State educational institution
Higher professional education
"Bashkir State Medical University
Federal Agency for Health and Social Development"
Department of Obstetrics and Gynecology IPO
COURSE WORK
Specialty: Obstetrics and Gynecology
"FAMILY PLANNING AND CONTRACEPTION"
Supervisor: Head of the Department, Doctor of Medical Sciences, Professor Kulavsky V.A.
Completed: cadet of the Department of Obstetrics and Gynecology, IPO Tyumeneva L.P.
Ufa 2010
History of contraception
Modern methods of contraception
Postcoital contraception
Intrauterine contraception.
Traditional methods of contraception.
natural contraception.
Surgical methods of contraception.
Adolescent contraception.
postpartum contraception.
Contraception in the perimenopausal age.
Conclusion.
Analysis of a clinical case.
Bibliography.
Family planning- a concept that is actively entering our lives. What is it and why is family planning so important for each of us, for each family? For many years, family planning was misunderstood as birth control. But family planning is a set of measures aimed at reducing morbidity and maintaining the health of women and children.
Family planning is essential for:
the birth of desired healthy children;
regulation of intervals between pregnancies;
determining the number of children;
controlling the choice of the time of birth of a child depending on the age of the parents;
maintaining women's health;
achieving harmony in psychosexual relationships in the family;
implementation of life plans.
reproductive health - this is a state of complete physical, mental and social well-being in the absence of diseases of the reproductive system at all stages of life.
reproductive system- this is a set of organs and systems of the body that provide the function of reproduction (childbirth).
The state of reproductive health is largely determined by a person's lifestyle, as well as a responsible attitude towards sexual life. In turn, all this affects the stability family relations, the general well-being of the person. One of the factors affecting the state of reproductive function is the prevention of unwanted pregnancy. Often a woman stands in front of difficult choice- Have a baby or have an abortion? This issue is especially difficult to resolve when an unwanted pregnancy occurs in a teenage girl. Abortion, especially during the first pregnancy, can cause serious psychological trauma and even lead to reproductive disorders. At the same time, the decision to give birth means for her a separation from her peers, leaving school (as a rule), jeopardizes further studies and the acquisition of a profession. Each such situation should be considered individually, carefully and with a greater understanding of the problem.
Some parents, teachers, community and religious leaders express concern that introducing young people to family planning, sex education and contraception will encourage irresponsible behavior and increase sexual activity among young people outside of marriage. The experience of many countries shows otherwise. Where sex education programs have been developed, youth sexual activity has not increased. On the contrary, the programs form adolescents in a responsible attitude towards sexuality, in connection with this there is an increase in the age of onset of sexual activity, which helps boys and girls to fully realize their life potential, maintain physical and moral health, protect themselves from mistakes, and have healthy offspring.
However, for adults, the problem of unwanted pregnancy is no less important. That is why family planning services great place It is given to the prevention of unwanted pregnancy and abortion, as well as to the problems of medical and social counseling, so that a woman does not make a decision about an abortion under the influence of temporary emotional experiences or life failures.
Abortion is one of the main problems of modern health care. It is well known that the health of children depends on the health of parents, the course and outcome of pregnancy and childbirth.
There are 78.1 million women in Russia
Most of them (38.6 million) are of childbearing age.
Only 25% of them use modern methods of contraception.
Seven out of ten pregnancies in Russia end in abortion.
2. History of contraception
A person used contraceptive methods, preventing the development of pregnancy for a very long time. Some methods of contraception that were used in primitive society still exist today. Below are the most curious methods of contraception that have been used at different times.
Already in ancient Africa, various substances of plant origin were known, which were used like a "cocoon inserted high into the vagina." In ancient Africa, "interrupted copulation" was described. In America, the Indians, even before the arrival of immigrants from Europe, used washing the vagina with a decoction of mahogany bark and lemon. They also believed that after chewing parsley, a woman bleeds for 4 days. In Australia, for example, contraceptive lumps were prepared from fucus extract. Opium was also used in Sumatra and neighboring islands. The issue of preventing pregnancy came to the fore in the Greco-Roman Empire, in connection with the spread of orgies at that time. To prevent pregnancy, various substances of plant and animal origin, or their decoctions, were used with some success. The attitude to these methods, for example, to the droppings of an elephant or a crocodile, of course, must take into account the conditions and level of development of a given era. World-famous Casanova said that he perfectly prevents pregnancy lemon peel placed in front of the uterus. While this is hilarious today, the recommendation is nonetheless sound, given lemon's acidifying effect on the contents of the vagina.
The use of various intrauterine devices, in order to prevent pregnancy, primarily a variety of balls, was also known on Far East, in China and Japan. The introduction of a loop into the uterine cavity was first used to prevent pregnancy at the beginning of the 20th century. The first such tool was proposed in 1909 by the German gynecologist Richter: a ring from the intestines of a silkworm, fastened with a metal wire. Then a gold or silver ring with an internal disk (Ott ring) was proposed, but since 1935 the use of intrauterine contraceptives was prohibited due to the high risk of developing inflammatory diseases of the internal genitalia. Only in the 60s of the XX century, interest in this method of contraception revived again. In 1962, Lipps used flexible plastic in the form of a double Latin letter "8" to create a contraceptive, which made it possible to insert it without significant expansion of the cervical canal. A nylon thread was attached to the device to remove the contraceptive from the uterine cavity.
In the 20th century, methods and methods of contraception have undergone tremendous development. In 1933, a book was published that already described 180 different spermicidal substances. During subsequent research developed certain spermicidal contraceptives that could be used as powders, tablets, or vaginal boluses. Animal skin male condoms have been used since the ancient world, but became widespread mainly in the first half of the 20th century. Somewhat later, rubber condoms appeared, the improvement of the reliability of which continued until the end of the last century. Of particular note important date in the first half of the 20th century - 1908 - when the cervical cap was developed. Intrauterine devices, not only intrauterine loops, but also spirals different shapes became widespread only in the late 1950s and early 1960s. Of great importance was the creation of more effective intrauterine devices containing copper.
The creation of hormonal contraception was new milestone in preventing pregnancy. The idea of hormonal contraception arose at the beginning of the 20th century, when the Austrian physician Haberland discovered that the administration of an ovarian extract causes temporary sterilization. After the discovery of sex hormones - estrogen in 1929 and progesterone in 1934, an attempt was made to synthesize artificial hormones, and in 1960 the American scientist Pincus and his coworkers created the first contraceptive pill, Enovid.
The birthday of the contraceptive pill is June 1, 1961, when Anovlar appeared, developed by Schering, the first oral contraceptive in Europe. It contained three times less hormones than its American predecessor and was suitable for long-term use. Since that time, the history of the development of combined Hormonal contraception developed along the path of reducing the dose of steroids (estrogens) and along the path of creating selective (selective action) gestagens.
At the first stage, preparations were created with high content hormones (enovid, infecundin) and many serious side effects. At the second stage, contraceptives with a low content of estrogens (30-35 μg) and progestogens with a selective effect appeared, which made it possible to significantly reduce the number of complications when taking them. The 3rd generation drugs include agents containing low (30-35 mcg) or minimal (20 mcg) doses of estrogens, as well as highly selective progestogens (norgestimate, desogestrel, gestodene, dienogest, drospirenone), which have an even greater advantage over their predecessors.
Now the content of hormones in contraceptive pills is regulated by the rule "As much as necessary. As little as possible." For the first time, the drug in a "calendar" package was released in 1964. Each day of the week on the package corresponds to one tablet. This simplifies the control of taking the drug.
Modern drugs contain minimal amounts of hormones, so they very rarely give complications and can be used without interruption for years, of course, with appropriate medical supervision.
Most modern drugs are monophasic. All tablets in the package are the same, which ensures ease of use and a guaranteed contraceptive effect.
3. Modern methods of contraception
Means used to prevent pregnancy are called contraceptives. Contraception is integral part system of family planning and is aimed at the regulation of the birth rate, as well as at the maintenance of women's health.
