Definition of the term Family planning

By definition the WHO, the term family planning provides those kinds of activity which have a purpose to help separate persons and married couples to achieve the certain results, namely:

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To avoid undesirable pregnancy; To bring into the world desired children; To regulate intervals between pregnancies; To choose time of a birth of the child depending on age of parents and conditions of their health; To define number of children in family.

Planning of family includes the following basic kinds of activity

Informing and consultation of the population on questions of family planning; The organization of services of family planning; Providing of the population with means of contraception; Treatment of infertility and sexual disorders; Formation of public opinion, change of developed representations about planning family as about especially medical or intrafamily problem; Increase of a level of knowledge and qualifications on the given problem not only obstetricians-gynecologists, but also doctors of other specialities, medical workers of an middle link, first of all midwifes; Deepening and expansion of work on sexual education of children and teenagers, preparation of teachers and parents on questions of sexual development of children; Attraction of mass media to illumination of problems of the family planning, sexual culture, family relations; Increase of availability and quality of medical services in service of family planning.

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The main purpose of planning of family - to help men and women to win one of basic freedom and a fundamental law of the person - to plan family, to make the free decision on number of children and intervals between their birth

The history of female and man's contraception

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leaves in an antiquity. Rudiments almost all modern means and methods of prophylaxis of pregnancy and interruption of already come pregnancy took place many centuries back.

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The African nationalities nandy and Indians of the South America for many centuries B.C. used abstention from sexual acts in certain days of menstrual cycle for the pregnancy prevention. This method of contraception presently name calendar

IIn ancient times a chemical method applied for prophylaxis of undesirable pregnancy. With that end in view women before sexual act entered into a vagina of substance which killed spermatozoids. So, in the Egyptian papyrus the preparation recipe vaginal tampon consisting of a clap, crocodile feces and honey is described. Feces of crocodile has sour reaction in which spermatozoids perish, and honey, having a sticky consistence, complicates penetration spermatozoids from a vagina into a uterine cervix. In ancient Egypt for contraception of the woman used the tampons impregnated with broth of an acacia and honey. Women of Ancient India applied vaginal tampons made from the acacia leaves and elephant feces for the pregnancy prevention. At a fermentation of these components dairy acid which causes spermatozoids destruction is formed. The Arabian women warned conception by introduction in a vagina of tampons with feces hoofed animals, cabbage, ear sulphur and some other substances. Antique Egyptians as tampons used the sea sponges impregnated with vinegar.

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In the Middle Ages women of Europe with the same purpose applied tampons from cotton wool and the papers impregnated with acetic acid. In Ancient China as contraceptive and abortive means there were used a mix of vegetable oil and mercury which entered into a vagina. Chinese women for contraception entered in a vagina mixes from pitch of a cedar, alum and a garnet apple. The wellknown Casanova (1725-1798y) in the biography described various methods of pregnancy prophylaxis, including introduction of a segment of a lemon in a vagina of the woman at once after sexual acts. In the beginning of XIX century R.Gjunter published a number of articles, in which described results of researches of influence of 101st name of various chemical substances (acid, alkali, alcaloids and others) on survival rate spermatozoids. It were the first proceedings about chemical methods of female contraception. Such substances name presently spermizids. Presently these methods of contraception in the changed kind concern chemical methods of pregnancy prophylaxis.

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In America American Indian women even before occurrence of the Spanish colonizers and other natives of Europe for the purpose of contraception applied vaginal washing after sexual act by broth from mahogany and a lemon. In ancient times in many countries the pregnancy prevention was reached by washing of a vagina after sexual act by an extract or broth of willow sheet, a juniper, an aloe, lavenders, parsley, marjoram, pineapple and other plants. Aristotle and Hippocrat recommended to women for removal of sperm from a vagina syringing by own urine. Prophylaxis of pregnancy by washing of a vagina by broths and infusions of plants and solutions of various chemical substances is carried presently to mechanical methods by contraceptions.

