UNDERSTANDING THE CONCEPT UNDERSTANDING THE CONCEPT OF PREVENTIVE AND OF PREVENTIVE AND

COMMUNITY MEDICINE IN COMMUNITY MEDICINE IN OBSTETRICS AND OBSTETRICS AND

IMPLEMENTING IT IN ANC OPDIMPLEMENTING IT IN ANC OPD

DR. ASHA JAINDR. ASHA JAIN

MBBS, MS Gynecology and ObstetricsMBBS, MS Gynecology and Obstetrics

SENIOIR GYNECOLOGISTSENIOIR GYNECOLOGIST

NEHRU HOMOEOPATHIC MEDICAL COLLEGE AND NEHRU HOMOEOPATHIC MEDICAL COLLEGE AND HOSPITALHOSPITAL

Obstetrics is largely a preventive Obstetrics is largely a preventive medicine. the aim of both is the medicine. the aim of both is the

same which is to ensure the same which is to ensure the good health of mother through good health of mother through out pregnancy and puerperium out pregnancy and puerperium so that every pregnancy may so that every pregnancy may culminate in a healthy mother culminate in a healthy mother

with a healthy baby. with a healthy baby.

SOCIAL OBSTETRICSSOCIAL OBSTETRICS

This concept has recently gained This concept has recently gained popularity which is defined as the popularity which is defined as the study of interplay of social and study of interplay of social and environmental factors and human environmental factors and human reproduction going back to reproduction going back to preconceptional and even pre marital preconceptional and even pre marital period.period.

SOCIAL AND ENVIRONMENTAL SOCIAL AND ENVIRONMENTAL FACTORSFACTORS

1. AGE OF MARRIAGE1. AGE OF MARRIAGE2. AGE OF CHILD BEARING2. AGE OF CHILD BEARING3. CHILD SPACING3. CHILD SPACING4. FAMILY SIZE4. FAMILY SIZE5. LEVEL OF EDUCATION5. LEVEL OF EDUCATION6. ECONOMIC STATUS6. ECONOMIC STATUS7. CUSTOMS AND BELIEFS7. CUSTOMS AND BELIEFS8. ROLE OF WOMEN IN SOCIETY8. ROLE OF WOMEN IN SOCIETY

contd. contd. All socia and environmental factors are interrelated All socia and environmental factors are interrelated

like early marriage is a social custom in third world like early marriage is a social custom in third world countries especially in Indian BIMARU states. countries especially in Indian BIMARU states.

Mean age of marriages Is 17.4 years, it is even Mean age of marriages Is 17.4 years, it is even lower in above states.lower in above states.

20% of all pregnancies are teenage pregnancy 20% of all pregnancies are teenage pregnancy forced by families and society.forced by families and society.

Pregnancy below 16 years leads to high Pregnancy below 16 years leads to high precentage of risks like PIH, anaemia, small pelvis, precentage of risks like PIH, anaemia, small pelvis, immature perineum with injuries, preterm births immature perineum with injuries, preterm births and high perinantal and maternal morbidity.and high perinantal and maternal morbidity.

MONSTERS OF OUR SOCIETY ARE IGNORANCE, MONSTERS OF OUR SOCIETY ARE IGNORANCE, POVERTY, ILLITERACY AND GENDER POVERTY, ILLITERACY AND GENDER DISCRIMINATION.DISCRIMINATION.

CONTD…CONTD…

Gender discrimination is quite prevalent in Gender discrimination is quite prevalent in Indian families. Best and good food goes to Indian families. Best and good food goes to the father and the sons.the father and the sons.

Very few realize that nutrition and health of Very few realize that nutrition and health of adolescent girl forms most important step adolescent girl forms most important step for the health of future pregnant woman.for the health of future pregnant woman.

It is not wrong to say that nutrition and It is not wrong to say that nutrition and health care of the pregnant woman starts health care of the pregnant woman starts at the age of 10 and not when she at the age of 10 and not when she becomes pregnant.becomes pregnant.

