malignant gestational trophoblastic disease
Untreated cervical or endometrial cancer
Current breast cancer
Current STI or recent PID Anatomical abnormalities distorting the uterine cavity
Unexplained vaginal bleeding Uterine fibriods distorting endometrial cavity
Wilson disease
Malignant gestational trophoblastic disease
May cause more bleeding or dysmenorrhea
Untreated cervical or endometrial cancer
Current breast cancer
Anatomical abnormalities distorting the uterine cavity
Uterine fibroids distorting endometrial cavity
 sterilization
Sterilization is an elective surgery that leaves a male or female unable to re
produce.
Male type: Vasectomy. Female type: Tubal occlusion.
Vasectomy;
Excision of a small section of both vas deferens followed by sealing of the
proximal and distal cut ends (office procedure done under local anesthesia).
Ejaculation still occurs. Sperm can still be found proximal to the surgical site,
so to ensure sterility one must use contraception for 12 weeks or 20
ejaculations and then have two consecutive negative sperm counts.

Bilateral Tubal Occlusion

Procedures can be performed either postpartum (during cesar ean section or
immediately after vaginal delivery) or interval (remote from a pregnancy). An interval
tubal occlusion should be performed in the follicular phase of the menstrual cycle in
order to avoid the time of ovulation and possi ble pregnancy.
 types of bto
LAPAROSCOPIC TUBAL OCCLUSION
Eighty to ninety percent of tubal occlusions are done laparoscopically. All methods occlude the fallopian
tubes bilaterally.

ELECTROCAUTERY
This involves the cauterization of a 3-cm zone of the isthmus. It is the most popular method (very effective
but most diffi cult to reverse).

CLIPPING
The Hulka-Clemens clip (also Filshie clip), similar to a staple, is applied at a 90-degree angle on the isthmus. It
is the most easily reversed method but also has the highest failure rate.

BANDING
A length of isthmus is drawn up into the end of the trocar, and a silicone band, or Fallope ring, is placed
around the base of the drawn-up portion of fallopian tube
 **Hysteroscopic Occlusion (Essure)**
A small coil implant (polyester, nickel, titanium, steel) is placed in the proximal fallopian tube to cause scarring, which
blocks sperm after about three months. It has a 99.8% effectiveness rate over two years. Alternative contraception is
required until confirmed by a hysterosalpingogram.

**Postpartum Tubal Occlusion Methods**

- **Pomeroy**: A segment is looped and tied, then cut to leave a gap.
- **Parkland**: A window is made in the mesosalpinx; segments are tied and excised.
- **Madlener**: Similar to Pomeroy but without excision.
- **Irving**: The isthmus is cut, with ends buried in surrounding tissue.
- **Kroener**: Resection of the distal ampulla and fimbriae.
- **Uchida**: Epinephrine is injected; the tube is tied, cut, and repositioned.

**Partial or Total Salpingectomy**

Removal of part or all of the fallopian tube.

**Luteal-Phase Pregnancy**
Pregnancy occurs after sterilization but was conceived before; 2–3 per 1,000 cases. It can be prevented by timing the
procedure or using pregnancy tests beforehand.

**Reversibility of Tubal Obstruction**

Approximately one-third of tubal ligations are reversible, but pregnancies after reversal are often ectopic until proven
otherwise.
 COMPLICATIONS OF TUBAL OCCLUSION

Failure of procedure (patient still fertile).

Poststerility syndrome: Pelvic pain/dysmenorrhea,
menorrhagia, ovar ian cyst.
Fistula formation: Uteroperitoneal fi stulas can occur, especially
if the procedure is performed on the fallopian tubes < 2–3 cm
from the uterus.
Infection.
Operative complications most commonly from anesthesia
 COLPOTOMY
Utilizes entry through the vaginal wall near the posterior cul-de-sac and oc cludes the fallopian tubes by
employing methods similar to those performed in laparoscopy and laparotomy.

HYSTERECTOMY
Removal of the uterus, either vaginally or abdominally; rarely performed for sterilization purposes. Failure rate
is < 1%. Pregnancy after hysterectomy = ectopic pregnancy = emergency.
 abstinence
Continuous Abstinence
Abstaining from vaginal intercourse at any time. It is the only 100%
effective way to prevent pregnancy.

Natural Family Planning (NFP)

A form of birth control based on the timing of sex during a woman’s
menstrual cycle. It can be an effective, low-cost, and safe way to prevent
an un wanted pregnancy. The success or failure of this methods will
depend on the patient’s ability to recognize the signs that ovulation is
about to occur and ab stain from having sex or use another form of
contraception during the fertile period. There are four methods of NFP:
1. Basal body temperature method 2. Ovulation/cervical mucus method
3. Symptothermal method 4. Lactational amenorrhea
Thank you