An indicator of the effectiveness of any contraceptive is the Pearl Index - the number of pregnancies that occurred within 1 year in 100 women who used one or another method of contraception.
Modern methods of contraception are divided into:
intrauterine;
hormonal;
traditional;
surgical (sterilization).
4. Hormonal contraception
One of the most effective and widespread methods of birth control has become hormonal contraception. Tablets (pellets) are one of the most effective contraceptives to date (with proper use, the effectiveness approaches 100%). GC classification:
combined estrogen-gestagen oral contraceptives;
progestogen contraceptives:
(mini-drank);
2) injection;
3) implants;
Vaginal rings with estrogens and gestagens.
Combined oral contraceptives (COC) are tablets containing estrogenic and progestogen components. Synthetic estrogen, ethinylestradiol, is used as the estrogen component of COCs, and various synthetic progestogens are used as the progestogenic component.
The mechanism of action is diverse. The contraceptive effect is achieved as a result of the blockade of cyclic processes of the hypothalamic-pituitary system in response to the administration of steroids (principle feedback), and also because of the direct inhibitory effect on the ovaries. As a result, there is no growth, development of the follicle and ovulation. In addition, progestogens, by increasing the viscosity of cervical mucus, make it impassable for spermatozoa. Finally, the progestogen component slows down the peristalsis of the fallopian tubes and the movement of the egg through them, and in the endometrium causes regressive changes up to atrophy, as a result of which the implantation of the fetal egg, if fertilization does occur, becomes impossible. This mechanism of action ensures high reliability of COCs. With proper use, contraceptive efficacy reaches almost 100%, the Pearl index is 0.05-0.5.
According to the level of ethinylestradiol, COCs are divided into:
high-dose (more than 35 mcg, currently not used for contraceptive purposes);
low-dose (30-35 mcg)
microdosed (20 mcg)
In addition, COCs are monophasic, when all the tablets included in the package have the same composition, and multi-phase (two-phase, three-phase), when the package, designed for a cycle of administration, contains 2 or 3 types of tablets different color, differing in the amount of estrogenic and progestogenic components. Gradual dosage causes cyclic processes in the target organs (uterus, mammary glands), resembling those during a normal menstrual cycle.
Complications when taking COCs.
In connection with the use of new low- and micro-dose COCs containing highly selective progestogens, side effects from the use of hormonal contraceptives are rare.
A small percentage of women taking COCs in the first 3 months. reception possible discomfort associated with the metabolic action of sex steroids. Estrogen-dependent effects include nausea, vomiting, edema, dizziness, heavy menstrual-like bleeding, and gestagen-dependent effects include irritability, depression, fatigue, decreased libido. Headache, migraine, breast engorgement, bleeding may be due to the action of both components of the COC. Currently, these signs are considered as symptoms of adaptation to COCs, usually do not require the appointment of corrective agents and disappear on their own by the end of the 3rd month of regular use.
The most serious complication when taking COCs is the effect on the hemostasis system. It has been proven that the estrogen component of COCs activates the blood coagulation system, which increases the risk of thrombosis, primarily coronary and cerebral, as well as thromboembolism. The possibility of thrombotic complications depends on the dose of ethinylestradiol included in COCs and risk factors, which include age over 35 years, smoking, arterial hypertension, hyperlipidemia, obesity, etc. It is generally accepted that the use of low- or microdosed COCs does not have a significant effect on the system hemostasis in healthy women.
When taking COCs, blood pressure rises, which is due to the influence of the estrogen component on the renin-angiotensin-aldosterone system. However, this phenomenon was noted only in women with an unfavorable history (hereditary predisposition, obesity, arterial hypertension in the present, OPG-preeclampsia in the past). Clinically significant changes in blood pressure in healthy women taking COCs have not been identified.
When using COCs, a number of metabolic disorders are possible:
decrease in glucose tolerance and increase in its level in the blood
(estrogenic influence), which provokes the manifestation of latent forms
diabetes;
adverse effect of gestagens on lipid metabolism (according to
an increase in total cholesterol and its atherogenic fractions), which increases the risk of atherosclerosis and vascular complications.
Weight gain due to the anabolic effect of progestogens, fluid retention due to the influence of estrogen, increased appetite. Modern COCs with a low content of estrogens and selective progestogens have practically no effect on body weight.
Estrogens can have a slight toxic effect on the liver, manifested in a transient increase in transaminases, cause intrahepatic cholestasis with the development of cholestatic hepatitis and jaundice. Gestagens, by increasing the concentration of cholesterol in bile, contribute to the formation of stones in the bile ducts and bladder.
Acne, seborrhea, hirsutism are possible with the use of gestagens with a pronounced androgenic effect. The currently used highly selective gestagens, on the contrary, exhibit an antiandrogenic effect and give not only a contraceptive, but also a therapeutic effect.
A sharp deterioration in vision when using COCs is a consequence of acute retinal thrombosis and requires immediate discontinuation of the drug. It should be borne in mind that COCs cause corneal edema with discomfort when using contact lenses.
A rare but worrying complication is amenorrhea following discontinuation of COC use. It is believed that COC does not cause amenorrhea, but only hides hormonal disorders with regular menstrual-like blood discharge. Such patients should definitely be examined for a pituitary tumor.
Long-term use of COCs changes the microecology of the vagina, contributing to the occurrence of bacterial vaginosis, vaginal candidiasis. In addition, the use of COCs is considered as a risk factor for the transition of existing cervical dysplasia to carcinoma. Women taking COCs should undergo regular cytological examinations of smears from the cervix. Any of the components of COCs can cause an allergic reaction. One of the most common side effects is uterine bleeding when using COCs (from "spotting" to "breakthrough"). The causes of bleeding are the lack of hormones for a particular patient (estrogens - with the appearance of blood discharge in the first half of the cycle, gestagens - in the second half), malabsorption of the drug (vomiting, diarrhea), missed pills, competitive action of other drugs taken with COCs ( some antibiotics, anticonvulsants, beta-blockers, etc.). In most cases, however, intermenstrual bleeding disappears on its own within the first 3 months. taking COCs and do not require the abolition of contraceptives.
COCs do not have a negative effect on fertility in the future (it is restored in most cases within the first 3 months after discontinuation of the drug), do not increase the risk of fetal defects. Accidental use of modern hormonal contraceptives in early dates pregnancy does not give a mutagenic, teratogenic effect and does not require termination of pregnancy.
The contraceptive benefits of COCs include:
high efficiency and almost immediate contraceptive effect;
method reversibility;
low frequency of side effects;
good fertility control;
lack of connection with sexual intercourse and influence on the sexual partner;
eliminating the fear of unwanted pregnancy;
ease of use.
reduced risk of developing ovarian cancer (by 45-50%), endometrial cancer (by 50 – 60%), benign diseases of the mammary glands (by 50- 757o), uterine fibroids, postmenopausal osteoporosis (increased bone mineralization);
reduction in the incidence of inflammatory diseases of the pelvic organs (by 50-70%) as a result of an increase in the viscosity of cervical mucus, ectopic pregnancy, retention formations (cysts) of the ovary (up to 90%), iron deficiency anemia due to less blood loss during menstrual flow than with normal menstruation;
relief of symptoms of premenstrual syndrome and dysmenorrhea;
therapeutic effect in acne, seborrhea, hirsutism (for COCs of the 3rd generation), with endometriosis, with uncomplicated ectopia of the cervix (for three-phase COCs), with some forms of infertility, accompanied by impaired ovulation (rebound effect after the abolition of COCs);
increasing the acceptability of IUDs;
a positive effect on the course of gastric and duodenal ulcers, rheumatoid arthritis.
Disadvantages of the method:
need for daily intake
the possibility of receiving errors,
lack of protection against sexually transmitted infections,
decrease in the effectiveness of COCs with simultaneous
taking other medications.
in the post-abortion period;
in the postpartum period (3 weeks after childbirth, if the woman is not breastfeeding);
with a history of ectopic pregnancy;
who have had inflammatory diseases of the pelvic organs; with menometrorrhagia; with iron deficiency anemia;
with endometriosis, fibrocystic mastopathy (for monophasic COCs);
with premenstrual syndrome, dysmenorrhea, ovulatory syndrome;
with retention formations of the ovaries (for monophasic COCs);
with acne, seborrhea, hirsutism (for COCs with 3rd generation progestogens).