Contd…Contd… Ignorance, poverty and illiteracy results into Ignorance, poverty and illiteracy results into

unplanned sexual activity and pregnancies.unplanned sexual activity and pregnancies. Though society is divided on the issue of sex Though society is divided on the issue of sex

education, it must be started at the school level education, it must be started at the school level which should consist of:which should consist of:Physiology and anatomy of reproductive sysemPhysiology and anatomy of reproductive sysemGenital hygiene and care during menstrual cycleGenital hygiene and care during menstrual cycleHarmful effects of premarital and unsafe sexHarmful effects of premarital and unsafe sexShould be taught about STD, HIV and Should be taught about STD, HIV and

contraceptioncontraception

Contd…Contd… Best way to educate and influence people in Best way to educate and influence people in

villages and town is to involve religious leaders villages and town is to involve religious leaders who can during their discourse point out the who can during their discourse point out the importance of sex education, family planning and importance of sex education, family planning and care of girl child.care of girl child.

School teachers can also be educated.School teachers can also be educated. Posters and mass media like radio and TV can also Posters and mass media like radio and TV can also

propagate the idea and importance of above propagate the idea and importance of above factors.factors.

Various NGO’s and medical societies can also help Various NGO’s and medical societies can also help in changing the attitude of people towards size of in changing the attitude of people towards size of family, care of adolescent girl and pregnant family, care of adolescent girl and pregnant mother and use of family planning devises.mother and use of family planning devises.

MATERNAL AND CHILD MATERNAL AND CHILD HEALTHHEALTH

Mother and child must be considered a single unit because:Mother and child must be considered a single unit because: 1. During antenatal period fetus is a part of mother and 1. During antenatal period fetus is a part of mother and

obtains all the building material and oxygen from mother’s obtains all the building material and oxygen from mother’s blood.blood.

2. Child’s health is closely related to maternal health, a 2. Child’s health is closely related to maternal health, a healthy mother brings forth a healthy baby.healthy mother brings forth a healthy baby.

3. Certain conditions and diseases are likely to have their 3. Certain conditions and diseases are likely to have their effect on fetus e.g.. DM, infections etc.effect on fetus e.g.. DM, infections etc.

4. After birth child is dependent on mother.4. After birth child is dependent on mother. 5. In the care cycle of women there are few occasions where 5. In the care cycle of women there are few occasions where

service to the child is simultaneously called for eg. Post service to the child is simultaneously called for eg. Post partum period care which is inseparable from neonatal care.partum period care which is inseparable from neonatal care.

6. Mother is first teacher of child.6. Mother is first teacher of child.

Contd…Contd… MCH care refers to promotive, preventive and MCH care refers to promotive, preventive and

rehabilitative health care for mother and child. rehabilitative health care for mother and child. It includes:It includes:Maternal healthMaternal healthChild healthChild healthFamily planningFamily planningSchool healthSchool healthHealth care of special cases like adolescent Health care of special cases like adolescent

girls, handicapped children and care of girls, handicapped children and care of children in special settings like daycare children in special settings like daycare centerscenters

Antenatal careAntenatal careCare of woman during pregnancy is Care of woman during pregnancy is

called antennal care. The aim is to called antennal care. The aim is to achieve healthy mother and a healthy achieve healthy mother and a healthy baby at the end of pregnancy.baby at the end of pregnancy.

In recent years there has been a mass In recent years there has been a mass reduction in maternal and perinatal reduction in maternal and perinatal morbidity and mortality.morbidity and mortality.

Apart from other factors proper Apart from other factors proper antenatal care has bought about antenatal care has bought about remarkable results.remarkable results.

Objectives of antenatal careObjectives of antenatal care1.1. Promote, protect and maintain helath of Promote, protect and maintain helath of

mother during pregnancymother during pregnancy2.2. Detect high risk casesDetect high risk cases3.3. Foresee complications and prevent themForesee complications and prevent them4.4. To remove anxiety and dread related to To remove anxiety and dread related to

pregnancy and deliverypregnancy and delivery5.5. To reduce MMR and IMR related to deliveryTo reduce MMR and IMR related to delivery6.6. Teach mother the elements of childcare, Teach mother the elements of childcare,

nutrition, hygiene, environmental sanitation nutrition, hygiene, environmental sanitation etc.etc.

7.7. Sensitize mother about family planningSensitize mother about family planning8.8. To attend under five children accompanying To attend under five children accompanying

the motherthe mother

MCH PROBLEMSMCH PROBLEMS

Main health problems affecting the Main health problems affecting the health of mother and child revolves health of mother and child revolves around:around:

1. Malnutrition1. Malnutrition2. Infections2. Infections3. Consequences of unregulated fertility3. Consequences of unregulated fertility4. Scarcity of health and other services 4. Scarcity of health and other services

with poor socioeconomic conditions.with poor socioeconomic conditions.

