1
2
3
4
Family Planning
（计划生育）
5
? Contraception
? Sterilization
? Artificial abortion
6
Learning Objectives
1,Mechanism and clinical application
of each contraceptive method.
2,Artificial abortion surgery:
indications,contra-indications,
treatment of complications.
3,Sterilization surgery:
indications,contra-indications,
prevention of complications.
7
?Systemic
contraceptives
?IUDs or IUCDs
?Barrier methods
?Natural methods
Contraceptive methods
8
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
9
1,Inhibition of ovulation
LHRH secretion↓
No midcycle LH surge
2,Interfering with fertilization by altering
cervical mucus
3,Interrupting implantation by altering
morphology and function of the endometrium
4,Altering the function of Fallopian tubes
Systemic Contraceptives
Mechanism:
10
I,Oral contraceptives
(1) Short-acting
(2) Long-acting
(3) Vacation pill
II,Long-acting contraceptive injection
III,Slow-releasing contraceptives
IV,Transdermal patch
Systemic Contraceptives
Types of the systemic contraceptives
11
I,Oral contraceptives
1,Short-acting Tablets (99.95%)
1) Monophaser
2) Biphaser
3) Triphaser
Systemic Contraceptives
12
Short-acting Tablets
13
Components:
(1) Estrogens,Ethinylestradiol,EE (炔雌醇 )
(2) Progestogens,Norethindrone,Megestrol,etc.
1,Compound Norethindrone Tablets
复发炔诺酮片 (避孕片 1号 )
Components,EE 35μg,Norethindrone 0.6mg
2,Compound Megestrol Acetate Tablets
复方甲地孕酮片 (避孕片 2号 )
Components,EE 35 μg,Megestrol 1.0mg
Tablets Monophasers
Systemic Contraceptives
14
3,Compound Levonorgesterel Tablets
复发左旋炔诺孕酮片 （ D-甲炔诺酮片、
复方左旋 18甲基炔诺酮片）
Components,EE 30 μg,Levonorgesterel 0.15mg
4,Compound Desogestrel Tablets (Marvelon)
复方去氧孕烯片 (妈富隆 )
Components,EE 30 μg,Desogestrel 0.15mg
Less side effects,Nausea,breast,weight,acne,
hirsutism
Tablets Monophasers
Systemic Contraceptives
15
Biphasers
Ovidal (CTR24)
去氧孕烯双相片
Components:
1st phase (day 1～ 7),
EE 40μg,Desogestrel (去氧孕烯 ) 0.025 mg
2nd phase (day 8～ 21),
EE 30μg,Desogestrel (去氧孕烯 ) 0.125mg
Systemic Contraceptives
16
Tablet Triphasers
Levonorgesterel Triphaser Tablets
左炔诺孕酮三相片 (左旋 18甲三相片 )
Components:
1st phase (day 1～ 6),
EE 30μg,Levonorgesterel (左炔诺孕酮 ) 0.050mg
2nd phase (day 7～ 11),
EE 40μg,Levonorgesterel (左炔诺孕酮 ) 0.075mg
3rd phase (day 12-21)
EE 30μg,Levonorgesterel (左炔诺孕酮 ) 0.125mg
Systemic Contraceptives
17
18
2,Long-acting Tablets (96%～ 98%)
1) Compound Quinestrol Monthly Tablets
复方炔雌醚片 (长效避孕片 1号，复方炔雌醚月服片 )
Components:
Quinestrol 3mg
Chlormadinone acetate (氯地孕酮 ) 12 mg
2) Three in one Compound Quinestrol Monthly Tablets
三合一炔醚片
Components:
Quinestrol 2mg
Chlormadinone acetate (氯地孕酮 ) 6 mg
Norgesterel (炔诺孕酮 ) 6 mg
Systemic Contraceptives
19