Absolute contraindications to the appointment of COCs:
hormone-dependent malignant tumors (tumors of the genital organs, breast) and liver tumors;
severe violations of the liver and kidneys;
pregnancy;
severe cardiovascular diseases, cerebrovascular diseases;
bleeding from the genital tract of unknown etiology;
severe hypertension (blood pressure higher than
180/110 mmHg Art.);
migraine with focal neurological symptoms;
acute deep vein thrombosis, thromboembolism;
prolonged immobilization;
a period of 4 weeks before and 2 weeks after abdominal surgery (increased risk of thrombotic complications);
smoking in combination with age over 35;
diabetes mellitus with vascular complications;
obesity 3-4 degrees;
lactation (estrogens pass into breast milk).
Conditions requiring immediate withdrawal of hormonal contraceptives:
sudden severe headache;
sudden impairment of vision, coordination, speech, loss of sensation in the limbs;
acute chest pain, unexplained shortness of breath, hemoptysis;
acute pain in the abdomen, especially prolonged;
sudden pain in the legs;
a significant increase in blood pressure;
itching, jaundice; skin rash.
COCs begin to be taken from the 1st day of the menstrual cycle, 1 tablet daily at the same time of day for 21 days.
It should be remembered that multiphase drugs must be taken in a strictly specified sequence. Then they take a 7-day break, during which a menstrual-like reaction occurs, after which a new cycle of administration begins. When performing an artificial abortion, you can start taking COCs on the day of the operation. If a woman is not breastfeeding, the need for contraception occurs 3 weeks after birth.
There is another scheme for using monophasic COCs: a woman takes 3 cycles of tablets in a row, then taking a 7-day break.
If the interval between taking the tablets was more than 36 hours, the reliability of the contraceptive action is not guaranteed. If a tablet is missed in the 1st or 2nd week of the cycle, then the next day you need to drink 2 tablets, and take the next tablets as usual, using additional contraception for 7 days. If the gap was 2 tablets in a row on the 1st or 2nd week, then in the next 2 days you should take 2 tablets, then continue taking the tablets as usual, using additional methods of contraception until the end of the cycle. If you miss a pill in the last week of the cycle, it is recommended to start taking the next pack without interruption.
At correct selection- COCs are safe. The duration of administration does not increase the risk of complications, so COCs can be used for as many years as necessary, up to the onset of postmenopause. It has been proven that taking breaks in taking drugs is not only unnecessary, but also risky, since during this period the likelihood of an unwanted pregnancy increases.
The birth of a child, especially if it is planned, is an extremely important event for every couple. At the same time, the birth of an unwanted child, when the parents (parent) are not ready for this, often turns into a tragedy, especially for the baby. In this regard, family planning, planning of childbearing is of great importance, which is largely determined by contraception (measures aimed at preventing pregnancy). Concentration matters also, when pregnancy is contraindicated or there is an extremely frequent occurrence of pregnancy and childbirth, which are not indifferent to the health of the mother.
Contraception leads to a decrease in the frequency of abortions, contributing to the preservation of a woman's health, and in the subsequent onset of pregnancy - a decrease in the frequency of miscarriage and other obstetric complications.
The use of contraception allows you to choose the optimal interval between the birth of children. Presumably, some contraceptives have protective properties against cancer, inflammatory diseases of the female genital organs, and some prevent infection with infections such as HIV, syphilis, gonorrhea, etc.
Of great importance is sexual hygiene and the use of contraceptive measures in adolescents, for whom abortion is extremely dangerous.
The following requirements are imposed on contraceptive methods: they must be reliable, safe for the health of a woman and a partner, not lead to infertility after their cancellation, not be teratogenic, and easy to use.
The degree of reliability, effectiveness of the use of contraceptives is expressed pearl index: the number of pregnancies during the year in 100 women who used the same method of contraception. The lower the Pearl index, the higher the effectiveness of the contraceptive used.
Contraceptive methods are divided into:
Biological (calendar);
barrier;
Intrauterine;
Hormonal;
Surgical (sterilization).
BIOLOGICAL (CALENDAR) METHOD
The biological (calendar) method is based on abstinence from sexual activity or the use of any methods of contraception during the periovulatory days of the menstrual cycle. The use of this method of contraception is associated with knowing the date of ovulation, which is calculated either according to the calendar, depending on the duration of the menstrual cycle, or according to rectal temperature. It should be borne in mind that the sperm in the genital tract remain viable for 8 days, and the egg for 24 hours.
The Pearl Index for this method is extremely high (up to 40).
BARRIER METHODS
Barrier methods are classified by some authors as traditional, since most of them have been used for many centuries. The essence of barrier contraception is to create a mechanical obstacle to the penetration of spermatozoa into the cervix. With the advent of new modern hormonal and intrauterine contraceptives, interest in them declined for some time. However, with the rise of sexually transmitted infections, they have become very popular again. There are mechanical and chemical means of protection against pregnancy.
Mechanical means contraceptives are divided into male and female. Male condoms are male condoms.
thin pouch cylindrical shape made of latex or vinyl. Some condoms are treated with spermicides, substances that destroy spermatozoa (see below). The condom is put on the erect penis before intercourse. The penis should be removed from the vagina before the erection ceases to prevent the condom from slipping off and semen from entering the woman's genital tract.
The effectiveness of a condom is reduced if it is used incorrectly: repeated use of a condom, intense and prolonged sexual intercourse, leading to macro- and micro-defects of the condom, improper storage, etc. Condoms are good protection against sexually transmitted infections, but infection viral diseases, syphilis is still not excluded when the damaged skin of the patient and a healthy partner come into contact. Side effects include an allergy to latex. The Pearl Index for this type of contraception ranges from 2 to 20.
Women's means of protection against pregnancy include the vaginal diaphragm and the cervical cap. The vaginal diaphragm is a latex dome-shaped cap with a flexible rim, the diameter of which ranges from 50 to 150 mm. It is advisable to cover the diaphragm from the outside with spermicides. The doctor carries out an individual selection of the diaphragm and trains the patient in the method of inserting it into the vagina. The rim of the diaphragm should be located in the posterior fornix of the vagina, and then its opposite edge is placed in front so that it touches the inside of the pubic bone. More often for nulliparous, a diaphragm with a diameter of 60-65 mm is used, and for those who have given birth - 70-75 mm.
A woman inserts her diaphragm while squatting or lying on her back. With his left hand, he spreads the labia, and with his right hand he brings the diaphragm compressed from the sides along the back wall of the vagina to the arch, and then, pushing it in front, positions it so that it corresponds to the inside of the pubic bone. After inserting the diaphragm into the vagina, the patient should check with her fingers inserted into the vagina whether it covers the cervix.
After intercourse, the diaphragm should be left in the vagina for at least 6 hours and no more than 24 hours.
Remove the diaphragm with your finger right hand, sipping it by the front edge. After removal, the diaphragm must be rinsed in warm water with soap and dry. The diaphragm can be used repeatedly.
Contraindications to the use of the diaphragm are: endocervicitis, colpitis, cervical erosion, rubber allergy, anomalies in the development of the genitals, prolapse of the walls of the vagina and uterus.
Side effects include infection of the urinary tract and inflammatory changes in the vaginal wall at the point of contact with the diaphragm ring.
The Pearl Index with the correct use of the diaphragm is 2. Incorrect insertion of the diaphragm significantly increases this figure.
Cervical caps are metal or latex cups that are worn over the cervix. Caps are also used with spermicides. Caps are introduced before sexual intercourse, removed after 6-8 hours, maximum after 24 hours. The cap is washed after use and stored in a dry place. Contraindications to contraception in this way are diseases and deformation of the cervix, inflammatory diseases of the genital organs, prolapse of the walls of the vagina, the postpartum period (Fig. 33.1).