ANTENATAL CAREANTENATAL CARE1.1. General historyGeneral history2.2. Family history regarding history of TB, HT, DM, congenital Family history regarding history of TB, HT, DM, congenital

anomalies, hereditary diseases.anomalies, hereditary diseases.3.3. Personal history: H/O medical and surgical problems and Personal history: H/O medical and surgical problems and

H/O deficiencyH/O deficiency4.4. Mestrual history: LMP, EDDMestrual history: LMP, EDD5.5. Obstetric history: Obstetric history:

1.1. Previous pregnancies- abortions induced or Previous pregnancies- abortions induced or spontaneousspontaneous

2.2. Normal deliveriesNormal deliveries3.3. Operative deliveries- instrumental or CSOperative deliveries- instrumental or CS4.4. Any complication during pregnancyAny complication during pregnancy5.5. Complications of laborComplications of labor6.6. Third stage complicationsThird stage complications7.7. PuerperiumPuerperium8.8. Condition of child Condition of child

General and medical General and medical examinationexamination

1.1. Height and weightHeight and weight

2.2. Stature and nutritional statusStature and nutritional status

3.3. GaitGait

4.4. Medical examination: Respiratory, Medical examination: Respiratory, cardiac, endocrinal and abdominal cardiac, endocrinal and abdominal examinationexamination

5.5. Examination of oral cavity Examination of oral cavity

6.6. Examination of breastExamination of breast

7.7. BP, edema feet, cyanosis, clubbing etc.BP, edema feet, cyanosis, clubbing etc.

Obstetric examinationObstetric examination

1.1. Height of uterusHeight of uterus

2.2. Presentation, lie and positionPresentation, lie and position

3.3. Fetal heart rateFetal heart rate

Vaginal examinationVaginal examination

EARLY PREGNANCYEARLY PREGNANCY1.1. To confirm diagnosis of pregnancyTo confirm diagnosis of pregnancy2.2. To rule out extra uterine pregnancyTo rule out extra uterine pregnancy3.3. Any adenexal pathologyAny adenexal pathology LATE PREGNANCYLATE PREGNANCY1.1. To rule out CPDTo rule out CPD2.2. At the time of labor and At the time of labor and 3.3. Any other obstetric indicationAny other obstetric indication

Laboratory examinationLaboratory examination

Hb, ABO Rh, blood sugar, urine Hb, ABO Rh, blood sugar, urine analysis, HIV, VDRL, HbsAganalysis, HIV, VDRL, HbsAg

ICT in Rh –ve if husband is positiveICT in Rh –ve if husband is positive

Advice Advice 1.1. Impress upon her need for regular attendance at the clinic Impress upon her need for regular attendance at the clinic

and assure her that pregnancy and labor would be smooth and assure her that pregnancy and labor would be smooth and safe.and safe.

2.2. Ideal number of visits:Ideal number of visits: First visit in 1First visit in 1stst 3 months 3 months Once a month till 28 weeksOnce a month till 28 weeks Twice a month till 36 weeksTwice a month till 36 weeks Weekly till deliveryWeekly till delivery

As it is difficult for the mother coming from low socio As it is difficult for the mother coming from low socio economic group minimum 3 visits during entire pregnancy economic group minimum 3 visits during entire pregnancy is a must.is a must.

11stst visit earliest < 20 weeks visit earliest < 20 weeks 22ndnd visit at 32 weeks visit at 32 weeks 33rdrd visit at 36 weeks visit at 36 weeks

3.3. Further visits justified by the condition of the mother.Further visits justified by the condition of the mother.4.4. Home visits are also paid by the health worker.Home visits are also paid by the health worker.5.5. All records are propely maintained in the ANC card.All records are propely maintained in the ANC card.