Systemic Contraceptives
3,Vacation pill/morning-after pills
1,Norethisterone Tablets (炔诺酮探亲片 )
2,Megestrol Acetate Tablets (甲地孕酮探亲避孕片 1号 )
3,Norgestrel Tablets (炔诺孕酮探亲避孕片 )
4,Anordrin Tablets (53号抗孕片,53号探亲片、
事后避孕片、双炔失碳酯片 Anordrin)
5,Me-Quingestanol Pill (甲醚抗孕丸 )
Components,Megestrol 0.5mg,
Quingestanol Acetate 0.8mg
20
Systemic Contraceptives
II,Long-acting contraceptive injection
1,Compound Hydroxyprogesterone Caproate Injection
复方己酸羟孕酮避孕针 (避孕针 1号 )
Components:
Hydroxyprogesterone Caproate 250mg
Estradiol Valerate 5mg
2,Compound Megestrol Acetate Injection (Inj.Mego-E)
复方甲地孕酮避孕针
(美尔伊避孕针、甲孕雌醇避孕针 )
Components:
Megestrol 25mg
17β-Estradiol 3.5mg
21
3,Norethisterone Enanthate Injection
庚炔诺酮避孕针
Components:
Norethisterone Enanthate (NET-EN,Norigest)
炔诺酮庚酸酯 200mg
Lasts 2 month
Systemic Contraceptives
22
III,Slow-releasing contraceptives
1,Hypodermic implant (皮下埋植剂 )
(1) Norplant I (99.8%) (D-炔诺孕酮埋植剂 I、
左炔诺孕酮埋植剂 I)
Levonorgestrel (左旋炔诺孕酮） 36mg× 6
For 5 years (LNG,85-30μg/day)
(2) Norplant II (D-炔诺孕酮埋植剂 I、
左炔诺孕酮埋植剂 I)
LNG 70mg× 2
For 3 years (LNG,45μg/day).
Systemic Contraceptives
23
2,Contraceptive vaginal ring
(1) Megestrol Acetate-Silica Gel Circle (97%)
甲硅环、甲孕酮硅胶避孕环
Megestrol 200～ 250mg
For 1 year (Megestrol,100-150 μg/day)
(2) D-Norgestrel-Silica Gel Circle
D-炔诺孕酮阴道避孕环、左旋炔诺孕酮阴道环
Levonorgestrel 5mg
For 3 months (LNG,20μg/day)
Systemic Contraceptives
24
25
26
3,Slow-releasing injectable
microglobes and microcapsules
3 months
IV,Transdermal patch
Systemic Contraceptives
27
1,Cancer
2,Thrombotic diseases
(血栓性疾病）
3,Adverse effects on metabolism
(1) Carbohydrate
(2) Lipid
(3) Protein
Systemic Contraceptives
Long-term safety
No
No if <50μg/day
Glucose tolerance test↓
Triglyceride↑HDL ↑
Cholesterol ↑
Total protein ↓ Albumin ↓
Globulin ↑
28
4,Future fertility
5,Adverse effects
on the embryo/fetus
Systemic Contraceptives
No adverse effect
(Ovulates within 3
months)
1) Controversial for
pregnancy during
medication.
2) Consensus,safe
if > 6 months
29
Systemic Contraceptives
Contraindications
1,Malignant or precancerous diseases and
patients with uterine or breast masses
2,Hematopathy and thrombotic diseases
3,Severe cardiovascular diseases
1) P→lipid metab →coronary artherosclerosis
2) E→blood coagulation↑→myocardiac
infarction
3) E→renin activity↑→hypertension
30
4,Endocrine diseases,diabetes,hyperthyroid
dysfunction
5,Lactation
6,Oligohypomenorrhea or older than
45 years old
7,Vaginal bleeding of unknown origin
8,Hepatitis and nephritis
9,Psychotic (精神病患者 )
Systemic Contraceptives
Contraindications
31
1,Abnormal uterine bleeding
1) Breakthrough bleeding
If happens in the first half cycle,add EE (炔雌醇 )
50-150μg/day for 2 weeks.