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Surgical methods of contraception are known for a long time too. Primitive tribes of natives of Australia and Java made surgical sterilisation of women by amputation of a cervix of a uterus with a stone knife. Sterilisation of men was reached by a cut deferent (seminiferous) canal. In the same tribes to avoid the birth of the undesirable child, on late terms of pregnancy abortion by rupture of fetal membranes was made. Ancient Egyptians spent surgical sterilisation of women by destruction of ovary by a thin wooden stick.

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The condom also is the invention of far times. Written data on it are found out in the Egyptian sources concerning by 1350 BC. It there was a condom from a skin of fish. In a tomb of Egyptian Pharaoh Tutanhamon (about 14001392 BC) there was a condom of reusable using which is now stored in the Egyptian national museum. Ancient Arabs used a prototype of the modern condom made from guts of pets. During same time Japanese used a similar product which was made from the most thin skin, guts or a horn.

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Intrauterine methods of contraception are the invention of thousand-year prescription. Before a far jump ancient nomads of the Near East entered into a uterus cavity of female camels small round stones. In Ancient China for the pregnancy prevention in a cavity of a uterus of the woman entered various substances. In Japan "kiotan" was used which was made from a thin skin and entered into the cervical canal of a uterus.

The historical traditions, serving to reduction fertility

The traditions stimulated breast feeding. Traditions of abstinence application : - Virginity till a marriage; - Circumcision of women; - Legitimation of elderly age for a marriage; - Postnatal abstinence; - Polygamous connections; - Abstinence of women after their children became parents. - Use mechanical, spermocidal systemic drugs protecting from pregnancy. The traditions resulting to infertility: Prostitution; Castration of men. Traditions of killing of pregnant women or the women having illegitimate sexual connections.

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Modern arsenal of contraceptive technologies

Combined oral contraceptives; Only progestin tablets; Implants, injective contraceptives; Voluntary female sterilization; Voluntary man's sterilization (vasectomy); Condoms; IUC; Spermocids and barrier methods of contraception; diaphragms and cervical caps; Natural methods of family planning; Method of lactational amenorrhea; The interrupted coitus; Abstinence (periodic sexual abstention); Postcoitus contraception; Abortion.

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Two estimation approaches of probability of pregnancy

Efficiency at usual use - typical or average probability of pregnancy for all users irrespective, whether they apply a method correctly and regular ; Efficiency at constant and correct use of the method.

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Consultation helps our patients to make and carry out the own choice concerning reproductive health and planning of family Choice of a method of planning of family and its application - process stage-by-stage. It includes studying situations, weighing pro and contra, decision-making and their realization. It will consist of 6 steps: Affability first of About what it is necessary to ask the patient Methods of contraception About a choice of a method The main thing - to explain how to use a method The information about repeated visit.
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What is mean the Realized choice ?

The realized choice means acceptance by the person of the independent, thought over decision on the basis of the objective information. To help the patients to make the realized choice concerning their reproductive health and a method of planning of family - one of the important purposes of consultation.

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 All combined C include estrogens and progestagens. In the majority modern C as an estrogen it is used ethynylestradiolum though the some one contain mestranolum.

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Modern C it is possible to divide into two groups: combined and unicomponent (mini-pili).
In turn among combined C there are distinguished one, two and three-phase. I. Monophase C Marvelon Femoden Logest Ganin Jarina Minisiston Microginon Ovidon II. Biphase C Anteovin Femoston III. Three-phase C Three - regol Threecvilar Threesiston

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The action mechanism of C

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Suppress ovulation. Condense cervical mucous, interfering with penetration of spermatozoids. Change endometrium, reducing probability of implantation. Reduce movement of spermatozoids in the top sexual path (Fallopian tubes).

Advantages of C
High efficiency at daily reception (0,1-0,8 pregnancies on 100 women within first year of use). Term of application of low-dosed COC (35 mkg EE and less) is not limited.