AdviceAdvice

At this time the mother is more receptive At this time the mother is more receptive to the advice concerning herself and the to the advice concerning herself and the baby. She must be advised for:baby. She must be advised for:

1.1. DietDiet

2.2. Personal hygienePersonal hygiene

3.3. DrugsDrugs

4.4. Warning signsWarning signs

5.5. RadiationRadiation

6.6. Childcare Childcare

Dietary adviceDietary adviceA daily intake of about 2500-2800 calories meet the A daily intake of about 2500-2800 calories meet the

total energy needs of the average pregnant woman.total energy needs of the average pregnant woman.

Wt gain is directly related to healthy and adequate dietWt gain is directly related to healthy and adequate diet Balanced and nutritious diet required is as follows: Balanced and nutritious diet required is as follows:

high protein, high roughage and rich in iron content.high protein, high roughage and rich in iron content. She is instructed to take such diet home resources She is instructed to take such diet home resources

available in the budget. She may be provided a diet available in the budget. She may be provided a diet chart keeping in mind 3G formula.chart keeping in mind 3G formula.1.1. 1G for grains e.g. chapati1G for grains e.g. chapati2.2. 2G for gram e.g. dal2G for gram e.g. dal3.3. 3G for green leafy vegetables and fruits.3G for green leafy vegetables and fruits.

Milk requirement 110 ml/dayMilk requirement 110 ml/day Water intake 2-3 lt/day, clean or boiled waterWater intake 2-3 lt/day, clean or boiled water Pictorial diet chart in regional languagePictorial diet chart in regional language

Care of minor symptoms during Care of minor symptoms during pregnancypregnancy

Morning sickness and vomitingMorning sickness and vomitingVaginal dischargeVaginal dischargeHeartburnHeartburnEdema Edema Leg crampsLeg crampsHeadacheHeadachePilesPilesCarpel tunnel syndromeCarpel tunnel syndrome

General adviceGeneral advice Personal hygiene: personal cleanliness, daily bath, rest and Personal hygiene: personal cleanliness, daily bath, rest and

sleep for 8 hrs at night and 2 hrs at middaysleep for 8 hrs at night and 2 hrs at midday Bowels: constipation should be avoidedBowels: constipation should be avoided Exercises: light house work and regular walking, ANC Exercises: light house work and regular walking, ANC

exercises as advisedexercises as advised Smoking and alcohol should be avoided Smoking and alcohol should be avoided Proper dental care Proper dental care Sexual intercourse should be avoided in last 3 monthsSexual intercourse should be avoided in last 3 months Drugs not essential should not be consumedDrugs not essential should not be consumed Avoid radiation Avoid radiation Warning signs: vaginal bleeding, swelling of feet, Warning signs: vaginal bleeding, swelling of feet,

headache, blurring of vision and fits, bleeding and leaking headache, blurring of vision and fits, bleeding and leaking in last months of pregnancy and any other unusual in last months of pregnancy and any other unusual symptoms.symptoms.

Childcare classes should be heldChildcare classes should be held Education on labor and child birth Education on labor and child birth

Contd…Contd…Lack of proper communication Lack of proper communication during ANC and non compliance during ANC and non compliance on the part of female and her on the part of female and her relatives leads to poor results. relatives leads to poor results. Therefore health worker has to Therefore health worker has to take pains to communicate health take pains to communicate health education ot pregnanct woman education ot pregnanct woman and her attendants at each visits.and her attendants at each visits.

supplementationsupplementation

Iron and folic acid 1 cap 60 mg Iron and folic acid 1 cap 60 mg elemental ironelemental iron

500 mg of folic acid500 mg of folic acid Ca 500-1000 mg with vitamin DCa 500-1000 mg with vitamin D ImmunizationImmunization

1.1. Two doses of TT 4-6 weeks apart after Two doses of TT 4-6 weeks apart after 16 weeks of pregnancy16 weeks of pregnancy

Identify high risk casesIdentify high risk cases

1.1. Elderly primigravida > 30 yearsElderly primigravida > 30 years2.2. Short strature < 140 cmShort strature < 140 cm3.3. Malpresentation, breech etc.Malpresentation, breech etc.4.4. APH, threatened abortion, repeated abortionAPH, threatened abortion, repeated abortion5.5. PET, eclampsiaPET, eclampsia6.6. AnaemiaAnaemia7.7. Twins, hydramnios, Twins, hydramnios, 8.8. Previous IUD, MRP, CSPrevious IUD, MRP, CS9.9. Elderly grand multiparaElderly grand multipara10.10. Post dated pregnancyPost dated pregnancy11.11. Pregnancy and medical problems e.g. DM, HT, TB Pregnancy and medical problems e.g. DM, HT, TB

etc.etc.