If happens in the second half cycle,increase o.c,by
0.5-1 tablet/day for 2 weeks.
2) Cessation of menstruation
Once,no need to treat
Twice,change types of o.c.
Amenorrhea,discontinue o.c,and try ovulation induction
3) Hypomenorrhea（月经过少）
No treatment or EE 50-100 μg/day for 22 days
Systemic Contraceptives
Side effects
32
2,Morning sickness-like reaction
VitB6 20mg,VitC 100mg,anisodamine (山莨菪碱 )10mg
tid po for 7 days.
3,Weight gain
P (containing weak androgen activity),stimulating
anabolism (合成代谢）
E,causing sodium and water retention
4,Pigmentation (moth patch) (蝴蝶斑 )
5,Others
Headache,breast swelling pain,appetite increase,
skin rash,pruritus (瘙痒 ),etc.
Side effects
Systemic Contraceptives
33
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
34
35
36
Types of IUD
1,IUD made with inert materials
Stainless steel,nylon,etc
Fewer adverse reactions,but higher expulsion
rate and pregnancy rate
2,IUD added with active substances
1) IUD with copper
2) IUD with progestogens,zinc,PG synthetase
inhibitor
3,Third generation IUD
IUDs
37
1) IUD with copper
TCu-200 (1 year cumulative rate)
Expulsion rate,5.61%
Pregnancy rate,1.51%
Removal rate (due to adverse effects),9.22%
Removal rate (due to other reasons),3.62%
‘Overall failure rate’ 19.96%
2) IUD with progestogens,zinc,PG synthetase
inhibitor
3,Third generation IUD
Anchoring IUD
IUDs
38
Mechanism
Primarily an aseptic inflammation reaction
(1) Phagocytic effect
(2) Leukocytes
(3) Prostaglandins
(4) Luteolysis (黄体溶解 )
(5) Fibrinolysis（纤溶）
(6) Immune factor
Interfering with implantation,sperms,development
of the fertilized eggs and embryos.
IUDs
39
Mechanism
IUD with active substances
1,IUD with copper:
(1) Inflammation reaction and PG
(2) Toxic effect on sperms
(3) Interference with implantation by
changing mucus (thinner) and its secretion
2,IUD with progestogens:
(1) Atrophic change in the endometrium
(2) Change in the cervical mucus
(3) Interference with metabolism in sperms
IUDs
40
IUDs
1,Timing
1) 3-7 days after completion of menstruation and
no recent sexual intercourse.
2) Immediately after an artificial abortion (<10 cm)
3) 42 days after a normal vaginal delivery
4) 6 months after a cesarean section
5) Day 3 of menses for progestin containing IUD
2,Selection of IUDs,depending on space of uterine
cavity
3,Method
4,Postoperative care
Procedures
41
42
43
44
(1) Pregnancy suspected
(2) Infection of the reproductive tract
(3)Tumours of the reproductive tract or uterus
malformation
(4) Tissue retention after abortion or delivery
(5) Cervical imcompetence,severe old laceration
of cervix and severe uterine prolapse
(6) Severe generalized diseases
(7) Polymenorrhea or menorrhagia?