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Combined oral contraceptives (COC):

Promote reduction menstrual bleeding (shorter and less plentiful menses). Reduce menstrual pains. Promote decrease an anemia. Promote an establishment regular menstrual cycle. Reduce risk of development of a ovarian and endometrial cancer. Reduce risk of development of benign tumours of breasts and ovarian cysts. Protect from ectopic pregnancy. Reduce risk of development of some inflammatory processes of small pelvic organs.

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Lacks of COC:
The constant desire to be protected (motivation) and daily reception is required. Some nausea, dizziness, insignificant painful breasts, headache, and also slightly bleeding discharge (usually pass after 2-3 cycles) are possible The delay of restoration of fertility after the discontinuance of reception is possible. Serious complications (a heart attack, an insult, blood clots in pulmonary or a brain, a liver tumor) are possible, though and it is rare. Short-term changes of psychoemotion background (mood, libido) and slightly alteration of bodyweight are possible. Nowadays oral contraceptives of the third generation are widely used.
New progestins do not reduce risk of infringements of brain blood circulation at an equal dosage of estrogens.

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Who should not use COC

Pregnant women (the established or suspected pregnancy). Nursing women (milk amount decreases). The women having inexplicable vaginal bleedings (up to an establishment of their reason). Women with active disease of a liver (virus hepatites). Smoking women are older than 35 years. The women having a heart attack, insult or increased AP (> 180/110) in the anamnesis. The women having infringements of blood coagulation or complicated current of a diabetes in the anamnesis. Women having breasts cancer. Women with migraines and local neurologic symptoms.

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When to begin application of COC

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From 1-st till 7-th day of menstrual cycle After 3 weeks after labor if the woman does not nurse After abortion (at once or within 7 days) If there is a firm confidence, that the patient is not pregnantin any day of menstrual cycle

Only progestin tablets (OP)

Exslutonum The mechanism of action
Condense cervical mucous, interfering with penetration of spermatozoids Change endometrium, complicating implantation Reduce movement of spermanozoids in the top sexual path (Fallopian tubes) Suppress ovulation

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Advantages
There are effective, if they are accepted at a time every day (0,5 pregnancies on 100 women within the first year of use) Method does not influence breast feeding (does not influence milk amount and quality) Immediate restoration of fertility after the discontinuance of reception It is not enough by-effects Term of application is not limited

Lacks
Cause changes in character of menstrual bleedings almost at all women (irregular bleedings / slightly discharge at early stages) Some increase or loss of body weight is possible Constant desire to be protected (motivation) and daily reception is required Method does not protect from STI and others STD (for example, VHB, AIDS)

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As against the COC, OP can be applied:

Noursering mothers requiring for contraception Smoking women (irrespective of age and quantity smoked cigarettes in day)

Women who have recently transferred insult should avoid use OP

When to begin application OP

On the 1-st day of menstrual cycle On any day of menstrual cycle if there is a firm confidence, that the patient is not pregnant After labor: Later 6 months if the woman uses L Later 6 weeks if she nurses, but do not use L At once or within 6 weeks if not nurses After abortion (at once)

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Injective contraceptives (IC, CIC)

Injective method of contraception is applied by more than 18 million women all over the world. Into structure IK enter progestagens prolonged action - depot - medroxiprogesteronum acetate (DMPA) - Depot - Provera and combined - an estrogen progestin injective contraceptives (CIC) - Cyclofem and Mesigyna

The mechanism of action IC and CIC

Suppress ovulation (inhibited influence on hypothalamo- pituitary system) Change physical and chemical properties of cervical mucousl (its viscosity and fibration raises), interfering penetration od spermatozoids Break a level of enzymes answering" for process of fertilisation Promote transformations in endometrium, interfering implantation Reduce movement of spermatozoids in the top sexual path.
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Common side effects DMF (disorder of menstrual function)(it is especial in the first months of contraception) Galactorrhoea Dizziness, headache, weariness Irritability Depression Increase of body weight Reduction libido