Warning signsWarning signs

Vaginal bleedingVaginal bleeding Swelling of face and fingersSwelling of face and fingers Continuous headachesContinuous headaches Dimness of visionDimness of vision Abdominal painAbdominal pain Persistent vomitingPersistent vomiting High feverHigh fever DysuriaDysuria Passage of fluid per vaginum Passage of fluid per vaginum Marked changes in fetal movement or no Marked changes in fetal movement or no

movementmovement

INTRANATAL CAREINTRANATAL CAREAim of good intranatal care is achieved by:Aim of good intranatal care is achieved by:

1.1. High asepsisHigh asepsis

2.2. Delivery with minimum trauma to the Delivery with minimum trauma to the mother and childmother and child

3.3. Readiness to deal with impending Readiness to deal with impending complication like PET, prolonged labor, complication like PET, prolonged labor, PPHPPH

4.4. Care of newborn at birth like Care of newborn at birth like resuscitation, care of cord, care of eyes resuscitation, care of cord, care of eyes etc.etc.

INTRANATAL CAREINTRANATAL CARE Every pregnant woman is educated to have Every pregnant woman is educated to have

child birth by trained birth attendantchild birth by trained birth attendant 85% pregnancies terminate into normal 85% pregnancies terminate into normal

delivery though incidence varies from place to delivery though incidence varies from place to placeplace

In India incidence of home delivery is 65% and In India incidence of home delivery is 65% and 35% hospital delivery in comparison to western 35% hospital delivery in comparison to western countries where hospital delivery is 95%countries where hospital delivery is 95%

Hospital delivery is safer and reduces maternal Hospital delivery is safer and reduces maternal and perinatal morbidity and mortalityand perinatal morbidity and mortality

Management of first stage of Management of first stage of laborlabor

1.1. Admission- MCH recordAdmission- MCH record2.2. ExaminationExamination3.3. Preparation of the patientPreparation of the patient4.4. EnemaEnema5.5. Frequent urinationFrequent urination6.6. Proper postureProper posture7.7. Food during laborFood during labor8.8. Pain relief in laborPain relief in labor

Monitoring of 1Monitoring of 1stst stage of stage of laborlabor

1.1. Vital signsVital signs2.2. Progress of laborProgress of labor3.3. Graphic recording of labor can be done Graphic recording of labor can be done 4.4. BP, Pulse, uterine contraction, descent BP, Pulse, uterine contraction, descent

of presenting part, fetal heart rate, of presenting part, fetal heart rate, leaking PVleaking PV

5.5. PV examination whenever indicatedPV examination whenever indicated6.6. Total duration of 1Total duration of 1stst stage is 19-16 hrs I stage is 19-16 hrs I

primigravida and 5-6 hrs in primigravida and 5-6 hrs in multigravidamultigravida

Monitoring of 2Monitoring of 2ndnd stage of stage of laborlabor

1.1. High asepsisHigh asepsis2.2. Delivery with minimum trauma to Delivery with minimum trauma to

the mother and childthe mother and child3.3. Readiness to deal with impending Readiness to deal with impending

complication like PET, prolonged complication like PET, prolonged labor, PPHlabor, PPH

4.4. Care of newborn at birth like Care of newborn at birth like resuscitation, care of cord, care of resuscitation, care of cord, care of eyes etc.eyes etc.

DOMICILIARY DELIVERYDOMICILIARY DELIVERYHome conditions should be satisfactoryHome conditions should be satisfactoryDelivery conducted by trained dai or Delivery conducted by trained dai or

LHVLHVAdvantages include: familiar Advantages include: familiar

surroundings, less cross infection, surroundings, less cross infection, mother can take care of other childrenmother can take care of other children

Disadvantages include: less nursing Disadvantages include: less nursing supervision, inadequate rest, place may supervision, inadequate rest, place may be unsuitable for the deliverybe unsuitable for the delivery

LHV of ANM should know when to refer LHV of ANM should know when to refer the case to the hospitalthe case to the hospital