Rice. 33.1. Vaginal latex capThe Pearl Index is higher than when using aperture.
Chemical methods of contraception(spermicides) consist in the introduction into the vagina of substances that can destroy the cell membrane of spermatozoa within a few seconds. For this purpose, you can use vaginal lavage immediately after sexual intercourse with acetic, boric, lactic, citric acids. Currently, the main spermicides that are part of the finished forms are benzalkonium chloride, which destroy the cell membrane of spermatozoa.
Spermicides are available in the form of vaginal tablets, suppositories, gels, creams, films, foams with special nozzles for intravaginal administration. Their contraceptive effect is manifested immediately after administration. With repeated sexual intercourse, additional administration of spermicides is required.
There are special polyurethane sponges impregnated with spermicides. Sponges are inserted into the vagina before sexual intercourse (it is possible a day before sexual intercourse). They have the properties of chemical and mechanical contraceptives and secrete spermicides, creating a mechanical barrier to the passage of spermatozoa. It is recommended to leave the sponge for at least 6 hours after intercourse for the reliability of the contraceptive effect, but it must be removed no later than 30 hours.
The Pearl Index when using chemical methods of contraceptives is quite large - up to 20. The use of spermacids together with mechanical means is more effective.
The positive side of barrier methods is their easy application by partners. Can be used during lactation.
The disadvantages include the possibility of allergic reactions, the need for manual manipulations on the genitals before or during intercourse.
HORMONAL CONTRACEPTION
A huge step forward was the introduction of hormonal contraception into genetic practice, which is not only a means of preventing unwanted pregnancy, but also a method of treating certain gynecological diseases.
All hormonal contraceptives contain either estrogens and gestagens, or only gestagens. The most commonly used estrogen is ethinyl estradiol.
The mechanism of action of hormonal contraceptives ultimately occurs due to the blockade of ovulation, since externally administered daily hormones disrupt the cyclic activity of the hypothalamic-pituitary system. At the same time, regressive changes occur in the endometrium up to atrophy, as a result of which the implantation of the egg, if fertilization does occur, becomes impossible.
In addition, gestagens, by increasing the viscosity of cervical mucus, make it impassable for spermatozoa; slow down the peristalsis of the fallopian tubes and the movement of the egg through them.
Over the past 45 years, work has been constantly carried out to improve the quality of hormonal contraceptives: by choosing the optimal ratio of estrogens and progestins, as well as selecting the dose of each of the drugs.
Depending on the composition, dose and method of use of hormonal contraceptives, they are divided into the following groups:
Combined oral contraceptives (COCs);
Gestagen contraceptives:
a) oral contraceptives containing microdoses of gestagens (mini-pill);
b) injection;
c) implants;
d) vaginal rings containing hormones;
Postcoital contraception (large doses of estrogens, progesterone, corticosteroids) used in the first hours after unprotected intercourse.
Combined oral contraceptives are tablets containing estrogen and progestogen components. Currently, low-dose (30-35 mcg) or micro-dose (20 mcg) preparations containing extremely low doses of estrogens are being sought.
Combined oral contraceptives are divided into monophasic, biphasic and triphasic.
Monophasic drugs include drugs that contain strictly dosed estrogens and gestagens. These include mersilon, marvelon, femoden, regulon, khanin, novinet, logest.
Biphasic and triphasic contain combinations of estrogens and gestagens, the dose of which depends on the day of the menstrual cycle, simulating it.
A biphasic (antevin) contraceptive in the form of large doses of both estrogens and progestogens is not used to prevent pregnancy.
Three-phase COCs, often used in practice, include the following: trisiston, triquilar, triregol.
Three-phase oral contraceptives are especially indicated for women younger than 18 and older than 35-40 years, as well as for patients with a high risk of developing thrombotic complications due to smoking, cardiovascular pathology, and metabolic disorders.
The drug Yarina deserves special attention, which, in addition to 30 mg of ethinylestradiol, contains 3 mg of drospirenone (veroshpiron). Drospirenone has antimineralcorticoid and antiandrogenic activity. In this regard, when taking Yarina, there is no increase in body weight, the tension of the mammary glands before menstruation decreases, and unpleasant skin manifestations often disappear: acene vulgaris.
Combined oral contraceptives should be used from the 1st day of the menstrual cycle for 21 days daily, preferably at the same time of day. This is followed by a 7-day break, during which a menstrual-like reaction occurs. Next, a 21-day COC is taken again.
In practice, oral contraceptives are most often used, but, as noted, hormonal preparations can be administered in another way: by injection under the skin, in the form of implants, intrauterine devices or in the form of a cervical ring loaded with hormones.
Injectable contraception recommended for women who do not want to use hormonal drugs daily or during lactation. For this purpose, the drug Depo-Provera, which is progesterone, may be recommended. The drug as a contraceptive is administered 1 time in 3 months at a dose of 150 mg. The first injection is made within the first 5 days from the onset of menstruation or immediately after an abortion, and in non-breastfeeding women - after childbirth. If breastfeeding is carried out, then Depo-Provera, in order to protect against possible pregnancy, is introduced no earlier than 6 weeks after birth.
The disadvantage of such contraception is the possibility of acyclic bleeding and the restoration of fertility only after 0.5 years, and sometimes even 1-2 years after discontinuation of Depo-Provera.
The efficiency of the method is quite high - the Pearl index is 1-2.
Subcutaneous implant involves the introduction under the skin of capsules containing gestagens (levonorgestrel), constantly entering the body in small doses. An example of an implant is a norplant, consisting of silastic capsules that are inserted under the skin. inside forearms through a small incision. Manipulation is carried out under local anesthesia. The action of the contraceptive begins after 24 hours and lasts up to 5 years.
The Pearl Index indicates high efficiency, amounting to 0.2-1.6.
The disadvantage of the method is, firstly, the possible appearance of blood discharge from the uterus outside the menstrual cycle and, secondly, the need to surgically remove the capsules.
As intrauterine device, having a shell that contains gestogens that are dosed into the body, is Mirena.
The hormone-containing coating is also used in the form vaginal ring- Nova-Ring. The way to prevent pregnancy hormonal contraception is the constant release of hormones by a ring, which is located in the vagina. An easily compressible ring, consisting of a substance that does not cause allergies, is inserted into the vagina (the method of insertion does not differ from that of the diaphragm). Being in the vagina a complex system Nova-Ring membranes continuously release estrogens and a progesterone metabolite at a dose that provides a stable hormonal background on which contraception is based.
A significant advantage of such an introduction into the body of hormones is the absence of the need for daily intake of combined oral contraceptives, and hormones with such intake into the body do not enter the liver.
The efficiency of the method is quite high. The Pearl Index is 0.6. observed pregnancies (6 per 1100 women) are determined by the violation of the method used.
Complications when taking hormonal contraceptives. In connection with the use of new low- and microdose COCs containing highly selective gestogens, side effects are rare. A small percentage of women taking COCs may experience discomfort during the first three months of use due to the metabolic effects of sex steroids. Some women experience nausea, vomiting, swelling, dizziness, heavy menstrual bleeding, irritability, depression, fatigue, decreased libido, headache, migraine, breast engorgement. These signs are considered as symptoms of adaptation, they usually do not require the appointment of corrective agents and disappear on their own by the end of the 3rd month of regular use of the drug.
The most serious complication when taking hormonal contraceptives is a change in the blood coagulation system: an increase in the formation and activation of fibrinogen, thrombin, factors VII and X, which increases the risk of developing venous thrombosis in the coronary and cerebral vessels, as well as thromboembolism. The possibility of thrombotic changes depends on the dose of ethinylestradiol included in the hormonal contraceptive.
Risk factors for the development of coagulation disorders under the influence of hormonal contraceptives include age over 35 years, arterial hypertension, obesity, varicose veins.