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Advantages
Contraceptive High efficiency (0,1-0,4 pregnancies on 100 women within the first year of use) Not contraceptive Promote reduction of menstrual bleedings (shorter and less plentiful menses) Reduce menstrual pains Reduce risk of development of an ovarian and endometrial cancer Reduce risk of development of benign tumours of breasts and ovarian cysts Protect from ectopic pregnancy

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Guarding attributes for users IC and CIC

Delay menses after several months of regular cycles (can be an attribute of pregnancy) Strong pains in the lower part of abdomen (can be an attribute of ectopic pregnancy) Strong (in 2 times is longer or in 2 times more usual) or long (> than 8 days) a bleeding Pus or bleeding from a place of an injection Migraines (vascular headache), repeated extremely strong headache or vision reduction

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Implants
Only progestin implants - Norplant - six thin bending capsules, filled by levonorgestrel (LNG) which are implanted to the woman under a skin of a forearm.

Action mechanism
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Condense cervical mucous, interfering with penetration of spermatozoids Change endometrium, complicating implantation Reduce movement of spermatozoids in the top sexual path (Fallopian tubes).

Advantages
High efficiency (0,2-1,0 pregnancies on 100 women within the first year of use) Immediate effect (<24 hours) Long validity (till 5 years) Immediate restoration of fertilisation after extraction of capsules It is not enough by-effects Capsules do not contain an estrogen
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Lacks
Cause changes in character of menstrual bleedings almost at all women (irregular bleedings / slightly discharge at early stages) Insignificant increase or loss of body weight is possible Woman cannot stop use of a method as soon as she will wish that The method does not protect from STI

When to begin application of implants

After 1-st till 7-th day of menstrual cycle After labor: Later 6 months if the woman uses L Later 6 weeks if she nurses, but do not use L At once or within 6 weeks if not nurses After abortion - at once, or within 7 days If there is a firm confidence, that the patient is not pregnant-on any day of menstrual cycle

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Intrauterine device
Allocating copper Copper 380, Nova , Multiload 375 Allocating progestin Progestasert , Mirena

Action mechanism
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Influence ability spermatozoids to pass through uterine cavity (copper) Influence reproductive process before ovicell will achieve uterine cavity (copper) Condense cervical mucous (progestin) Change a condition of endometrium (progestin)

Advantages IUD
Contraceptive High efficiency (0,5-1,0 pegancies on 100 women within the first year of use Copper T 380A) Long validity (till 10 years for IUD Copper T 380A) Immediate restoration of fertilisation after removal IUD Not contraceptive Reduce menstrual pains (only progestin) Reduce menstrual bleeding (only progestin)

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Lacks IUD
Intensifying menstrual bleedings and pains on the first some months (only for copper IUD) It is possible spontaneous expulsion IUD Seldom (<1/1000 cases) happen perforation of a uterus during introduction IUD IUD can increase risk of extrauterine pregnancy and development IDPO with the subsequent infertility at the women who are included in group of risk of infection STI and others STD

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Who should not use IUD

Pregnant women (the established or suspected pregnancy) Women with inexplicable vaginal bleedings (up to an establishment of their reason) Women with an active infection of sexual ways (vaginitis, cervicitis) Women, recently (within last 3 months) transferred IDPO or septic abortion Women with congenital anomalies of a uterus or benign tumours (leuomyoma) of a uterus which considerably deform its cavity Women with illness of heart valves in an active phase Women with malignant trophoblastic tumour Women with established pelvic tuberculosis The women having a cancer of genitals The women subject to risk of infection STI (having more than one sexual partner or whose partner has more than one sexual partner)

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When to introduce IUD

On any day of menstrual cycle if there is a firm confidence, that the patient is not pregnant With 1-st till 7-th day of menstrual cycle After labor: Right after labor; At the first 48 hours or later 4-6 weeks - only IUD Copper 380; Later 6 months if the woman uses L After abortion - at once or within 7 days if there are no attributes of an infection of pelvic organs

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Barrier methods of contraception and spermicides

Barrier methods of contraception can be determined as protection from undesirable pregnancy by an obstacle to hit of sperm in a vagina or in cervix of the uterus in the chemical either mechanical way, or a combination of both.