Contra-indications
IUDs
45
1) Uterine bleeding
Mechanical compression injuries
Increased PGs and activated fibrinolysis
Indomethacin (消炎痛 ) 25-50mg tid po
EACA (氨基己酸 ),2-4g tip po
云南白药,0.4g tid po
2) Pain or discomfort
IUDs
Adverse effects
46
1) Perforation of the uterus and IUD ectopia
2) Infection
3) Incarceration (节育器嵌顿 )
IUDs
Complications
47
48
? IUD and PID (pelvic inflammatory disease)
? IUD and ectopic pregnancy
? Displacement or expulsion of IUD
? Pregnancy with IUD in place
IUDs
Problems associated with IUD
49
50
51
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
52
Types:
(1) Male condom (安全套 )
(2) Female condom
(3) Vaginal spermicides
Nonoxynol-9 (壬苯醇醚膜 ) (95%)
乐乐迷避孕膜
Mechanism,Damage sperm membrane
Usage,Insert into vagina 3-5 min before coitus
Barrier methods
53
54
55
56
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
57
(1) Coitus interruptus (体外排精 )
(2) The safe period (安全期 )
(3) Postcoital douche (性交后冲洗 )
(4) Prolongation of lactation
Natural methods
58
Immunization
GnRH analogues
Postcoital contraception (紧急避孕 )
Other contraceptive methods
59
Mechanism
1,Prevent or postpone ovulation
2,Interfere with fertilization or implantation
Methods
1,Morning-after IUD insertion
2,Morning-after pill (98%) (<3 days)
Steroid or nonsteroid hormones
Postcoital Contraception
60
Steroids
(1) Levonorgestrol Tablets (左炔诺孕酮片 )
毓婷 Levonorgestrel 0.75mg twice (12h)
(2) Anordrin Tablets (53号抗孕片 ) (Sugar coated)
Anordrin (双炔失碳酯 ) 7.5mg once.
(3) Compound Levonorgesterel Tablets
复发左旋炔诺孕酮片 (EE 30 μg,LNG 0.15mg)
4 tablets twice (12h)
Nonsteroids
Mifepristone (RU486) (米非司酮 ) (息隐、含珠停 )
25mg once 80%
100mg once 100%
Postcoital Contraception
61
Methods:
1,Minilaparotomy（经腹）
2,Laparoscopy（腹腔镜术）
Sterilization:Tubal ligation (结扎术 )
Contra-indications:
(1) Acute illness
(2) Severe illness that can not tolerate surgery
(3) Infection
(4) Severe neurosis (神经官能症 )
(5) Twice or more 37.5℃ within 24 hours
62
Minilaparotomy （经腹）
63
64
65
1,Drug induced
2,Surgical
Vacuum suction (6～ 10 weeks)
Surgical curettage (11～ 14 weeks)
Artificial abortion (人工流产 )
66
Drug induced abortion (药物流产 )
Combination therapy with Mifepristone
and Misoprostol
Indications,
(1) Pregnancy within 7 weeks
(2) Surgical abortion rendered difficult
(3) Refusal of surgical abortion
(4) Within half year of a cesarean section or lactating
Method:
Mifepristone (米非司酮 ) 50mg/day for 3 days
Misoprostol (米索前列醇 ) 0.6mg on the 4th day morning
67
Mechanism:
Mifepristone competes with progesterone for P receptors
on decidua (蜕膜 ).
Misoprostol causes uterine contraction.
Complete abortion rate,≥90%
Side effects and complications:
(1) Digestive tract symptoms
(2) Pain caused by uterine contraction
(3) Bleeding usu,10-14 days or even 2 months
(4) Infection
Contraindications:
Those of RU486 and Misoprostol
Drug induced abortion (药物流产 )
68
Surgical Abortion (人工流产术 )
Contra-indications:
(1) Acute or severe illness
(2) Acute infection of reproductive tract
(3) Hyperemesis gravidarum (妊娠剧吐） with acidosis
(4) Twice 37.5℃ within 24 hours
Methods:
1,Vacuum aspiration (负压吸引 )
For pregnancy within 10 weeks.
2,Surgical curettage with forceps (钳刮术 )
For pregnancy for 11-14 weeks
69
70
71
Surgical curettage with forceps (钳刮术 )
72
Complications
1,Artificial abortion syndrome
2,Uterine perforation
3,Bleeding during the operation
4,Embolism
5,Retention of conceptus
6,Postoperative infection
7,Postoperative adhesion formation
Surgical Abortion (人工流产术 )
73
74
75
For newly married couples:
For couples with one child:
For couples with two or more children:
For lactating women:
For perimenopausal women:
Selection of Contraception Methods
76
2
3
4
Family Planning
（计划生育）
5
? Contraception
? Sterilization
? Artificial abortion
6
Learning Objectives
1,Mechanism and clinical application
of each contraceptive method.