Contraindications to the use of combined oral contraceptives are:
Acute deep vein thrombosis, thromboembolism;
Severe violations of the liver and kidneys;
Liver disease;
Severe cardiovascular diseases; vascular diseases of the brain; bleeding from the genital tract of unknown etiology;
Severe arterial hypertension (blood pressure above 180/110 mm Hg);
Migraines with focal neurological symptoms;
Lactation (estrogens pass into breast milk).
Conditions requiring immediate withdrawal of hormonal contraceptives:
sudden severe headache;
Sudden impairment of vision, coordination, speech, loss of sensation in the limbs;
Acute chest pain, unexplained shortness of breath, hemoptysis;
Acute pain in the abdomen, especially prolonged;
sudden pain in the legs;
Significant increase in blood pressure;
Itching, jaundice;
Skin rash.
The effectiveness of hormonal contraceptives is extremely high -
the Pearl index is 0.05-0.5.
POSTCOITAL CONTRACEPTION
Emergency contraception should not be used regularly and should only be used in exceptional cases (rape, condom rupture, diaphragmatic displacement, in cases where the use of other methods of contraception is not possible) or in women who have infrequent sexual intercourse.
Most often, either combined oral contraception or pure gestagens are used.
The first dose of hormones should be carried out no later than 72 hours after unprotected intercourse, the second - 12 hours after the first dose.
Postinor, a Hungarian drug containing 750 mg of levonorgestrel, was created specifically for postcoital progestational contraception.
The effectiveness of this contraception is not high enough - the Pearl index is 2-3.
After using emergency contraception, it is advisable to conduct a pregnancy test, if the result is negative, choose one of the methods of planned contraception. If pregnancy does occur, then it should be interrupted, since a teratogenic effect of large doses of hormones is possible.
INTRAUTERINE CONTRACEPTION
Intrauterine contraception (IUD) is associated with the introduction into the uterus of intrauterine devices (IUDs) made from inert substances (silver; gold; plastic; plastic; containing copper or silver). Some IUDs contain hormones that are gradually released into the body. The history of the creation and widespread introduction into the practice of VMC began in the 60s of the last century. Currently, the forms of IUDs and their materials are very different. Intrauterine contraceptives end with threads, for which, if necessary, it is possible to remove the IUD from the uterine cavity by sipping.
The most commonly used are the following IUDs (Fig. 33.2): copper containing (Copper T-380, Multiload); Mirena, which is a T-shaped contraceptive with a semi-permeable membrane that releases daily gestagens (levonorgestrel).
The method of introducing the IUD is as follows: the cervix is exposed with mirrors, treated with a disinfectant, its front lip is captured with bullet forceps. Measure the length of the uterine cavity with a probe and select the appropriate size of the contraceptive. The IUD is placed in the uterus with a special tube - a conductor, which, without expanding the cervical canal, is inserted into the uterine cavity to the bottom and the contraceptive is pushed out with a special pusher. The threads are cut, leaving 2-3 cm of their length.
Usually, the contraceptive is located in its cavity without difficulty if its size is comparable to the size of the uterus.
After childbirth, the IUD is advisable to use after 2-3 months, after cesarean section - after 5-6 months. Before using the IUD, it is extremely important to exclude infection of the genital tract. When inserting an IUD, you should follow the rules of asepsis and antisepsis.
The benefits of intrauterine contraception include:
Possibility of long-term use;
Immediate contraceptive action;
Rapid establishment of fertility after removal of the IUD;
Low cost;
Possibility of use during lactation.
Unfortunately, the use of IUDs does not exclude the presence of serious complications. The most frequent and adverse complication VMK are inflammatory diseases of the internal genital organs, often with the development of purulent tubal-ovarian formations, endometritis, peritonitis. However, more often these complications occur when intrauterine devices are used without taking into account contraindications.
Contraindications:
Pregnancy;
Inflammatory diseases of the female genital organs;
Violation of the menstrual cycle;
Tumor diseases of the genital organs;
Allergy to VMC.
SURGICAL CONTRACEPTIVE METHODS
Surgical methods of contraception consist in the sterilization of women or men. In women, obstruction of the tubes is created.
Such sterilization in women is as follows: by mini-laparotomy or laparoscopy, they enter the abdominal cavity and either coagulate the fallopian tube section, or ligatures, rings, and special clamps are applied to the fallopian tube.
In women, it is subsequently possible to restore the patency of the tubes by performing plastic surgery.
In men, the spermatic cords are tied and cut (vasectomy), after which sperm cannot enter the ejaculate.
The Pearl Index is 0-0.2. Isolated cases of pregnancy may be in violation of operations on the pipes.
Lecture No. 3 Words 846.
Family planning. Abortion and its complications. Methods of contraception.
Family planning- one of the main ways to solve the global demographic problem of stabilizing the population of the Earth.
According to the WHO definition, family planning is the control of the reproductive (childbearing) function of a woman for the birth of only desired children.
Women's consultation- a medical and preventive institution of a dispensary type, providing all types of outpatient obstetric and gynecological care to the population.
For example, a women's clinic provides:
Work on the formation of a healthy lifestyle;
abortion prevention;
Women use contraceptives.
Unfortunately, abortion remains one of the main methods of birth control in Russia. In 2010 1236400 abortions were performed. If at the end of the 80s of the last century about a third of all abortions in the world were performed in the USSR, then since the beginning of the 90s, thanks to the development of family planning services, the frequency of abortions has been gradually decreasing. Nevertheless, abortion in more than 40% of cases remains the cause of secondary infertility.
induced abortion- This is an abortion up to 12 weeks at the request of a woman.
Methods of artificial termination of pregnancy.
- Surgical, or instrumental. The surgical method involves the extraction of the fetus using special tools.
- medical method. Medical or pharmaceutical abortion is the termination of pregnancy using pills.
Abortion is performed with the assistance of a qualified specialist - an obstetrician-gynecologist, using approved and recommended methods and in a medical institution that is suitable for this. Abortion is always a risk of developing various complications that can occur both during the operation itself and in the near future after it.
Complications of abortion.
Early complications (during surgery):
- Bleeding.
- Remains of the ovum.
- perforation of the uterus.
- The death of a woman.
Late complications:
- Infertility.
- Violation of the menstrual cycle.
- Cervical (isthmic-cervical) insufficiency.
- Bleeding during subsequent births.
- Anomalies of attachment of the placenta.
- Weakness of labor activity.
The main prevention of abortion is to prevent unwanted pregnancy -
it's contraception.
Methods of contraception.
There are: 1) non-hormonal methods;
2) hormonal methods.
Non-hormonal methods of contraception.
- barrier method . Efficiency 80%.
Mechanism of action: preventing the meeting of the sperm with the egg (the sperm does not enter the uterus).
A male condom, a female condom, a vaginal diaphragm and uterine caps are used.
Currently, condoms are the only way to protect against sexually transmitted diseases.
There are no contraindications.
2. chemical method(Spermicides). Efficiency 70-75%.
Mechanism of action: chemical substances, introduced into the vagina, reduce the activity or kill some of the spermatozoa.
The drugs are available in the form of balls, pastes, ointments and tablets that are inserted into the vagina. For example, Pharmatex.
Contraindications: allergic reaction to the drug.
3. Intrauterine contraception (IUD)). Efficiency 85%.
Mechanism of action: increased peristalsis of the fallopian tubes, as a result of which the fertilized egg enters the uterus ahead of time and cannot be implanted.
An IUD is inserted into the uterus for 5 years.
Contraindications to the introduction of the IUD:
A) painful menstruation
B) heavy menstruation
C) inflammatory diseases of the female genital organs.
d) tumors of the female genital organs.
Navy Disadvantages:
1) painful menstruation;
2) heavy menstruation;
3) exacerbation of chronic inflammation of the female genital organs;
4) Expulsion of the IUD (spontaneous expulsion of the IUD from the uterus).
5) The onset of pregnancy (pregnancy can be saved).
4. Surgical method (sterilization). Efficiency 100%.
Mechanism of action: as a result of cutting the fallopian tubes with a scalpel in women or
The vas deferens in men, the spermatozoa cannot meet with
Ovum.
