mijloace de impiedicare a sarcinii
TRANSCRIPT
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Contraceptia
- prevenirea voluntara a conceptiei sau a fecundarii
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Mijloace de impiedicare a sarcinii
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Metode
A. LocaleB. HormonaleC. ChirurgicaleD. De calcul ale
ovulatieiE. NaturaleF. Abortive
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Metode locale
PrezervativeSpermicideDiafragme(cape)Sterilete
- simple
- de cupru
- hormonale
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Hormonale
Orale- pilule estro-progestative
- normodozate(50 μg etinilestradiol)- microdozate(35, 30, 20, 15μg etinilestradiol)
- pilule progestative- macrodozate, microdozate(cu blocarea ovulatiei)- cu actiune locala(fara blocarea ovulatiei)
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Hormonale
Intramuscular(la 3 luni,150 mg acetat de medroxiprogesterona)
Intrauterin(sterilet cu eliberare de levonorgestrel)
Subcutanat(implant de progestagel)
Transdermic
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Chirurgicale
La femeieligatura
trompelorobstructia
trompelor pe cale interna
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ChirurgicaleLa barbat
- vasectomiaPrincipiul consta
in intreruperea ductului deferent si impiedicarea spermatozoizilor de a ajunge de la testicul in uretra pentru a fi ejaculati impreuna cu lichidul seminal.
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Metode de calcul
Ogino-Knaus (abstinenta sexuala periodica)
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Naturale
Coitus interruptus
Dusul vaginal
Lactatia
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Abortive
Suctiune-aspiratie
Dilatare-chiuretaj
Prostaglandinele
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Organele genitale
1.Ovar2.Trompe3.Uter4.Fundul uterului
1.Canalele deferente2.Testicul3.Prostata4.Uretra
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Organele genitale feminine
1. Vaginul
2 si 3. Uterul
4. Trompele uterine
5. Pavilionul trompei
6. Ovarele
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Ovulatia, migratia spermatozoizilor
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Fecundatia si nidatia
Fecundatia se realizeaza in partea distala a trompei uterine.
Nidatia oului in uter are loc la 7 zile dupa fecundatie.
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Lunare
Metode hormonale
saptamanale
zilniceIntrauterine
Alte metode
Bariera
Defiţni-tive
Natura-le
Momen-tane
Metode contraceptive feminine
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zilniceIntrauterine
Alte metode
Bariera
Defini-tive
Natura-le
Momen-tane
Metode contraceptive masculine
Hor-monale
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50% din sarcini sunt nedorite.
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Care metoda contraceptiva este cea mai buna ?
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“Ce îşi doreşte femeia ?” − Sigmund Freud
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• Siguranta.
• Eficienta.Accesibilitate.
• Acceptare din partea partenerului.
Ce isi doreste femeia de la contraceptie?
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Metode contraceptiveEstrogeni/progestative
oral transdermal transvaginal injectabil
Progestative numai oral injectabil implant Intrauterin DIU hormonal
Abstinenta periodica
DIU non-hormonal
Metode de bariera Prezervativul masculin Prezervativul feminin Diafragma Capacul cervical
Sterilizarea Ligatiura trompelor transcervical vasectomia
• Contraceptia de urgenta
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Contraceptivele in lume
Lume
Tari dezvoltate Tari mai putin dezvoltate
Ligatura trompelor
Vasectomie
Contraceptive orale
Progestative injectabile
Prezervativ
Alte metode
Neprotejat
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Metode contaceptive utilizate inSUA
0
5
10
15
20
25
30
Female sterilization
Pill
Male condom
Male sterilization
No method
Withdrawal
Injectable
Periodic abstinence
Diaphragm
IUD
Hatcher, R.A. et al. Contraceptive Technology. 18th revised edition, 2004.
Ligatura trompelor
Contraceptive orale
Prezervativul masculin
Vasectomia
Neprotejat
RetragereaProgestativ injectabil
Abstinenţa periodică
Diafragma
DIU
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fK Romania a derulat in luna septembrie 2010 un studiu online pe platforma www.askGfK.ro prin care si-a propus sa afle care sunt metodele de contraceptie cunoscute si folosite de romani, factorii care ii influenteaza in luarea deciziei privind utilizarea, precum si sursele de informare la care apeleaza.
Concluziile cercetarii arata ca, in general, cele mai cunoscute metode contraceptive sunt: prezervativul (95%), pilulele contraceptive (94%), retragerea inaintea ejacularii (83%), steriletul (75%), metoda calendarului (74%) si pilula de a doua zi (72%).