CARE OF BABYCARE OF BABY

1.1. Cleaning airwayCleaning airway

2.2. APGAR scoreAPGAR score

3.3. Care of cordCare of cord

4.4. Care of eyesCare of eyes

5.5. Breast feedingBreast feeding

6.6. Maintenance of body temperature Maintenance of body temperature 36.5 – 37.536.5 – 37.5˚c˚c

CARE OF MOTHERCARE OF MOTHER

Objectives is to prevent postnatal Objectives is to prevent postnatal complication complication

Adequate breast feeding, child Adequate breast feeding, child immunizationimmunization

Provide family planningProvide family planning

BREAST FEEDINGBREAST FEEDING

1.1. Should be initiated in ½ hour of normal deliveryShould be initiated in ½ hour of normal delivery2.2. 4-6 hours of CS4-6 hours of CS3.3. Helps to establish bond between mother and Helps to establish bond between mother and

childchild4.4. ColostrumColostrum

Rich in proteins and other nutrientsRich in proteins and other nutrients Antibodies which provide protection to the newborn to Antibodies which provide protection to the newborn to

various diseases and diarrheavarious diseases and diarrhea

5.5. Demand feedingDemand feeding6.6. No feeding bottlesNo feeding bottles

Exclusive breast feeding for 6 monthsExclusive breast feeding for 6 months

ADVANTAGES OF BREAST ADVANTAGES OF BREAST FEEDINGFEEDING

1.1. Safe clean, cheap and readily availableSafe clean, cheap and readily available2.2. Fully meets nutritional requirement of infantFully meets nutritional requirement of infant3.3. Contains antimicrobial factor e.g. Contains antimicrobial factor e.g.

macrophages, lymphocytes, secretory IgA etc. macrophages, lymphocytes, secretory IgA etc. prevents against various infectionsprevents against various infections

4.4. Easily digested by normal premature infantsEasily digested by normal premature infants5.5. Promotes bonding between mother and child Promotes bonding between mother and child 6.6. Suckling helps in development of jaw and teethSuckling helps in development of jaw and teeth7.7. Prevents malnutrition and infant mortalityPrevents malnutrition and infant mortality8.8. Helps in spacing of child birthHelps in spacing of child birth9.9. Helps in involution of uterusHelps in involution of uterus

ARTIFICIAL FEEDINGARTIFICIAL FEEDING

Artificial feeding and weaning started Artificial feeding and weaning started at 4-5 month. Supplementary food at 4-5 month. Supplementary food like cow’s milk, cooked rice, dal, like cow’s milk, cooked rice, dal, vegetables etc. should be given.vegetables etc. should be given.

IMMUNIZATION PROGRAMIMMUNIZATION PROGRAMAt birth – BCG, OPV At birth – BCG, OPV 0dose0dose

6 weeks – 1 DPT, OPV6 weeks – 1 DPT, OPV

10 weeks – 2 DPT, 10 weeks – 2 DPT, OPVOPV

14 weeks – 3 DPT, 14 weeks – 3 DPT, OPVOPV

9 months – measles9 months – measles

16 – 24 weeks – DPT, 16 – 24 weeks – DPT, OPVOPV

5 – 6 years – DT5 – 6 years – DT

10 – 16 years - TT10 – 16 years - TT

Hepatitis B – 0 week, Hepatitis B – 0 week, 6 weeks, 6 months6 weeks, 6 months

MMR – 15 monthsMMR – 15 months

OPTIONAL OPTIONAL

TyphoidTyphoid

HepatitsHepatits

Meningitis etc.Meningitis etc.

FAMILY PLANNINGFAMILY PLANNING

Family planning refers to practices that help Family planning refers to practices that help individual or couples to attain certain individual or couples to attain certain objectives:objectives:

1.1. To avoid unwanted birthTo avoid unwanted birth

2.2. To bring about wanted birthTo bring about wanted birth

3.3. To regulate interval between pregnancyTo regulate interval between pregnancy

4.4. To determine number of children in familyTo determine number of children in family

5.5. To control the time at which birth occur in To control the time at which birth occur in relation to age of the parents.relation to age of the parents.

