Overview of hormonal contraception
prgesterone implamts and POP decresases the risk of seizures
oestrogen is contraindicated in sezirues because of enzyme interaction
But ocp isnt contraindiacted in seizrues and in sickle cell anemia
but if used then HIGHHH dose oestrogen will have to be used
better to use progesterone only
but why does it lead to failure in contraception when its mainly prjgesteron ethats to give the contraceptive effect and oestrogen is just to prevent breathough bleeding.
maybe both helps in contraception simultanoeusly but if porgesterone but if oestrogen isnt there then high dose progesterone is needed.
but leads to breakthough bleeding thaat oesstrogen might have prevented happening
the implants and injections is not or is? prefeered in adolesecnrt and premananuapasual age because of its bone activity.
breakthought bleeding and the delay to reach fertility is the maintwo reasons why women hesitate to use this
progesert is no longer available. it has completely been replaced by mirena.
why is iucd contradinicated between 48 hours and six weeks after delivery? Because risk of infection?
puerperal sepsis means genital infextion after delivery
Emergency contraception
the 2nd method can be used but high oestrogen levels lead to GI effects so not preferred. the first one has minimal GI effects.
the last one is a small dose of mifepristone and not available clinically yet
delaying ovulation so sperms will die by the tim eshe ovulates but what if ovulation has happen already?? and the ovum can live for 24 hours !! Then it has other mechanism of action. its high dose of progesterone anyway. but it doesnt prevent implantation?
Long acting reversible contraception
After molar pregnancy must use contraceotion because following up for GTN using bhcglevels which can get convulated if theres a pregnancy - so must use a contraceotion method and CutT is contraindicated here,
malignancy and anatomy and and infection
past history of ectopic is not a C/I
for people with high risk of stds like hiv and sex workers and iv drug users use a combination method...condom is ideal because prevents stds but use a combination method because condom has high faiure rate.
Cut t complications ⇒ infection, perforation, spontanous expulsion
If thread canot be seen or felt then 1.P/S examintion and see whether its still there and covered by mucous 2. use a cytocrush to sweap ti see whether its coiled inside 3. ultra sound.
Thread is used to see whether its in its place and 2 its used to pull out cuT
Process to insert and pull out the cutT?
If cuT hook removal fails then must go for a hysteroscopic removal.
X ray with sound was used reviously where the sound was used in refrence to see whether the cuT was still inside or not.
They ask the next step, not the best step.
sometimes mirena leads to amenorrhea
Mirena can be used for 1. contraception 2 tx for aub 3. hrt endometrium
for contraception used for 5 years. but for aub, 7 to 10 years.
Most effective contraceotion is mirena which is more effective than LRT even.
Hormonal contraception MOA ⇒ preventiong of fertilizatiion vs prevention of implantation.
mirena doesnt prevent ovulation unlike the njections and implants. it acts only locally. so less systemic effects but doesnt prevent ovulation or fertilization.
It doesnt act centrally and depressed the hypothalamus and the pituitary as oppsed to the injection and implants/
OCP could also have been chosen but hhypertensive so didnt choose.
Tubal sterilization and contraception during lactation
RECANALISATION CAN BE DONE BUT WOMEN SHOUDNT BE CONSELLED AS SUCH BECAUSE IT would lead to taking it lightly and requesting more reversals
Although it can be done under LA should ideally be done under GA. Accepted to only be done under GA.
Can use one port as well..and have the intruments through the camera port.
The abdomen needs to be distended with gas to cause a pneumoperitoneum. so can easily see.
to identify the tubes precisely can 1, trace back from the fimbriae but sometimes its obtsructed by omentum or soemthing so in that case 2, use the relationships to determine which is which Anterior RL, middle FT and post OL.
In india they use the ring applicator and the ring mainly and not any clips. There are several other clips that can be used
Most popular methods are the pomeroys and modefied pomeroys method. Both involved cutting off a part of the tube and to e 100% sure you can sedn the tube for HPE to confirm its a tube and to find out any pathology.
in polmeroys its cut in one slice but in the modifed one, its cut in 2 sides. so less failure rate.
lapocopy has higher failure rate because 1 clipping and ringing isnt as good and 2 mistake due to misidentifcation
after pregnancy the fundus is just below the umbilicus and then contracts a lot
cant d laporscopr after delivery because uterus covers is .... so will do a mini laportomy. that is after a vaginal delivery. IT can be done under local anethesia,
but if doing ceasarian then can do sterilisation during the ceasarian itself!!!
preferred is by laporoscopy but if dont have then can do interval sterilization by mini laportomy as well
but instead of 2 fb below the ubilicus, its 2fb above the pubic syphysis
unipolar cautery is where you burn the tube with one end...and the damage is extensive as the burn spread to adjacent tissue...
bipolar cautery is where theres two poles and you place it on either side of the pole and it only burns the region between the poles...so less damage
so unipolr cautery is the most damage > bipolar cautery > pomeroys modified > pomerouys >falope ring > clips.
Sp its in the above order, the least chance of failure rate. However the most chance of success of reversal is the oppsite of the above order.
the possibility of reversal is why we ont favour the cautery method anymore....and why we clip the isthmus anc not the ampulla as then the anastomses will be between varying diameters.
but when counselling mst say permanent because musnt take it lightly and reversal has just a 40% sucess rate.
varying forms of anesthisa. from iv sedation to injection sedation to local infiltration to regional to general.
s and e dont need anetshia just iv sedation...but if we are doing it with TL then can do under GA for laporcopy.
not done a lot. but the devise is essure
Contraception during lactation
Rule of 3s work for how well natural contraceotion works for after delivery. with and without breast feeding.
Rule of six is for when to use ocp after delivery. with and without breast feeding.
OCP cannnot be used before that because 1. it interfers with breast milk rpoduction and 2. it increses the thromboembolic state when pregancy itself is a high risk state.
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