Gynecological Surgery

Contraception and Family Planning

Rapid population growth is a critical issue worldwide. Family planning matters save women’s lives preventing unintended pregnancies. Slower population growth conserves resources, improves health and living standards. Benefits of fertility control are interrelated. Benefits are: improved quality of life, better health, less physical and emotional stress of life, better education, job and economic opportunities. Benefits are enjoyed by the couple, the children, other family members, the community and the country. Contraception and fertility control are not synonymous. Fertility control includes both fertility inhibition and fertility stimulation. While the fertility stimulation is related to the problem of the infertile couples, the term contraception includes all measures, temporary or permanent, designed to prevent pregnancy due to the coital act. Methods of contraception are two types Temporary and Permanent. Temporary includes Barrier methods, Natural Contraception, Intrauterine contraceptive devices (IUCD’s). Permanent methods include Tubal occlusion for female and Vasectomy for males.

Intrauterine Contraceptive devices: is a widely acceptable reversible method of contraception for spacing of births, amongst many, either a copper impregnated device like Cu T, multi load or a hormone releasing device like LNG-IUS induces uniform suppression of endometrium and produces very scanty cervical mucus. It should not be used in newly married women or when any pelvic pathology is present. The device can be introduced in the interval period of following abortion or following childbirth. The introduction is an outdoor procedure and can be done even by trained paramedical personnel without anesthesia. The technique employed is either push-out in Lippes loop or “withdrawl” in Cu T. The immediate complications include cramp-like pains or even syncopal attacks. The delayed complications include pelvic pain, menstrual irregularities, and expulsion of the IUD or even Perforation of the uterus. Complications are much less with third generation of IUD’s.

Steroidal Contraception’s

Enovid was used in the first contraceptive field trial in Puerto Rico in 1956 by Pincus and his colleagues. Intensive pharmacological research and clinical trials were conducted during the following years to minimize the adverse effects of estrogen without reducing the contraceptive efficacy, resulted in lowering the dose of estrogen to minimum of 20ug or even 15 ug in the tablet

Progestin only contraception (POP/MINI PILL)

POP is devoid of any estrogen compound, it contains very low dose of a progestin in any one of the following form –Levonorgestrel 75ug, norethisterone 350ug. Desogestrel 75ug, lynestrenol 500ug, or norgestrel 30ug. It has to be taken daily form the first day of the cycle.

Injectable Progestin’s

The preparations commony used are depomedroxy progesterone acetate (DMPA) and norethisterone enanthate (NET-EN). Both are administered intramuscularly within five days of the cycle. The injection should be deep. Z-tract technique and the site not to be messaged. DMPA in a dose of 150mg every months or 300mg every six months; NET-EN in a dose of 200mg given at two-monthly intervals.

Emergency Contraception’s (EC):  emergency contraception include the following

Harmones

IUD

Anti-Progesterone

Others

Sterilization: permanent surgical contraception, also called voluntary sterilization, is a surgical method whereby the reproductive function of an individual male or female is purposefully and permanently destroyed. The operation done on male is vasectomy and that on the female is tubal occlusion, or tubectomy.

Couple must be counselled adequately before any permanent procedure is undertaken. Individual procedure must be discussed in terms of benefits, risks, side effects, failure rate and reversibility. Vasectomy is a permanent sterilization operation done in male where segments of vas deferens of both the sides are resected and the cut ends are ligated. Other methods to block the Vas are Electrocoagulation: May be used to encourage scar tissue formation and Fascial interposition: following ligation, excision and cautery. This is done to prevent recanalization

Tubectomy: in this operation where resection of a segment of both the fallopian tubes is done to achieve permanent sterilization. The approach may be Abdominal or Vaginal

Laparoscopic Sterilization is the commonly employed method of endoscopic sterilization. It is gradually becoming more popular—especially, in the camps. The procedure is mostly done under local anesthesia. The operation is done in the interval period, concurrent with vaginal termination of pregnancy or six weeks following delivery. It should not be within following delivery.

Related conferences:

Advanced Nursing Science 2018, April 20-21, 2018 Las Vegas, USA

Nursing & Healthcare Congress 2018, on April 23-25, 2018 Dubai, UAE

Gynecology Congress 2018, on August 22-23, 2018 Tokyo, Japan

Gynecologic Congress 2018, on July 23-24, 2018 Rome, Italy

Women’s Health 2018, Congress on July 18-19, 2018 Sydney, Australia

Health Care 2018, Summit on August 13-14, 2018 Bali, Indonesia

Health Economics Congress 2018, on September 13-14, 2018 Zurich, Switzerland

Health Economics 2018, Conference on April 12-13, 2018 Amsterdam, Netherlands

Public Health 2018, Summit on February 26-28, 2018 London, UK

Neonatal 2018, Conference on June 27-28, 2018, Vancouver, Canada