1. Family Planning Clifford dela Cruz Harmony Que Paula Valera

2. INTRAUTERINE DEVICES

3. Main benefits High levels of effectiveness Lack of systemic side effects Single act for long term use Does not require frequent use

4. Failure Rates Copper T 380A IUD and levonorgestrel IUD – Less than one 1% Clinician dependent – Correct insertion – Lower incidence of expulsion – Lower pregnancy rates Cumulative pregnancy rate – Copper T 380A IUD- 1.7% (12 years) – LNG-UIS -1.1% (5 years)

5. Major adverse events Pregnancy Expulsion Removal for bleeding or pain

6. More suited for older parous women who wish to prevent pregnancies

7. Types of IUDS 1960s- plastic polyethylene with barium sulfate 1970s- smaller devices 1980s- Copper IUDs were made (T380A, T220C, Multiload CU250, CU375)

8. Copper 380A is approved- 12 years effectiveness T Shaped devises – Levonorgestrel Intrauterine System (LNG IUS) 20 mg of LNG is released onto the endometrial cavity Thickens cervical mucus

9. Mechanism of Action Spermicide – Inflammatory reaction, 1000% increase of leukocytes – Phagocytosis of the sperm, impedes cell transport and viability – Hence prevents fertilization – Inflammation disappears upon removal

10. Time of Insertion Any day of the cycle Much preferred after the cycle to avoid bacterial growth

11. Adverse Effects Uterine bleeding – Copper T 380A causes 55% increase of menstrual blood loss Perforation of uterine fundus

12. Complications related to Pregnancy No evidence of congenital anomalies Increase of fetal death not increased No conclusive evidence that IUDs cause sepsis during pregnancy Ectopic pregnancy is increased to threefold if woman becomes pregnant with IUD in place Increased risk of prematurity with pregnant women with IUD in place

13. Contraindications Pregnancy or suspicion of pregnancy PID Postpartum endometritis Infected abortion Known/suspected uterine or cervical malignancy Genital bleeding Untreated acute cervicitis Previously inserted unremoved IUD

14. Overall Safety Not associated with endometrial or cervical carcinoma May be associated with reduction in risk of these neoplasms

15. STERILIZATION

16. Popular choice If the wife is older than 30 Couple has been married more than 10 years Couple does not desire to have more children

17. Male Sterilization Vasectomy – Procedure Vas deferens is isolated and cut Ends of the vas are closed either by ligation and fulguration – Complications Hematoma Sperm granulomas Spontaneous reanastomosis

18. Female Sterilization Tubal ligation – Pomeroy – Modified Irving

19. INDUCED ABORTION

20. Still not legal in the Philippines Done in selected states in the US and in some countries in Europe

21. Three principal methods – Transcervical evacuation – Induction of labor – Major operations

22. Curettage methods – Vacuum aspiration – more common in the first trimester Endometrial aspiration Dilatation of cervix – Dilatation and evacuation- more common beyond first trimester Greater amount of cervical dilatation

25. Induction of Uterine Contractions – More common in 2 nd trimester abortions – Methods Infusion of hypertonic solution in amniotic cavity Administration of prostaglandin E2 (misoprostol) Major Operations – Hysterotomy and hysterectomy

26. Pharmacologic Agents Progesterone antagonists – Examples Mifepristone – Mechanism of action High receptor affinity prevents progesterone from binding to its receptors Inhibits the action of circulating progesterone Endometrial decidua degeneration, cervical softening, promoting contractions

27. Prostaglandin analogues – Misoprostol – Binds to myometrial cells to cause contractions leading to expulsion of tissues – Also causes cervical ripening and dilatation of cervix

28. Antimetabolite – Methotrexate – Blocks dihydrofolate reductase (enzyme for DNA synthesis), inhibiting growth of rapidly dividing cells – Must be followed by a uterotonic to increase uterine contractions and expulsion of products of conception

29. Complications Infection Heavy uterine bleeding Uterine perforation Mortality < 1/100,000 Slight complications: <6 weeks or less Beyond 10 weeks: complications increase progressively with gestational age