Man's" method: Condom "Female" methods: Diaphragm; Cervical contraceptive cap; Female condom; Spermicide foam; Spermicide suppositories and foamed tablets; Spermicide pastes and gels Spongs.

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Action mechanism
Prevent hit of sperm in a female reproductive path Prevent transfer of microorganisms causing STI and others STD, causing VHB and AIDS, from one partner to another (only latex and vinylic condoms)

Advantages 1
Contraceptive Immediate effect Do not influence breast feeding Can be used as a safety method in parallel with other contraceptives There is no risk connected to a method for health There are no system by-effects Are widely accessible (in drugstores and nonmedical institutions) Are sold without the recipe It is not required medical survey before the beginning of use Inexpensive method (for short term)

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Advantages - 2
Not contraceptive Promote involving of the man into planning family Unique method of planning of the family, providing protection from STI and others STD (only latex and vinilic condoms) Can extend the period up to ejaculation Can promote decrease in risk of development of a cancer of cervix of a uterus Can be used at treatment immunologic forms of infertility (within 36 months) for prevention of hit of sperm antigenes in a vagina Can be used at occurrence at the woman of allergic reactions to a seed liquid and-or spermatozoids Can be used for improvement erection at patients after operations on abdominal organs (the ring of a condom carries out a role weak band).

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Diaphragms
Contraceptive action of a diaphragm is determined in part by its barrier function interfering hit of sperm in cervix of a uterus, and in part its function as tank of spermizid. Presence of spermizid agent in a dome of a diaphragm has great value for achievement of the maximal contraceptive action.

Types
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Diaphragms differ among themselves on the size which is defined by diameter of circle in millimeters, and are four basic kinds depending on features of a structure of circle: Diaphragm with circle with a flat spring; Diaphragm with a spiral spring; Diaphragm with arcuate spring; Diaphragm with circle as the crosspiece.

Cervical caps
Now there are three types contraceptive caps: going deep hollow cap with circle (frequently named simply cervical cap), cap Vimule and dome-shaped cap. They are made from latex gum. In the majority of the countries they have no wide application.
FAMILY PLANNING

Action mechanism
Prevent hit of sperm in the top reproductive path of the woman (a uterus and Fallopian tubes) and serves as capacity for spermizid. Average efficiency - 6-18 pregnancies on 100 women within the first year of use if they are applied together with spermizid

By-effects
Allergic reactions to gum or on spermizid substance; spermizid substance can cause irritation of skin and a mucous membrane in the woman or her partner If a diaphragm or cap remain in a vagina too for a long time plentiful fetid discharge appears (it can take place in any case when there is an alien body in a vagina for a long time) If the diaphragm has been washed badly out and dried before a reuse, candidous colpitis can develop (some women prefer to have two diaphragms that each of them had time to dry out after use) As a result of pressure by diaphragm circle on urethra relapsing cystitis can develop Cases of development of a toxic shock syndrome is marked a both at menstruated, and at nonmenstruated women using a diaphragm. The relationship of cause and effect between application of diaphragms and development of a toxic shock syndrome is not established. However it is recommended to not leave a diaphragm or cap in a vagina more than 24 hours

FAMILY PLANNING

Who can use a diaphragm and cap

Women who prefer to not use or should not use hormonal methods (for example, smoking women older than 35 years) Women, wishing to have protection from STI and others STD which partners do not want to use condoms Pairs having the rare sexual relations Pairs in which any of partners has more than one sexual partner (the raised risk of infection STI and others STD) even if thus other method of contraception is used

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Who should not use a diaphragm and cap