Indications for contraceptionIndications for contraception

1.1. To restrict family and stabilize To restrict family and stabilize populationpopulation

2.2. Medical disorders in femalesMedical disorders in females

3.3. Obstetric and gynecology Obstetric and gynecology indication indication

4.4. Eugenic and fetal conditionEugenic and fetal condition

Commonly used Commonly used contraceptivescontraceptives

1.1. Pills and injectablesPills and injectables

2.2. IUCD’sIUCD’s

3.3. Condoms and vaginal Condoms and vaginal contraceptivescontraceptives

4.4. Tubectomy (98.1%) and Tubectomy (98.1%) and vasectomy (1.99%)vasectomy (1.99%)

Preference of contraceptivesPreference of contraceptives After marriage or nulliparousAfter marriage or nulliparous

1.1. Pills or condom till pregnancy is plannedPills or condom till pregnancy is planned After 1After 1stst child birth child birthIUCDIUCD

1.1. Condom with vaginal contraceptionCondom with vaginal contraception2.2. Pills after 6 monthsPills after 6 months3.3. injectablesinjectables

After 2After 2ndnd pregnancy pregnancy1.1. IUCDIUCD

5 years after complete family5 years after complete family1.1. Tubectomy and vasectomy Tubectomy and vasectomy

ORAL PILLSORAL PILLS

combination of hormones estrogens and combination of hormones estrogens and progesterone: mostly used from 25-35 progesterone: mostly used from 25-35 years of ageyears of age

Common names: MALA-D, MALA-N, OVRAL, Common names: MALA-D, MALA-N, OVRAL, TRIQUILARTRIQUILAR

21 tabs are taken from 521 tabs are taken from 5thth -25 -25thth day with 7 day with 7 days of iron tabsdays of iron tabs

If no side effects then taken for 3-5 years If no side effects then taken for 3-5 years continuouslycontinuously

Mini pills or only progesterone pillsMini pills or only progesterone pills

MECHANISM MECHANISM

Prevents midcycle FSH and LH surge Prevents midcycle FSH and LH surge from anterior pitutary- no follicular from anterior pitutary- no follicular development therefore no ovulationdevelopment therefore no ovulation

Peripheral- cervical mucus becomes Peripheral- cervical mucus becomes less penetrableless penetrable

Endometrium becomes unreceptiveEndometrium becomes unreceptive

ABSOLUTE ABSOLUTE CONTRAINDICATIONS CONTRAINDICATIONS

1.1. Recent liver diseaseRecent liver disease

2.2. H/O any thromboembolic H/O any thromboembolic disorderdisorder

3.3. EpilepsyEpilepsy

4.4. Ca breast, cervix or uterusCa breast, cervix or uterus

5.5. Undiagnosed vaginal bleedingUndiagnosed vaginal bleeding

RELATIVE RELATIVE CONTRAINDICATIONSCONTRAINDICATIONS

1.1. MigraineMigraine

2.2. Severe allergySevere allergy

3.3. HTHT

4.4. SmokingSmoking

5.5. Woman > 35 yearsWoman > 35 years

BENEFITS OF ORAL PILLSBENEFITS OF ORAL PILLS Pills are highly effective if taken regularlyPills are highly effective if taken regularly Pregnancy rate is as low as 0.1% per 100 Pregnancy rate is as low as 0.1% per 100

woman yearwoman year Apart from contraceptive effectsApart from contraceptive effects

1.1. reduces chances of functional ovarian cystsreduces chances of functional ovarian cysts2.2. Corrects of menorrhagia and prevents anemiaCorrects of menorrhagia and prevents anemia3.3. Regularizes mensesRegularizes menses4.4. Relief of dysmenorrheaRelief of dysmenorrhea5.5. Reduces chances of ectopis pregnancyReduces chances of ectopis pregnancy6.6. Decrease chances of fibroids, fibroadenoma Decrease chances of fibroids, fibroadenoma

and fibrocystic diseases through reduction of and fibrocystic diseases through reduction of estrogen receptorsestrogen receptors

SIDE EFFECTS OF ORAL PILLSSIDE EFFECTS OF ORAL PILLS

1.1. Nausea and vomitingNausea and vomiting2.2. Breakthrough bleedingBreakthrough bleeding3.3. Pill amenorrheaPill amenorrhea4.4. LeucorrheaLeucorrhea5.5. CandidiasisCandidiasis6.6. Weight gainWeight gain7.7. HTHT8.8. Alters carbohydrate and lipid Alters carbohydrate and lipid

metabolismmetabolism

CENT CHROMAN (SAHELI)CENT CHROMAN (SAHELI)