The disadvantage of the method: the irreversibility of the process.
5 . Physiological method of contraception. Efficiency - 55%.
Mechanism of action: a woman calculates the days of ovulation (middle of the cycle), when the probability of pregnancy is high, because. a mature egg is released from the ovary as a result of ovulation. Therefore, it is not necessary to prevent pregnancy after menstruation and before the next menstruation.
Disadvantage of the method: low efficiency (55%).
Hormonal contraception.Efficiency 99%.
Mechanism of action: suppression of ovulation.
Classification according to the method of administration of the drug:
1 group : in tablets (per os):
A) COCs - combined oral contraceptives, contain 2 hormones (analogues of estrogens and progesterone). Preparations - Marvelon, Jeanine, Minisiston. Taking pills daily.
B) Mini - drank - contain one hormone (progestin), prescribed more often to nursing mothers, because. you can breastfeed. Taking pills daily.
Preparations: Charosetta, Microlut.
C) Urgent contraception (emergency). Efficiency 99%.
Mechanism of action: suppression or delay of ovulation, disruption of the fertilization process, the advancement of the blastocyst through the tube and the impossibility of implanting the blastocyst into the endometrium. This method is used only in exceptional cases, after unprotected intercourse, during the first 24-72 hours, otherwise there will be no effect. This method cannot be considered as a regular method of preventing pregnancy.The disadvantage of the method: violation of the menstrual cycle due to a large dose of the drug.
Therefore, this method is used as a last resort, no more than 2 times a year.
2 group . Intramuscular administration of the drug every 3 months.
Depot - Provera. Efficiency 99%.
The mechanism of action is the suppression of ovulation.
3 group . Subcutaneous administration of the drug - Norplant (introduced under the skin of the shoulder 6 capsules
For 5 years).
4 group . Introduction of the drug through the skin: EVRA - patch. Thin patch
It is applied to the skin for 7 days 3 times a cycle.
5 group . Intrauterine route of administration: the Mirena coil is inserted into the uterus for 5 years.
6 group . Vaginal route of administration: a thin ring is inserted into the vagina,
Impregnated with hormone, for 21 days. The drug Nova-Ring.
Contraindications for hormonal contraceptives.
1) Thrombophlebitis now or in the past.
2) Diseases of the cardiovascular system, cerebral vessels, ischemic heart disease,
3) Arterial hypertension.
4) Diseases of the liver.
5) Malignant tumors of the mammary glands and genital organs.
6) Bleeding from the genital tract of unknown cause.
7) Diabetes.
8) Smoking more than 15 cigarettes per day over the age of 35
Disadvantages of COC:
1) They do not protect against sexually transmitted diseases.
2) Taking pills requires great care, because. can't miss any
Tablets.
3) Sometimes there are nausea, vomiting, weight gain, headaches.
Teenagers who are not married need the following scheme (the "Gold Standard"):
COC + condom.
All currently existing contraceptives are usually divided into:
Traditional:
1. Biological (or physiological, rhythmic).
2. Barrier (or mechanical).
3. Spermicidal (or chemical).
4. Interrupted sexual intercourse.
Modern:
1. Intrauterine contraception.
2. Hormonal contraception.
3. Voluntary surgical sterilization men and women.
Contraceptives can also be divided into:
men's;
women's.
biological method.
The biological (physiological) method is a way to prevent pregnancy by determining the fertile days of the menstrual cycle, during which a woman abstains from sexual activity or uses other contraceptives.
It is based on the following principles:
Ovulation in a healthy woman occurs 14-15 days before the start of the next menstruation;
The viability of spermatozoa in a woman's body is up to 7-8 days;
The viability of the egg after ovulation is usually 24 hours.
The period of fertility can be determined in several ways, including using a calendar (calendar method), tracking changes in body temperature (temperature method), monitoring cervical mucus (cervical method).
calendar method. Fertile days are determined by subtracting 18 (21) days from the shortest and 11 (8) days from the longest menstrual cycle.
The method is not effective for women with short or irregular menstrual cycles.
temperature method. It is based on determining the time of ovulation by the rise in basal temperature.
It is known that:
1) in the first half of the cycle, in the follicular phase, the basal temperature is below 37°C;
2) 12-24 hours before ovulation, it decreases slightly.
3) after ovulation, in the luteal phase, the temperature rises by an average of 0.2 - 0.5 ° C;
The temperature should be measured every morning before getting out of bed, on an empty stomach. It is necessary to use the same thermometer, preferably electronically programmed, setting the period of fertility and safe days.
The temperature is measured at the same time on the same part of the body for 7 minutes. when it is determined in the rectum or in the vagina, within 5 minutes. when measured in the mouth. Temperature indicators are recorded in a table or graphically.
Rice. 30. Dynamics of basal temperature during the cycle.
Fertile is considered the period from the beginning of the menstrual cycle until the basal body temperature is elevated for 3 consecutive days and this increase is not associated with any disease.
Cervical method based on measuring the nature of cervical (cervical) mucus during the menstrual cycle under the influence of estrogens. On days close to ovulation (fertile days), the mucus is abundant, light, transparent, viscous, the consistency of raw egg white. Ovulation occurs 24 hours after the disappearance of abundant mucus, and the fertile period continues after that for another 4 days.
On other (safe) days of the menstrual cycle, cervical mucus is absent or observed in small quantities with a white or yellowish tinge.
symptothermal way combines elements of all three previous ones.
Barrier Methods
The mechanism of the contraceptive action of barrier methods is based on preventing the penetration of sperm into the vagina (condom) and the cervical canal (vaginal diaphragms, cervical caps) due to the creation of a mechanical obstacle.
Condom – a thin latex rubber product used by men. Efficiency 88%.
Advantages: Protects against sexually transmitted diseases (STDs), including AIDS; inexpensive, readily available.
Flaws: may tear if worn incorrectly or not sized; reduces sensitivity.
Mode of application. A twisted condom is put on the penis in a state of erection, when its head is not covered by the foreskin. The closed end of the condom is clamped between the large and index fingers in order to squeeze the air out of it and then straighten it along its entire length. After the end of intercourse until the relaxation of the penis, the condom is removed, holding it by the rim to prevent spillage of the seed. If a violation of its integrity is detected, a spermicidal cream (jelly, foam) should be immediately introduced into the vagina.
Vaginal diaphragm, cervical cap - latex products. Sized individually. They are introduced before sexual intercourse by the woman herself, whose instruction is carried out in the antenatal clinic. Before injection, it is recommended to apply a spermicidal cream to the inner surface to enhance effectiveness (72% - 82%). These funds are left in the vagina for 6 hours after sexual intercourse.
After removing the product, wash it with hot water and soap, place it in a 50-70% alcohol solution for 20 minutes.
Contraindications: inflammatory diseases and anomalies in the development of the genital organs, cervical erosion, allergies to rubber, spermicides.
Currently, new types of female barrier contraceptives have appeared: disposable diaphragms, female condoms, contraceptive sponges, etc.
Chemical Methods
The mechanism of action of chemicals (spermicides) is based on the ability active substance, which is part of them, destroy spermatozoa within a few seconds.
Efficiency: 79%, when properly applied is much higher.
Advantages: protects against some STDs, provides additional lubrication.
Flaws: with sensitivity to spermicides - itching and dryness.
Mode of application. Spermicides are produced in various forms under different brand names: "pharmatex", "patentex", "nonoxynol", etc.
Rice. 31. Various forms spermicides.
Candles, tablets, films inserted into the vagina for 15 minutes. before intercourse. It takes time for them to dissolve and foam. At jelly, cream, foam contraceptive protection begins immediately after administration. For the introduction of jelly, cream, an applicator is needed, and for foam, a nozzle attached to the aerosol container.
The action of the contraceptive effect lasts 1 hour. With each subsequent sexual intercourse, additional administration of spermicides is necessary. They can be used with condoms, diaphragms, caps and on their own.
Rice. 32. Introduction of spermicides.
contraceptive sponge made of polyurethane impregnated with spermicide is a combination of barrier and chemical methods. A sponge (tampon) is inserted deep into the vagina before intercourse.
