Contraception

CONTRACEPTION

Dr John Pradee

CONTRACEPTION

Dr John Pradeep

POST CONCEPTIONAL METHODS

MENSTRUAL REGULATION

Aspiration of uterine contents 6-14

days of a missed period.

Cervical dilatation is indicated only in

nullipara or in apprehensive subjects.

ComplicationsIMMEDIATE: Uterine Perforation. Trauma.

LATE: Tendency to Abortion. Premature labour. Infertility. Menstrual disorders. Ectopic pregnancy

Differs from Abortion

Lack of certainty if a pregnancy

is being terminated.

Lack of legal restriction.

Increased safety of early

procedure.

MENSTRUAL INDUCTION

PROSTAGLANDIN F2

Disturbing normal progesterone-prostaglandinbalance

Sustained contraction of uterus in few minutes

Cyclic contraction of uterus in 3-4 hrs

Bleeding starts & continues for 7-8

days

MISCELLANEOUS METHODS

ABSTINENCE

• Complete Sexual

Abstinence

• May causes

Temperamental

changes

and even Nervous

breakdown.

COITUS INTERRUPTUS• Male withdraws before

ejaculation.

• Precoital secretion of

the male mey contain

sperms.

• Even one drop of

semen is sufficient to

cause pregnancy.

SIDE EFFECTS:

• Pelvic Congestion.

• Vaginismus.

• Anxiety Neurosis.

SAFE PERIODWomen’s menstrual

cycles are not always regular.

Programmed sex.Failure rate: 9 per

100 women.Method not

applicable during the post natal period.

NATURAL FAMILY PLANNING METHODS

Basal Body Temperature (BBT)

method.

Cervical mucus method.

Symptothermic method.

BBT Method

The rise BBT at the time of ovulation,

as a result of increased production in

the progesterone.

Temperature measured preferably

before getting out of bed in the

morning.

Abstinence is necessary for the entire

period.

Cervical mucus methodAlso known as “Billings method”.Observation of changes in the

characteristics of cervical mucus.Ovulation period

Cervical mucus iswatery clear( Raw egg white, smooth, slippery, & profuse)

Symptothermic method

Temperature

+

Cervical Mucus

+

Calendar Technique

BREAST FEEDINGLactation prolong postpartum

amenorrhea.

Vaccine prepared from ß- sub unit of

Human chorionic gonadotropin (hcG).

Antibodies appear 4-6 wks and lasts

upto 5 months.

Booster dose can be given after that.

BIRTH CONTROL VACCINE

ABORTION

Defined as termination of

pregnancy before the foetus

becomes viable (capable of living

independently.)Types: Spontaneous. Induced. 6 million abortions/ year in India.4 million are Induced & 2 million are Spontaneous.

ABORTIONAL HAZARDS

EARLY COMPLICATIONSHaemorrhageShockSepsisUterine perforationCervical injuryThromboembolismPsychiatric

complications.

LATE COMPLICATIONSInfertilityEctopic gestationIncreased risk of

Spontaneous abortion

Reduced birth weight

THE MEDICAL TERMINATION OF PREGNANCY ACT 1971

Conditions under which a

pregnacy can be terminated.

Person or persons who can

perform such terminations.

Place where such terminations

can be performed.

Conditions under which pregnancy can be terminated.

MEDICAL

EUGENIC

HUMANITARIAN

SOCIO ECONOMIC

FAILURE OF

CONTRACEPTIVE DEVICES

MEDICAL: where continuation of

pregnancy might endanger the mother’s

life or cause grave injury to her physical or

mental health.

EUGENIC: where there is substantial risk of

the child being born with serious

handicaps due to physical or mental

abnormalities.

HUMANITARIAN : where pregnancy is

due to rape.

SOCIO-ECONOMIC : where actual or

reasonably forseeable environments

(whether social or economic) could

lead to risk of injury to health of the

mother.

FAILURE OF CONTRACEPTIVE

DEVICES The anguish caused by

an unwanted pregnancy resulting

from a failure of any contraceptive

device or method can be

presumed to constitute a grave

mental injury to the health of the

mother.

PERSON WHO CAN PERFORM ABORTION

RMP having experience in gynecology

and obstetrics ( pregnancy doesn’t

exceed 12 weeks).

12-20 weeks – Two RMP’s are

necessary to terminate a pregnancy.

WHERE ABORTION CAN BE DONE

Hospital established or maintained by

government or a place approved for the

purpose of this Act by government.

Name of the abortion seeker is kept

confidential.

MTP rules

Approval by Board :

The Chief Medical Officer of

the district is empowered to

certify that a doctor has the

necessary training in

gynaecology & obstetrics to do

abortions.

Qualification required to do abortion :“If he has assisted a RMP in the

performance of 25 cases of medical termination of pregnancy in an approved institution.”The doctor may also qualify to do MTP’s :a. 6 months house manship in OBG.b. A post graduate qualification in OBG.c. 3 years of practice in OBG for those

doctors registered before the 1971 MTP Act was passed.

d. 1 year of practice in OBG for those doctors registered on or after the date of commencement of the Act.

The place where abortion is

performed :

Non-governmental institutions

may also take up abortions

provided they obtain license from

the Chief Medical Officer of the

district.

Thank You