2,Artificial abortion surgery:
indications,contra-indications,
treatment of complications.
3,Sterilization surgery:
indications,contra-indications,
prevention of complications.
7
?Systemic
contraceptives
?IUDs or IUCDs
?Barrier methods
?Natural methods
Contraceptive methods
8
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
9
1,Inhibition of ovulation
LHRH secretion↓
No midcycle LH surge
2,Interfering with fertilization by altering
cervical mucus
3,Interrupting implantation by altering
morphology and function of the endometrium
4,Altering the function of Fallopian tubes
Systemic Contraceptives
Mechanism:
10
I,Oral contraceptives
(1) Short-acting
(2) Long-acting
(3) Vacation pill
II,Long-acting contraceptive injection
III,Slow-releasing contraceptives
IV,Transdermal patch
Systemic Contraceptives
Types of the systemic contraceptives
11
I,Oral contraceptives
1,Short-acting Tablets (99.95%)
1) Monophaser
2) Biphaser
3) Triphaser
Systemic Contraceptives
12
Short-acting Tablets
13
Components:
(1) Estrogens,Ethinylestradiol,EE (炔雌醇 )
(2) Progestogens,Norethindrone,Megestrol,etc.
1,Compound Norethindrone Tablets
复发炔诺酮片 (避孕片 1号 )
Components,EE 35μg,Norethindrone 0.6mg
2,Compound Megestrol Acetate Tablets
复方甲地孕酮片 (避孕片 2号 )
Components,EE 35 μg,Megestrol 1.0mg
Tablets Monophasers
Systemic Contraceptives
14
3,Compound Levonorgesterel Tablets
复发左旋炔诺孕酮片 （ D-甲炔诺酮片、
复方左旋 18甲基炔诺酮片）
Components,EE 30 μg,Levonorgesterel 0.15mg
4,Compound Desogestrel Tablets (Marvelon)
复方去氧孕烯片 (妈富隆 )
Components,EE 30 μg,Desogestrel 0.15mg
Less side effects,Nausea,breast,weight,acne,
hirsutism
Tablets Monophasers
Systemic Contraceptives
15
Biphasers
Ovidal (CTR24)
去氧孕烯双相片
Components:
1st phase (day 1～ 7),
EE 40μg,Desogestrel (去氧孕烯 ) 0.025 mg
2nd phase (day 8～ 21),
EE 30μg,Desogestrel (去氧孕烯 ) 0.125mg
Systemic Contraceptives
16
Tablet Triphasers
Levonorgesterel Triphaser Tablets
左炔诺孕酮三相片 (左旋 18甲三相片 )
Components:
1st phase (day 1～ 6),
EE 30μg,Levonorgesterel (左炔诺孕酮 ) 0.050mg
2nd phase (day 7～ 11),
EE 40μg,Levonorgesterel (左炔诺孕酮 ) 0.075mg
3rd phase (day 12-21)
EE 30μg,Levonorgesterel (左炔诺孕酮 ) 0.125mg
Systemic Contraceptives
17
18
2,Long-acting Tablets (96%～ 98%)
1) Compound Quinestrol Monthly Tablets
复方炔雌醚片 (长效避孕片 1号，复方炔雌醚月服片 )
Components:
Quinestrol 3mg
Chlormadinone acetate (氯地孕酮 ) 12 mg
2) Three in one Compound Quinestrol Monthly Tablets
三合一炔醚片
Components:
Quinestrol 2mg
Chlormadinone acetate (氯地孕酮 ) 6 mg
Norgesterel (炔诺孕酮 ) 6 mg
Systemic Contraceptives
19
Systemic Contraceptives
3,Vacation pill/morning-after pills
1,Norethisterone Tablets (炔诺酮探亲片 )
2,Megestrol Acetate Tablets (甲地孕酮探亲避孕片 1号 )