The contraceptive action begins immediately and lasts for 24 hours. After use, the sponge is thrown away.
Douching with spermicidal solutions (acetic, boric acid, lemon juice) after intercourse is not a reliable method, since spermatozoa can enter the uterus a few seconds after ejaculation.
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DEPARTMENT OF EDUCATION OF THE BELGOROD REGION
GBOU SPO "Valuisky College"
Tutorial
for self-preparation of students for practical classes
Family planning
Contraception
Ovsyannikova T.A., teacher of special disciplines
Valuiki, 2013
It is printed by decision of the scientific and methodological council of the college.
Ovsyannikova T.A., teacher of special disciplines.
Ovsyanikov P.N., teacher of anatomy and physiology.
Reviewers:
Zelensky V.V., district obstetrician-gynecologist, Valuyskaya Central District Hospital, doctor of the highest qualification category.
Mirgorodsky A.P., head of the maternity department of the Valuyskaya Central District Hospital, doctor of the highest qualification category.
Educational and methodical manual “Family Planning. Contraception” is intended for self-preparation of students for practical exercises in the academic discipline “Healthy person and his environment”. Section 3. Mature age.
The manual is compiled in accordance with the qualification characteristics of the paramedic, the requirements curriculum discipline and contains basic knowledge on the topic under study.
The manual presents modern methods and means of contraception. Colorful illustrations contribute to a better understanding of the topic.
Family planning is a complex of medical, social and legal measures carried out with the aim of having desired children, regulating the intervals between pregnancies, controlling the time of childbirth, and preventing unwanted pregnancies.Family planning is one of the most important health problems of the entire state as a whole. The solution to this problem is aimed at creating conditions for the birth of healthy and desirable children, protecting the reproductive health of the population and thereby preserving the gene pool of the nation.
The purpose of studying this topic is to train a paramedic who has the knowledge and skills necessary to identify human problems in the field of family planning, contraception, who is able to teach the population the features of maintaining and promoting health at different age periods and family planning issues.
Birth control is one of the most important tasks of each state, since the birth rate provides normal conditions for the existence of future generations.
The student must know:
Family planning.
Methods and forms of family planning counseling.
Indications, contraindications, rules of admission, disadvantages, advantages of various methods of contraception.
Principles of contraception in adulthood.
The student must be able to:
Identify risk factors that affect family planning.
Educate couples on proper use certain types contraception.
Carry out sanitary and educational work with women about modern methods of contraception.
FAMILY PLANNING
« Family planning is all activities that have the purpose of helping individuals or couples achieve certain outcomes: avoid unwanted pregnancies, produce desired children, regulate the intervals between pregnancies, and timing of childbearing according to the age of the parents, determine the number of children in family” (WHO Expert Committee).
The problem of family planning concerns every person, but in essence it is a problem of the country's national security, since it is directly related to the health of future generations.
As part of the implementation of the federal program "Family Planning", a family planning service has been established in the country. Currently, there are approximately 200 regional family planning and reproduction centers in Russia. They are faced with the task of changing the established practice of achieving the desired number of children in the family, using not contraception, but abortion, which causes irreparable harm to women's reproductive health. In addition, the tasks of family planning centers include explanatory work on the optimal age for having children. An important role in the implementation of the "Family Planning" program is played by public organizations working in this area: the Russian Association "Family Planning", which has 50 branches in the regions of the country, the International Association "Family and Health", Russian society on contraception.
The purpose of the complex of measures for family planning is to solve the following tasks:
Avoid unwanted children.
Have only desired children.
Adjust the intervals between pregnancies.
Set the number of children.
Control the choice of the time of birth of the child, depending on the age of the parents.
Some of these tasks are solved by:
Provision of contraceptives.
Infertility treatments.
Miscarriage treatment.
Preparing for a desired pregnancy is the main point in family planning. Spouses for 2 months. before the planned pregnancy should be completely abandoned bad habits(alcohol, smoking, drugs). The favorable age of the mother is 19-35 years. The interval between births should be at least 2-2.5 and preferably no more than 5 years. Conception is permissible after at least 2 months. after an acute infectious disease suffered by the spouses. It is advisable to conceive in autumn and winter (the percentage of spontaneous mutations and the risk of immune conflict are reduced). In women suffering from chronic diseases, pregnancy is permissible, depending on the disease, only in the absence of exacerbations for 1-5 years. Pregnancy for women workers exposed to adverse factors can be recommended only after 1-3 years of work in production, i.e. after the development of persistent adaptation.
ARTIFICIAL TERMINATION OF PREGNANCY
Unfortunately, in our country, the main method of contraception is induced abortion, despite the fact that induced abortion is a risk factor for many forms of reproductive pathology and is one of the causes of maternal death.
Artificial termination of pregnancy is carried out at the request of a woman with a gestational age of up to 12 weeks.
For medical reasons, abortion is carried out regardless of its duration if pregnancy and childbirth can worsen the woman’s health and threaten her life, or if abnormalities in the development of the fetus are detected. Medical indications include an extensive list of diseases of various organs and systems, which is regulated by law by special documents.
According to social indications - with a gestational age of up to 22 weeks.
Social indications for artificial termination of pregnancy:
The presence of a court decision on the deprivation or restriction of parental rights.
Pregnancy as a result of rape.
The stay of a woman in places of deprivation of liberty.
The presence of a disability of I - II groups in a husband or the death of a husband during pregnancy.
The most severe in its consequences is the termination of pregnancy in late dates(13-22 weeks), which is carried out according to medical and social indications and remains one of the most difficult problems in obstetrics.
METHODS OF ARTIFICIAL TERMINATION OF PREGNANCY
Medical contraindications to the operation of artificial termination of pregnancy
Acute and subacute inflammatory diseases of the female genital organs.
Acute inflammatory processes of any localization, the presence of purulent foci, regardless of their location
Acute infectious diseases.
Late pregnancy. In later terms, abortion is contraindicated if termination of pregnancy during this period is more dangerous to health and life than continuation of pregnancy and childbirth.
Less than 6 months after previous termination of pregnancy.
Vacuum excochleation
It is carried out at a gestational age of 2-3 weeks (delay of menstruation up to 21 days) by removing the fetal egg on an outpatient basis.The most gentle method of abortion,characterized by minimal trauma and low frequency complications.
Dilation and curettage
The method of dilating the cervix using Hegar dilators, followed byremoval of the ovum andcurettage of the uterine cavity with a curette. Heldwith a gestational age of up to 12 weeks in a hospital.
medical abortion
When terminating an early pregnancy (up to 6 weeks), mifepristone can be used:
as monotherapy, or in combination with synthetic analogues of prostaglandins.
Basic conditions for medical abortion
The presence of a uterine pregnancy, confirmed by ultrasound data.
Correspondence of the size of the uterus to the expected gestational age.
The delay in menstruation does not exceed 42 days.
Contraindications for medical abortion
Absolute
Ectopic pregnancy
uterine fibroids
Adrenal insufficiency
Acute inflammatory diseases
Blood coagulation disorders
relative
The presence of a scar on the uterus
Small uterine fibroids
Pregnancy on the background of the IUD.
Complications of abortion
CONTRACEPTION
In the prevention of unplanned pregnancy, the use of various methods of contraception by partners is of great importance, which makes it possible to avoid induced abortion. The method of contraception is selected taking into account medical indications and contraindications, as well as taking into account the living conditions of the family.
CONTRACEPTIVE METHODS
Natural (physiological, biological)
Barrier
Chemical
Surgical
Hormonal:
Combined oral contraceptives (COCs).
Microdoses of gestagens (mini-drank).
Postcoital drugs.
Injectable (prolonged) preparations.