Women, whose age, number of deliveries in the anamnesis or problems with health do pregnancy extremely dangerous (help to choose a highly effective method) Women with repeated infections urinary ways (IUW) Women having metroptosis (ptosis of a uterus in a vagina) Women with serious cystocele and rectocele (bulging walls of a bladder or a rectum in a vagina) Women with a toxic shock syndrome in the anamnesis Women with vaginal stenosis (narrowing of vaginal canal) Women with genital anomalies

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SPERMICIDS
Spermicids are chemical substances, inactivated or killing spermatozoids in a vagina before they have time to penetrate into the top departments of a sexual path. Into structure of modern spermicids two components enters, as a rule: spermodamaged chemical substances and the basis (carrying agent).
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Action mechanism
Spermicidal substances used almost in all available now spermicids, represent surfactant - superficially active substances which destroy cellular membranes of spermatozoids. Role of the carrier which is included in spermicidal drugs - to provide a dispersion of the chemical agent in a vagina by covering of cervix of the uterus and its keeping on a place so that any spermatozoid has not avoided contact with spermicidal component.

As a rule, spermicides are differed as the carrier included in their structure and are issued as:
Aerosols (foams) Pastes Gels (cream) Vaginal foamed tablets Vaginal foamed suppositories Soluble suppositories Soluble films Substance used for greasing of condoms Sponges

FAMILY PLANNING

Syringing by spermicides after coitus is not a reliable contraceptive method as does not exclude an opportunity of penetration spermatozoids in cervical canal (in a time interval between ejaculation and syringing)

Principles of a choice
Aerosols (foams) are effective right after introduction. Aerosols are recommended when spermicid is applied separately (without other method of contraception). Foamed vaginal tablets and suppositories are convenient at storage and transportation, but demand 15-minute expectation after their introduction up to the sexual act. Dissolved vaginal suppositories is also necessary to enter 10-15 minutes prior to the sexual act. Sperimicidal jelly are usually used only in a combination to a diaphragm.

FAMILY PLANNING

Lacks of spermicids means

Average efficiency - 3-21 pregnancies on 100 women within the first year of use Woman should enter a contraceptive 10-15 minutes prior to the sexual act (vaginal foamed tablets, suppositories and a film) Each introduction is effective only within 1-2 hours

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Method of lactate amenorrhea (L)

Method of lactate amenorrhea (L) is use of breast feeding refers to as a method as a method of protection from pregnancy. It is based on physiological effect which renders sucking by the child of a of mothers breast on suppression ovulation. Duration of anovulation varies from 4 till 24 months after labor though at some women an ovulation is restored on the second month of the postnatal period. The data of scientific researches show, that even after restoration menstrualsimilar discharge a frequency of approach of pregnancy at feeding women is lower, than among the women who stopped breast feeding.

FAMILY PLANNING

For maintenance of effective protection against undesirable pregnancy it is necessary:

Extremely breast feeding; Amenorrhea; After labor passed no more than 6 months.

action mechanism
Suppresses ovulation

Advantages
It is effective (1-2 pregnancies on 100 women within the first 6 months of use) Absence of system by-effects Not contraceptive For the child: Passive immunization (transfer of protective antibodies) The best source of nutrients Reduction of contact to infectious microorganisms of water, other milk or a children's feed, and also kitchen utensils For mother: Reduction postnatal hemorrhage

FAMILY PLANNING

Lacks L
Possesses high efficiency only before renewal menses or no more than 6 months Does not protect from STI and others STD (including VH, AIDS)
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Who should not use L

Women at whom menses renewed Women who do not have breast feeding exclusively (or nearly so extremely) Women who have the child 6 months of age

Natural planning of family (NPF)

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Natural methods of family planning are based on supervision over physiological attributes of fertility (an opportunity of fertilisation) and unfertility (when fertilisation is improbable) during phases of menstrual cycle.