It is a non – steroidal low estrogenic It is a non – steroidal low estrogenic compoundcompound

30 mg tab is taken twice a week for 3 30 mg tab is taken twice a week for 3 months and then weeklymonths and then weekly

Contraindication: same as pillsContraindication: same as pillsFailure rate is 4 per 100 woman yearFailure rate is 4 per 100 woman yearSide effects: delayed cycle in 8% of Side effects: delayed cycle in 8% of

cases otherwise quite safecases otherwise quite safe

LONG ACTING INJECTABLESLONG ACTING INJECTABLES

1.1. Injection of progesterone DEPO Injection of progesterone DEPO PROVERA (medroxy progesterone PROVERA (medroxy progesterone acetate) taken every 3acetate) taken every 3rdrd month month

2.2. Can be taken continuously for 3 Can be taken continuously for 3 years if no side effectsyears if no side effects

3.3. Mode of action is by suppression of Mode of action is by suppression of ovulationovulation

4.4. Main side effect- menstrual Main side effect- menstrual irregularity irregularity

HORMONE IMPLANTSHORMONE IMPLANTS

1.1. Hormone laden implants: multiple Hormone laden implants: multiple rod and single rodrod and single rod

2.2. Not easily available in IndiaNot easily available in India

IUCDIUCD

Have been in use since 1962Have been in use since 1962

First generation: Lippe’s loopFirst generation: Lippe’s loop

Second generation: Cu-T 200Second generation: Cu-T 200

Third generation: multiload Cu devise, Third generation: multiload Cu devise, hormone bearing IUCD’s like hormone bearing IUCD’s like progestasert and mirenaprogestasert and mirena

INDICATION: TO BE USED PAROUS WOMENINDICATION: TO BE USED PAROUS WOMEN

MECHANISMMECHANISM

1.1. Causes foreign body tissue reaction Causes foreign body tissue reaction in endometriumin endometrium

2.2. Copper interferes with uterine Copper interferes with uterine estrogen receptorsestrogen receptors

3.3. Increased prostaglandin liberation in Increased prostaglandin liberation in endometrium causes abnormal endometrium causes abnormal uterine activityuterine activity

4.4. Phagocytosis of sperms and Phagocytosis of sperms and blastocyteblastocyte

ABSOLUTE ABSOLUTE CONTRAINDICATIONSCONTRAINDICATIONS

1.1. Carcinoma of genital organsCarcinoma of genital organs

2.2. Infection after child birth or abortion Infection after child birth or abortion

3.3. Recent history of STD or PIDRecent history of STD or PID

4.4. Unexplained vaginal bleedingUnexplained vaginal bleeding

5.5. Distortion of uterine cavity Distortion of uterine cavity

6.6. Genital TBGenital TB

SIDE EFFECTS OF IUCDSIDE EFFECTS OF IUCD

1.1. Abnormal uterine bleedingAbnormal uterine bleeding

2.2. Pain and dyspareuniaPain and dyspareunia

3.3. InfectionsInfections

COMPLICATION OF IUCDCOMPLICATION OF IUCD

1.1. Uterine perforationUterine perforation

2.2. Expulsion Expulsion

3.3. ectopic pregnancyectopic pregnancy

FAILURE RATE OF IUCD IS 2 – 5 PER FAILURE RATE OF IUCD IS 2 – 5 PER 100 WOMAN YEAR100 WOMAN YEAR

PERMANENT PERMANENT CONTRACEPTIONCONTRACEPTION

Male sterilization Male sterilization 1.1. It is safer, easier, less expensive with low It is safer, easier, less expensive with low

failure rate 0.1-1%failure rate 0.1-1% Female sterilization Female sterilization

1.1. post partum within seven dayspost partum within seven days2.2. Interval anytime after mensesInterval anytime after menses3.3. Late post partum when uterus is fully involutedLate post partum when uterus is fully involuted4.4. At the time of CSAt the time of CS

FAILURE RATE DEPENDS ON THE METHOD OF FAILURE RATE DEPENDS ON THE METHOD OF TUBAL LIGATION. LAP STRILIZATION, TUBAL LIGATION. LAP STRILIZATION, FAILURE RATE 0.2-1-3%FAILURE RATE 0.2-1-3%

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