3,Norgestrel Tablets (炔诺孕酮探亲避孕片 )
4,Anordrin Tablets (53号抗孕片,53号探亲片、
事后避孕片、双炔失碳酯片 Anordrin)
5,Me-Quingestanol Pill (甲醚抗孕丸 )
Components,Megestrol 0.5mg,
Quingestanol Acetate 0.8mg
20
Systemic Contraceptives
II,Long-acting contraceptive injection
1,Compound Hydroxyprogesterone Caproate Injection
复方己酸羟孕酮避孕针 (避孕针 1号 )
Components:
Hydroxyprogesterone Caproate 250mg
Estradiol Valerate 5mg
2,Compound Megestrol Acetate Injection (Inj.Mego-E)
复方甲地孕酮避孕针
(美尔伊避孕针、甲孕雌醇避孕针 )
Components:
Megestrol 25mg
17β-Estradiol 3.5mg
21
3,Norethisterone Enanthate Injection
庚炔诺酮避孕针
Components:
Norethisterone Enanthate (NET-EN,Norigest)
炔诺酮庚酸酯 200mg
Lasts 2 month
Systemic Contraceptives
22
III,Slow-releasing contraceptives
1,Hypodermic implant (皮下埋植剂 )
(1) Norplant I (99.8%) (D-炔诺孕酮埋植剂 I、
左炔诺孕酮埋植剂 I)
Levonorgestrel (左旋炔诺孕酮） 36mg× 6
For 5 years (LNG,85-30μg/day)
(2) Norplant II (D-炔诺孕酮埋植剂 I、
左炔诺孕酮埋植剂 I)
LNG 70mg× 2
For 3 years (LNG,45μg/day).
Systemic Contraceptives
23
2,Contraceptive vaginal ring
(1) Megestrol Acetate-Silica Gel Circle (97%)
甲硅环、甲孕酮硅胶避孕环
Megestrol 200～ 250mg
For 1 year (Megestrol,100-150 μg/day)
(2) D-Norgestrel-Silica Gel Circle
D-炔诺孕酮阴道避孕环、左旋炔诺孕酮阴道环
Levonorgestrel 5mg
For 3 months (LNG,20μg/day)
Systemic Contraceptives
24
25
26
3,Slow-releasing injectable
microglobes and microcapsules
3 months
IV,Transdermal patch
Systemic Contraceptives
27
1,Cancer
2,Thrombotic diseases
(血栓性疾病）
3,Adverse effects on metabolism
(1) Carbohydrate
(2) Lipid
(3) Protein
Systemic Contraceptives
Long-term safety
No
No if <50μg/day
Glucose tolerance test↓
Triglyceride↑HDL ↑
Cholesterol ↑
Total protein ↓ Albumin ↓
Globulin ↑
28
4,Future fertility
5,Adverse effects
on the embryo/fetus
Systemic Contraceptives
No adverse effect
(Ovulates within 3
months)
1) Controversial for
pregnancy during
medication.
2) Consensus,safe
if > 6 months
29
Systemic Contraceptives
Contraindications
1,Malignant or precancerous diseases and
patients with uterine or breast masses
2,Hematopathy and thrombotic diseases
3,Severe cardiovascular diseases
1) P→lipid metab →coronary artherosclerosis
2) E→blood coagulation↑→myocardiac
infarction
3) E→renin activity↑→hypertension
30
4,Endocrine diseases,diabetes,hyperthyroid
dysfunction
5,Lactation
6,Oligohypomenorrhea or older than
45 years old
7,Vaginal bleeding of unknown origin
8,Hepatitis and nephritis
9,Psychotic (精神病患者 )
Systemic Contraceptives
Contraindications
31
1,Abnormal uterine bleeding
1) Breakthrough bleeding
If happens in the first half cycle,add EE (炔雌醇 )
50-150μg/day for 2 weeks.
If happens in the second half cycle,increase o.c,by
0.5-1 tablet/day for 2 weeks.