Efficiency of a method
Now a natural method of contraception is used about 5-8 % of pairs. The parameter of contraceptive failure (frequency of approach of pregnancy at regular use of a method) leaves much to be desired. Actually pregnancy comes in 20% of cases of typical application of a method. Among ideal users this parameter can make 2% only at postovulative application of a method, at use of a symptomthermal method the parameter of "failures" achieves 6%, an ovulative method - 8%, and application of a calendar method results to pregnancy at 10% of cases. FAMILY PLANNING

The factors determining efficiency:

Desire of pair to apply the given method of contraception; Correct use of a method periodic abstinention or other ways of contraception at days of fertile period; Corresponding training and knowledge of the given method of contraception; Regularity of menstrual cycle.

Advantages NPF
Contraceptive It is possible to use both for prevention, and for approach of pregnancy Absence of the risk connected to a method for health Absence of system by-effects Does not demand monetary expenses Not contraceptive Enables the woman of deeper understanding of physiology of the organism, reproductive system and menstrual cycle Promotes involving the man in planning family Promotes an establishment more close matrimonial relations It is used for diagnostics and treatment of infertility and premenstrual syndrome

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Lacks NPF
- Average efficiency (9-20 pregnancies on 100 women within the first year of use) - Detailed training for correct use of the most effective methods NPF is required - Presence of specially prepared worker is required - Abstention during time fertile phases for avoidance of conception is necessary - Daily conducting records is required - Presence of vaginal infection can complicate interpretation of cervical slime - Presence of rectal thermometer for some methods is necessary - Does not protect from STI and others STD (for example, VH, AIDS)

FAMILY PLANNING

Who should not use NFP

Women, whose age, number of labors at anamnesis or whose state of health make pregnancy extremely dangerous Women with unsteady menstrual cycle (nursing, right after abortion) Women with irregular menstrual cycle (only for a calendar method) Women whose partners do not wish to abstain from the sexual relations on the certain days of a cycle Women who do not wish to use this method on personal motives

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NFP methods
Calendar (or rhythmic); Rectal temperature method; Cervical slime method; Symtothermal.

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Voluntary sterilization
Voluntary surgical sterilization of women
The majority of the data of the different countries specify, that death rate at carrying out of surgical sterilization makes approximately 10 cases on 100000 procedures that speaks about its relative safety. VSS is much more safe, than not desired or representing threat for health pregnancy. The skilled surgeon and the medical personnel should carry out procedure of sterilization. For it presence of the corresponding equipment and medical maintenance is necessary.

FAMILY PLANNING

Tubal occlusion
Tubal occlusion is a surgical blocking passableness of tubes with the purpose of hindrance to junction spermatozoid and ovum, i.e. to fertilisation. Tubal occlusion is a method of the permanent termination of female reproductive function

Advantages of tubal occlusion

Contraceptive High efficiency (0,2-4 pregnancies on 100 women within the first year of use) Approaches patients for which health pregnancy represents serious danger Absence of long-term by-effects Does not change sexual function (does not influence on produce of ovarian hormones) Not contraceptive Reduces risk of development of ovarian cancer

FAMILY PLANNING

Lacks of tubal occlusion

The method is irreversible The patient subsequently can regret for the decision Small risk of complications (the risk grows at use of the general anesthesia) Short-term a discomfort / pain after operation The qualified doctor (the gynecologist or the surgeon for a laparoscopy) is required Necessity of application of the expensive equipment Does not protect from STI and others STD (for example, VHS, AIDS)

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The general provisions concerning patients

The patient has the right to change the decision at any moment before procedure. The patient cannot be induced any ways to consent to voluntary sterilization (VS). The patient should write the application or sign the standard form of the voluntary consent to procedure prior to the beginning of operation. The consent of the spouse is not an obligatory condition. Without dependence from where and when and in what conditions voluntary sterilization is carried out, it is necessary to provide the same level of consultation and the subsequent supervision and also to observe all recommended measures on preventive maintenance of infections, as in case of visiting by the patient of stationary medical institution.