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Contraceptia naturala
Coitus interruptus Dusul vaginal Alaptarea Abstinenta periodica Metoda Ogino Metoda temperaturii bazale Metoda Billings
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Planificarea familiala
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Ciclul menstrual
Ovulaţia Corpul galben
Menstruaţia
ProgesteronEstrogeni
LH
FSH
Ziua 28 Ziua 1
Menstra
Ziua 12Ziua 16 Ovulaţia
Perioadapreovulatorie
Perioadapostovulatorie
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Abstinenta periodica(metoda calendarului sau metoda Ogino-Knaus)
A
B
Menstruaţia
Menstruaţia
Menstruaţia
Menstruaţia
Perioada fertilăZile posibil fertile Zile preovulaţie Zile postovulaţie
Spermatozoizii pot supravietui in vagin sau in uter 1 – 5 zile.Ovulul poate traii până la 24 de ore.
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Abstinenta periodica (temperatura bazala)
Luna Ziua
Menstruaţia
Tem
per
atu
ra
Dupa ovulatie, progesteronul creste temperatura bazala cu 0,4-0,7 grade C. Decalajul termic indica prezenta ovulatiei.
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Abstinenta periodica(metoda Billings)
• Examinarea mucusului cervical
• Metoda simptotermala (temperatura bazala + mucusul cervical)
• calendarul
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Metoda Billings
Zile infertile
Menstruaţia
Zile infertile
Accentuarea secretiei
Incepe secretia de mucus cervical
Secretie maxima
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Amenorea de lactatie(alaptarea)
Eficienta: 98% in primele 6 luni de alaptare
Alaptare din 3 in 3 ore
pentru a stimula suficient secretia de PRL
Dezavantaje: hipoestrogenism(libidou diminuat, uscaciune vaginala, osteoporoza)
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Retragerea(coitus interruptus)
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Contraceptiepentrubarbati
5€
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Metode de bariera
spermicidele
tamponul contraceptiv
capacul cervical
diafragma
preservativul masculin
preservativul feminin
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Spermicide
Eficienta: 94-74% (daca este folosit corect).
Trebuie folosite cu cel puţin 30 de minute inainte.
Dezavantaje: modificarea mediului local: reactii alergice.
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Tamponul contraceptiv
Tamponul este imbibat cu spermicid.Eficienta: 70 -98%.
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Prezervativele
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Prezervativul
Eficacitate 98%
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Prezervativul feminin
Fund desac
Orificiul
Eficienta: 95%
Femodom
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DiafragmeleDiafragmele sunt eficiente in 92-96% din cazuri
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Spirala sau dispozitivul intrauterin(DIU)
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DIU
Este o piesa in forma de T impregnata cu levonorgestrel.
Se monteaza in uter de ginecolog.
Are doua fire care pot fi reperate in vagin de catre femeie(pentru a se convinge ca DIU este in uter).
Eficacitate: 99%.
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Contraceptivele hormonale orale
Eficacitate: 99% daca sunt administrate corect
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Contraceptivele combinate (pilulele estro-progestative)
Monofazice: toate cele 21 de pilule sunt active, continand aceleasi cantitati de estrogen si progestativ(E/P).
Bifazice: 21de pilule active ce contin 2 combinatii diferite de E/P (de ex., 10/11).
Trifazice: 21 de pilule active ce conţin 3 combinaţii diferite de E/P (de ex., 6/5/10).
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Mecanism de actiune
Suprima ovulatia
Scad proliferarea endometrului
Diminuiaza motilitatea tubara si uterina
Cresc vascozitatea mucusului cervical
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Contraceptivele combinate (pilulele estro-progestative)
Complicaţtii• Tromboembolism venos• Infarct miocardic si AVC• HTADepresieAmenoree
Fumatul creste frecveta complicatiilor!
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Efecte secundare ale estro-progestativelor
Reactii alergice 3%
Ingrasare 6%
Metroragii 15%
Amenoree 33%
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Inelele vaginale cu estro-progestative
• Timp de 3 saptamani, inelul plasat in vagin elibereaza continuu estrogeni si progestativ, hormoni care inhiba ovulatia.
• Favorizeaza
ingrosarea glerei cervicale, marind dificultatea penetrarii spermatozoizilor in uter.
• Modifica endometrul,
facand dificila implantarea.
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Patch-ul cu estro-progestativ(Evra)
Estro-progestativul este adus in organism timp de 3 saptamani pe cale transdermica.
Hemoragia de privare(menstruatia) se produce in saptamana fara pach.