2) Cessation of menstruation
Once,no need to treat
Twice,change types of o.c.
Amenorrhea,discontinue o.c,and try ovulation induction
3) Hypomenorrhea（月经过少）
No treatment or EE 50-100 μg/day for 22 days
Systemic Contraceptives
Side effects
32
2,Morning sickness-like reaction
VitB6 20mg,VitC 100mg,anisodamine (山莨菪碱 )10mg
tid po for 7 days.
3,Weight gain
P (containing weak androgen activity),stimulating
anabolism (合成代谢）
E,causing sodium and water retention
4,Pigmentation (moth patch) (蝴蝶斑 )
5,Others
Headache,breast swelling pain,appetite increase,
skin rash,pruritus (瘙痒 ),etc.
Side effects
Systemic Contraceptives
33
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
34
35
36
Types of IUD
1,IUD made with inert materials
Stainless steel,nylon,etc
Fewer adverse reactions,but higher expulsion
rate and pregnancy rate
2,IUD added with active substances
1) IUD with copper
2) IUD with progestogens,zinc,PG synthetase
inhibitor
3,Third generation IUD
IUDs
37
1) IUD with copper
TCu-200 (1 year cumulative rate)
Expulsion rate,5.61%
Pregnancy rate,1.51%
Removal rate (due to adverse effects),9.22%
Removal rate (due to other reasons),3.62%
‘Overall failure rate’ 19.96%
2) IUD with progestogens,zinc,PG synthetase
inhibitor
3,Third generation IUD
Anchoring IUD
IUDs
38
Mechanism
Primarily an aseptic inflammation reaction
(1) Phagocytic effect
(2) Leukocytes
(3) Prostaglandins
(4) Luteolysis (黄体溶解 )
(5) Fibrinolysis（纤溶）
(6) Immune factor
Interfering with implantation,sperms,development
of the fertilized eggs and embryos.
IUDs
39
Mechanism
IUD with active substances
1,IUD with copper:
(1) Inflammation reaction and PG
(2) Toxic effect on sperms
(3) Interference with implantation by
changing mucus (thinner) and its secretion
2,IUD with progestogens:
(1) Atrophic change in the endometrium
(2) Change in the cervical mucus
(3) Interference with metabolism in sperms
IUDs
40
IUDs
1,Timing
1) 3-7 days after completion of menstruation and
no recent sexual intercourse.
2) Immediately after an artificial abortion (<10 cm)
3) 42 days after a normal vaginal delivery
4) 6 months after a cesarean section
5) Day 3 of menses for progestin containing IUD
2,Selection of IUDs,depending on space of uterine
cavity
3,Method
4,Postoperative care
Procedures
41
42
43
44
(1) Pregnancy suspected
(2) Infection of the reproductive tract
(3)Tumours of the reproductive tract or uterus
malformation
(4) Tissue retention after abortion or delivery
(5) Cervical imcompetence,severe old laceration
of cervix and severe uterine prolapse
(6) Severe generalized diseases
(7) Polymenorrhea or menorrhagia?