FAMILY PLANNING

Who should not use tubal occlusion

Women who are pregnant (the established or suspected pregnancy) Women with inexplicable vaginal bleedings (up to an establishment of their reason) Women with sharp pelvic or a system infection (before the infection will be cured or taken under the control) Women who cannot transfer surgical operations Women who are not sure in the intentions be relative fecundity in the future Women who do not give the voluntary realized consent to procedure

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When to perform operation of tubal occlusion

In any day of menstrual cycle if firm confidence, that the patient is not pregnant. From 6-th till 13-th day of menstrual cycle (the proliferative phase is more preferable). After labor: - minilaparotomy - on the first 2 days or later 6 weeks; - laparoscopy - does not approach for women after labor. After abortion: 1-st trimester - at once or within 7 days if there are no attributes of an infection of pelvic organs (minilaparotomy or a laparoscopy); 2-nd trimester - at once or within 7 days if there are no attributes of an infection of pelvic organs (only minilaparotomy).

FAMILY PLANNING

Voluntary surgical sterilisation of men (vasectomy)

Vasectomy is the man's voluntary sterilization (VS) which is carried out by a standard method (one or two small sections) or nonscalpeling technology (a preferable method).

Action mechanism
FAMILY PLANNING
After blocking of deferent duct (vas deferens) spermatozoids are absent in ejaculate.

Advantages
Contraceptive High efficiency (0,1-0,15 pregnancies on 100 women within the first year of use) Constant method

Lacks of vasectomy
- The method is irreversible - The patient can regret for the decision subsequently - Delay of efficiency (application of other method of contraception during till 3 months or 20 ejaculates after operation is required) - Risk and the possible by-effects connected to operation, it is especial at use of the general anesthesia - Short-term pain / discomfort after procedure - It is required the qualified medical attendant - Does not protect from STI and others STD (for example, VHS, AIDS)

FAMILY PLANNING

Who can use vasectomy

Men of any age Men who want to use a constant highly effective method of contraception Men for which spouse pregnancy represents serious health hazard because of their age, numbers of labors in anamnesis or problems with health Men who voluntary give the realized consent to procedure Men who are sure, that they have achieved the desirable size of family

FAMILY PLANNING

Urgent (postcoital) contraception

It should be used after the unprotected sexual act in the event that pregnancy is not planned or is undesirable.

Effectiveness of method
It is high enough and achieves 96% if from the moment of the "unprotected" sexual act has passed no more than 72 hours.

FAMILY PLANNING

Kinds
Combined estrogen - progestagen OC Geatagens Danasolum Mifepristonum (Ru-486) Intrauterine device

Advantages
All kinds are very efficient (less 3% failure). IUD also provides long contraceptive protection.

Lacks
COC are effective only in the event that the first doze is accepted within 72 hours after the unprotected sexual act. COC can make a sick, vomiting or painful breasts. First doze CPT (clean progestin tab) should be accepted within 48 hours after the sexual act, however they to a lesser degree make a sick and painful breasts. Antiprogestins are effective only in the event that are accepted within 72 hours after the unprotected sexual act. Now they expensive and are available on sale only in some countries. IUD effectively only when it is entered within 5 days after the unprotected sexual act. Introduction IUD is small procedure which is carried out trained medical person and should not be carried out to the women subject to risk of infection STI and others STD (such as VSH and AIDS).

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Who can use urgent contraception

Patients who need immediate protection against pregnancy (for example, after the unplanned, unprotected sexual act if the condom has torn or has leaked, after rape)
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Who cannot use urgent contraception

Women who are pregnant or at which presence of pregnancy is suspected

Teenagers should be recommended the following methods of contraception

Calendar - abstention 3 days up to and within 3-4 days after ovulation Barrier method - man's and female condoms, vaginal diaphragms, cervical caps, spermizids. Hormonal contraceptives can be recommended only if: Gynecologic age of 12 years (menarche age + 2 years); Regular monthly; Height of 160 cm; Absence of superfluous weight of a body; Presumably - Janin, Jarina. Spermizids Suppositories - Patenten Oval - foaming candles (nonoxynol-9) for 10 minutes.

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THANK FOR ATTANTION

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