Subcutaneous implants (norplant).
temperature method
The measurement of basal temperature is based on the hyperthermic effect of progesterone on the hypothalamus (in the second half of the cycle, the temperature in the rectum increases by 0.4-0.6). "Dangerous" and "safe" days can be determined.
rhythmic method
This is the method periodic exposure, which is based on the determination of the time of ovulation and the exclusion of sexual intercourse in the periovulatory period. It is recommended to refrain from sexual intercourse from the 10th to the 17th day of the cycle in a 28-day cycle.
Only suitable for women with regular menstrual cycles. Efficiency up to 60 - 70%.
Barrier Methods
male condom
Use of latex products.
Single application.
Before use, check the expiration date and quality.
Do not use Vaseline or oil for lubrication.
After ejaculation, check the integrity of the condom.
The disadvantage of this method is the violation of the sharpness of sexual feelings and the possible rupture of the condom. Using a condom prevents AIDS.
female condom
It is a plastic bag that lines the inside of the vagina and ends with a ring on the outside.
Caps Diaphragms
Contraindications: colpitis, cervical erosion, prolapse of the vaginal walls. This remedy is removed 8 hours after administration. The efficiency of this method is low - 65 - 70%.
Chemical Methods
So calledspermicides destroy the outer shell of spermatozoa, disrupt their mobility, the ability to penetrate the shell of the egg during fertilization (creams, gels, aerosol foams, foam and non-foam suppositories). Spermicides are available in the form of balls, pastes, tablets. Contraceptin T, lutenurin, gramicidin paste, Galascorbin, Chloceptin tablets - these drugs are introduced into the vagina 10-15 minutes before sexual intercourse. The effectiveness of these funds is low - 50 - 60%.
Intrauterine device (IUD)
There are several types of IUDs. The most common are copper-containing and hormone-containing (Mirena).
IUDs containing copper cause cellular changes in the endometrium that prevent implantation. With their use, copper contraception in the cervical mucus is toxic to spermatozoa, and the eggs undergo degenerative changes.
IUDs containing the hormone cause changes in the endometrium, similar to changes when using progestogenic oral contraceptives. In addition, having an adverse effect on the cervical mucus, they block the transport of sperm. The hormone levonergestrel that is released reduces heavy, painful periods.
Depending on the type of IUD, their effectiveness is maintained for 3 to 8 years. They are hygienic, do not disturb the harmony of sexual life, and can be removed at any time. The IUD is inserted on the 4th - 6th day of the menstrual cycle, immediately after an early induced abortion, after childbirth - after 6 weeks.
Complications on the introduction of the IUD
Violation of the menstrual cycle.
perforation of the uterus.
development of inflammatory diseases.
The fall of the Navy.
Pain in the lower abdomen.
The IUD is removed on an outpatient basis at the request of the woman after the expiration of the period of use or in case of complications. Re-introduction of it is possible in 1 - 2 months after removal.
The IUD does not protect against STIs and AIDS.
Contraindications to the appointment of the IUD
Pregnancy.
Inflammatory diseases of the female genital organs (acute and subacute), diseases and anomalies in the development of the reproductive system: uterine fibroids, endometriosis, infantilism, bicornuate and saddle uterus, cicatricial deformity of the cervix, endocervicitis, cervical erosion, endometrial polyposis and hyperplasia, algomenorrhea, ovarian dysfunction .
General somatic diseases: anemia, leukemia, subacute endocarditis, diabetes, severe allergies, oncological diseases.
Ectopic pregnancy in history or recurrent inflammatory process in the uterus and appendages,
Nulliparous.
Women who have multiple sexual partners.
Surgical methods
(Sterilization)
For men:
Vasectomy (ligation of the spermatic cord) consists in blocking the vas deferens to prevent the passage of sperm. A small segment is cut out of the vas deferens, and the ends of the duct are tied up. Thus, a barrier is formed that prevents spermatozoa from reaching the ejaculate. The spermatozoa produced by the testicles are absorbed by the tissues without any harm to the body.
Among women:
Ligation (creation of artificial obstruction) of the fallopian tubes during mini-laparotomy, laparoscopy and hysteroscopy.
The methods are irreversible. Written consent is required for the operation.
HORMONAL DRUGS
Combined oral contraceptives (COCs).
Monophasic
Double-vased
Three-pot
Microdoses of gestagens (mini-drank).
Postcoital drugs.
Prolonged drugs.
Subcutaneous implants (norplant).
Combined oral contraceptives (COCs)
Monophasic drugs
All tablets have the same composition. They contain estrogen and progestin. Used at a constant dose for 21 days followed by a 7-day off-take interval.
Double-vase drugs
In biphasic COCs, the first 10 and subsequent 11 tablets differ in the composition and dosage of their hormonal components.
Three-venous preparations
Three-phase COCs consist of tablets of three different formulations that mimic the fluctuations in ovarian hormone levels that are characteristic of a normal menstrual cycle.
Contraceptive benefits of COCs
High efficiency and safety.
Fast reversibility.
The use is not related to sexual intercourse.
Remove the fear of unwanted pregnancy.
Non-contraceptive benefits of COCs
Regulation of the menstrual cycle:
Reduce the amount of menstrual blood loss.
Increase the number of regular cycles.
Reduce premenstrual tension.
Give the opportunity to change the start date of the next menstruation.
Reducing the incidence of iron deficiency anemia.
COCs reduce the risk of developing
Ovarian cancer by 50%.
Endometrial cancer by 60%.
Benign diseases of the mammary glands.
Uterine fibroids.
Bone loss in premenopause.
Absolute contraindications to the use of COCs
Confirmed or suspected pregnancy.
Malignant tumors of the breast and genital
organs.
The presence of thromboembolic complications in history.
Damage to the cerebral and coronary arteries.
Vaginal bleeding of unknown etiology.
Acute diseases of the kidneys and liver.
Diabetes.
Mental illness.
Smoking women over the age of 35.
Start taking COCs
From the 1st day of the menstrual cycle.
After the abortion on the same day.
Postpartum: after three weeks if the woman is not breastfeeding; after six months if breastfeeding.
Rules for taking COCs
Daily at the same time, 1 tablet.
After completing the 21st tablet, take a 7-day break, if there are 28 tablets in a pack, do not take a break
If you want to delay your period - do not take a 7-day break
!!! If a tablet is missed for more than 12 hours
Take the missed pill.
Take the next tablets as usual.
Additional contraception for 7 days.
If there are less than 7 tablets left in the pack, start the next pack without interruption.
Microdoses of gestagens (mini-pill)
Contain only progestogen in a low dose. Reception of tablets is begun from the first day of menstruation and is made daily in a continuous mode. Can be recommended to women in the postpartum period.
Postcoital drugs
Consist of large doses of estrogens or progestogens. These tablets are used in the first 24 - 48 hours after sexual intercourse.
Injectable (prolonged) drugs
They consist of small doses of progestogen (Depo-Provera). Injections of these drugs are done 1 time in three months. Used by women who are contraindicated in estrogen and nursing mothers during lactation.
Subcutaneous implants
They are syllastic capsules that are injected subcutaneously into the shoulder area and secrete a certain portion of the hormone daily, which provides contraception for 5 years.
emergency contraception
Combined hormonal pills and progestin-only pills can be used as emergency contraception after unprotected intercourse. When using progestin-only tablets, take 1 tablet immediately after intercourse, and another 1 tablet 12 hours later, or 1 tablet within 72 hours without re-dosing.
If the composition of the combined hormonal tablets includes 30 micrograms of ethinyl estradiol and 150 micrograms of levonorgestrel, you should drink 4 tablets within 72 hours after unprotected intercourse and another 4 tablets after 12 hours.
Copper-containing IUDs can also be used as emergency contraception.
Literature
Contraception after childbirth / I. A. Kuznetsova [et al.] // Gynecology. - 2008. - No. 4.
Kulakov V.I., Prilepskaya V.N., Radzinsky V.E. Female surgical contraception. Guide to outpatient care in obstetrics and gynecology - M.: GEOTARMedia, 2006.
Prilepskaya V.N. Guide to contraception. - M.: MEDpress-inform, 2006.
Radzinsky, V. E. Medical abortion: present and future / V. E. Radzinsky // Farmateka. – 2008.