Contra-indications
IUDs
45
1) Uterine bleeding
Mechanical compression injuries
Increased PGs and activated fibrinolysis
Indomethacin (消炎痛 ) 25-50mg tid po
EACA (氨基己酸 ),2-4g tip po
云南白药,0.4g tid po
2) Pain or discomfort
IUDs
Adverse effects
46
1) Perforation of the uterus and IUD ectopia
2) Infection
3) Incarceration (节育器嵌顿 )
IUDs
Complications
47
48
? IUD and PID (pelvic inflammatory disease)
? IUD and ectopic pregnancy
? Displacement or expulsion of IUD
? Pregnancy with IUD in place
IUDs
Problems associated with IUD
49
50
51
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
52
Types:
(1) Male condom (安全套 )
(2) Female condom
(3) Vaginal spermicides
Nonoxynol-9 (壬苯醇醚膜 ) (95%)
乐乐迷避孕膜
Mechanism,Damage sperm membrane
Usage,Insert into vagina 3-5 min before coitus
Barrier methods
53
54
55
56
Systemic contraceptives
IUDs or IUCDs
Barrier methods
Natural methods
Contraceptive methods
57
(1) Coitus interruptus (体外排精 )
(2) The safe period (安全期 )
(3) Postcoital douche (性交后冲洗 )
(4) Prolongation of lactation
Natural methods
58
Immunization
GnRH analogues
Postcoital contraception (紧急避孕 )
Other contraceptive methods
59
Mechanism
1,Prevent or postpone ovulation
2,Interfere with fertilization or implantation
Methods
1,Morning-after IUD insertion
2,Morning-after pill (98%) (<3 days)
Steroid or nonsteroid hormones
Postcoital Contraception
60
Steroids
(1) Levonorgestrol Tablets (左炔诺孕酮片 )
毓婷 Levonorgestrel 0.75mg twice (12h)
(2) Anordrin Tablets (53号抗孕片 ) (Sugar coated)
Anordrin (双炔失碳酯 ) 7.5mg once.
(3) Compound Levonorgesterel Tablets
复发左旋炔诺孕酮片 (EE 30 μg,LNG 0.15mg)
4 tablets twice (12h)
Nonsteroids
Mifepristone (RU486) (米非司酮 ) (息隐、含珠停 )
25mg once 80%
100mg once 100%
Postcoital Contraception
61
Methods:
1,Minilaparotomy（经腹）
2,Laparoscopy（腹腔镜术）
Sterilization:Tubal ligation (结扎术 )
Contra-indications:
(1) Acute illness
(2) Severe illness that can not tolerate surgery
(3) Infection
(4) Severe neurosis (神经官能症 )
(5) Twice or more 37.5℃ within 24 hours
62
Minilaparotomy （经腹）
63
64
65
1,Drug induced
2,Surgical
Vacuum suction (6～ 10 weeks)
Surgical curettage (11～ 14 weeks)
Artificial abortion (人工流产 )
66
Drug induced abortion (药物流产 )
Combination therapy with Mifepristone
and Misoprostol
Indications,
(1) Pregnancy within 7 weeks
(2) Surgical abortion rendered difficult
(3) Refusal of surgical abortion
(4) Within half year of a cesarean section or lactating
Method:
Mifepristone (米非司酮 ) 50mg/day for 3 days
Misoprostol (米索前列醇 ) 0.6mg on the 4th day morning
67
Mechanism:
Mifepristone competes with progesterone for P receptors
on decidua (蜕膜 ).
Misoprostol causes uterine contraction.
Complete abortion rate,≥90%
Side effects and complications:
(1) Digestive tract symptoms
(2) Pain caused by uterine contraction
(3) Bleeding usu,10-14 days or even 2 months
(4) Infection
Contraindications:
Those of RU486 and Misoprostol
Drug induced abortion (药物流产 )
68
Surgical Abortion (人工流产术 )
Contra-indications:
(1) Acute or severe illness
(2) Acute infection of reproductive tract
(3) Hyperemesis gravidarum (妊娠剧吐） with acidosis
(4) Twice 37.5℃ within 24 hours
Methods:
1,Vacuum aspiration (负压吸引 )
For pregnancy within 10 weeks.
2,Surgical curettage with forceps (钳刮术 )
For pregnancy for 11-14 weeks
69
70
71
Surgical curettage with forceps (钳刮术 )
72
Complications
1,Artificial abortion syndrome
2,Uterine perforation
3,Bleeding during the operation
4,Embolism
5,Retention of conceptus
6,Postoperative infection
7,Postoperative adhesion formation
Surgical Abortion (人工流产术 )
73
74
75
For newly married couples:
For couples with one child:
For couples with two or more children:
For lactating women:
For perimenopausal women:
Selection of Contraception Methods
76