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Contraceptivele (numai) cu progestative
DIU impregnat cu progestativ
Pilule
Implant
Injectie
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Implantul progestativ
Eficacitate 99%
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Contraceptive cu progestative injectabile
Eficienta 99.7% Administrare: la 3 luni Dupa 6 luni de la
intrerupere, femeia poate ramane gravida
Dezavantaje: ingrasare, osteoporoza
Depo-Provera
Depo-Provera = depot medroxyprogesterone acetate 150 mg
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DIU impregnata cu progestativ
Mirena
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Metode chirurgicale
Ligatura trompelorVasectomia
Dezavantaj: sunt permanente
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Sterilizare
Ligatura trompelor
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Tehnica Essure
Tehnica Essure consta in
Introducerea unui micro‑ implant, de 0,8 /2 mm prin histeroscopie in fiecare trompa.
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Vasectomia
Testicul
Canal defer.
SectiuneaPenis
Gland
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Metode abortive
Primul trimestru
Suctiune-aspiratie Dilatare si chiuretaj
Trimestrul doi si trei
Dilatare si chiuretaj Injectie cu solutie salina Dilatatie si extractie Prostaglandine Histerotomie
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Мetodele de avort, recomandate de OMS
Săptămâni de la ultima menstruaţie
Se preferă:
Alte metode
Dilatatare şi chiuretaj
Soluţie hipertonică
Prostaglandine intraamniotic
Vacuum/aspiraţie
Mifepriston
Dilataţie şi evacuare
Prostaglandine intravaginal
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Metode abortive chirurgicale
Fatul
Lichid amnioric
Suctiune
Embrion
Dilatatie si chiuretaj Suctiune-aspiratie
Injectie salina
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Avortul medicamentos
Definitie
Terminarea voluntara a sarcinii, indusa de medicamente, fara aplicarea unor proceduri chirurgicale.
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Avortul medicamentos
Este recomandat de OMS
Este sigur si eficient (95-98%)
Diminueaza rata complicatiilor, in special celor infectioase
Peostaglandina E
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Contractiiuterine ritmice
Blocareaprogesteronului
Necroza deciduei
Ramolirea colului
Detasarea Expulzia
Avortul
Avortul medicamentosMifepriston + Misoprostol(mecanism de actiune)
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Contraceptia de urgenta
Pilula “de a doua zi”
Montarea DIU
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Contraceptia de urgenta
La contraceptia de urgenta (postcoitala) se recurge in caz de contact sexual neprotejat.
Actioneaza dupa fertilizare, dar inainte de implantarea ovulului fertilizat in endometru; nu este avort.
Contactul sexual neprotejat poate fi consecinta neutilizarii contraceptiei, a uitarii de a lua pilula sau se poate datora altor cauze (viol, ruperea prezervativului etc.)
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Contraceptia de urgenta
Estrogen şi progestativ (100 µg de etinil- estradiol şi 0.5 mg de levonorgestrel de 2x cu interval de 12 ore între administrări.
Levonorgestrel (0.75 mg de 2x, cu interval de 12 ore
intre administrari. Estrogen in doza mare (de ex., 5 µg de etinil-
estradiol, zilnic, 5 zile la rand.
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Contraceptia de urgenta(contraceptia postcoitala)
Prima administrare
in primele 72de ore
A doua administr.
12-24 ore
care urmeaza raportului
in 12-24 ore
care urmeaza primei admin
Duparaport
Ziua1
Ziua2
Ziua3
Eficacitate
95%
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Schema Yuzpe(utilitazta in Romania)
3 tablete de Microginon, ca prima doua.
A doua doza, 4 tablete de Microginon, dupa 12 ore de la prima doza, in cadrul celor 72 de ore (3 zile) de la contactul neprotejat.
Cu o ora inainte de Microginon: Torecan sau Emetiral pentru a prevenii greturile si varsaturile.
Daca apar varsaturi sau diaree se repeta ultima doza.
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Montarea DIU in scop contraceptiv imediat
Montat in primele 5 zile dupa raportContraindicat la nulipareEsec 1%Risc de endometrita sau anexita
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Contraceptia de urgenta(rezumat)
DIU in primele 5 zile(nu la nulipare).
Hormonal(numai in primele 3 zile dupa raportul sexual:
- prima doza: 3 tb. Microgynon;- a doua doza: 4 tb. Microginon, dupa 12
ore de la prima administrare).
Obs. Inainte de prima administrare cu o ora: Torecan sau Emetiral
In caz de diaree sau varsaturi se repeta ultima doza
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