4. Conception requires Juxtaposition of the male and female gametes at the optimal stage of maturation Transportation of the conceptus to the uterine cavity at a time when the endometrium is supportive of its continued development and implantation.
6. 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
19. 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
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34. 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
35. 4. Endocrine diseases: diabetes, hyperthyroid dysfunction 5. Lactation 6. Oligohypomenorrhea or older than 45 years old 7. older than 35 years old smoking wemen 8. delivery within half a year or menses not recovery 9. Hepatitis and nephritis 10. Psychotic ( 精神病患者 ) Systemic Contraceptives Contraindications
41. 3. Norethisterone Enanthate Injection 庚炔诺酮避孕针 Components: Norethisterone Enanthate 炔诺酮庚酸酯 200mg can be used in lactation menstrual disorder ↑ Long-acting contraceptive injection
42. in the first month : D5 and D12 next months: D10-D12 menstrual onset 12-16 days after injection side effcts: irregular bleeding , menorrhagia in the first 3 months treatment : hemostatic , estrogen, short –acting OC Long-acting contraceptive injection
43. 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 (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 no estrogen , can be used in lactation implanted on 7 days of menstrul cycle side effct: irregular blot bleeding , amenorrhea treatment : hemostatic , estrogen Slow-releasing contraceptives
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46. (1) Megestrol Acetate-Silica Gel Circle (97%) 甲硅环、甲孕酮硅胶避孕环 Megestrol 200 ~ 250mg For 1 years 哺乳期首选 Contraceptive vaginal ring
47. 3. Slow-releasing injectable microglobes and microcapsules – 0.1mm For 3 months IV. Transdermal patch Systemic Contraceptives
50. 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 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 Types of IUD
51. Mechanism 1.Primarily an aseptic inflammation reaction- foreign body macrophage ,Leukocytes ↑ - blastokinin ↓ - implantation ↓ 2.Prostaglandins velocity of embryo transport ≠ endometrial development 3. oppressed ischemic endometrium -> plasminogen ↑ - fibrinolysis ↑- blastula dissolve . IUDs
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53. 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) 3 months 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 Procedures
59. 1 ) Uterine bleeding Mechanical compression injuries Increased PGs and activated fibrinolysis Indomethacin ( 消炎痛 ) 25-50mg tid po aminohexanoic acid ( 氨基己酸 ), 2-4g tip po 云南白药 , 0.4g tid po Severe menorrhagia causing anaemia and requiring removal of the device 2) Pain or discomfort Colicky pain may occur for a time after insertion, particularly if the device is large. If dysmenorrhoea occurs, prostaglandin synthetase inhibitors relieve the symptom. Otherwise the possibility that it is caused by infection must be thought. Adverse effects
89. 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. > 14 days or even 2 months (4) Infection Drug induced abortion ( 药物流产 )
97. 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