EMERGENCY CONTRACEPTIONand SURGICAL STERILIZATION

Dr feda thekr allah Done by :shaden haddad

Emergency contraception Emergency contraception prevents pregnancy

after unprotected intercourse or in case of contraceptive failure(it doesn’t prevent implantation)

Used only if woman is not pregnant from previous intercourse

No evidence to harm patient if pregnant 2 types :• Emergency contraceptive pills(postcoital or

morning after pills)• Emergency IUD insertion

Emergency contraceptive pills

Contains high dose of progesterone and estrogen or progesterone alone (plan B)

Ist dose taken within 72 hours of unprotected vaginal intercourse

Given with antiemetic It inhibits ovulation, interferes with fertilization and tubal

transportation , prevents implantation ,causes regression of corpus leuteum but it doesn’t cause abortion

A single dose of plan B has higher efficacy and lower side effects

Side effects :nausea ,vomiting, dizziness, breast tenderness (due to high dose of estrogen in pills)

Contraindicated in patients with history of stroke , heart disease , DVT and PE.

Disadvantages: short window period ,not used for long term contraception

Emergency IUD insertion (copper T) must be performed within 120 hours of

unprotected intercourse, it elicit an inflammatory response

It reduces risk of pregnancy by 99,8%, it is the most effective type of emergency contraception

Not acceptable by women who are not candidates for IUD insertion including those with multiple partners and victims of rape

Adv: long term contraception (10 years) Disadv: must be placed by a doctor, infection and

perforation ,paragard associated with heavy menses and dysmenorrhea .

Surgical sterilization Irreversible procedures Ideal in stable monogamous relationship where no

additional children desired Indicated in women whom pregnancy is life

threatening .o 2 types: 1)tubal sterilization 2)vasectomyBoth tubal ligation and vasectomy are highly effective form of preventing pregnancy but vasectomy is more safe , simpler ,and more effective

Tubal sterilization Method : surgically occluding fallopian tubes it prevents ovum and sperm from fusing Done by 2 methods post partum :1)Laparoscopic *bipolar cautery *silastic banding *clipping *ligation sutures2)Hysteroscopic

Laparoscopic

Tubal sterilization (hysteroscopic transcervical nonincisional approach)Essure Flexible form fitting microinserts introduced into uterine

portion of fallopian tube. Outer spring coils molds to shape fallopian tube to anchor

the microinserts Sterilization accomplished over 12 wks due to growth of

tissue around coil resulting in obstruction (until all tube is obstructed backup method of birth control used for three months.

adv:1)Lack of general anesthesia2)No surgical incision it can be done by transcervical approach3)Can be performed in the office4)Fast to be done5)Best for obese women with prior abdominal surgeries and risk for menses .

Tubal sterilization (hysteroscopic transcervical nonincisional approach) Failure rate not more than 0.5% Varies according to : age and surgeons experience When interval laparoscopic approach is undertaken , falope

rings have highest efficacy in women under 28.electrocautary and falope rings have equal efficacy 28 years and above.

Side effects: no side effects, in some cases post tubal ligation syndrome (pain and menstrual disturbances)

adv: reduce risk of ovarian cancer Disadv:risk of infection, hemorrhage , viscous injury and

vascular damage here there is low risk of pregnancy but if occurred it will be ectopic

ESSURE

vasectomy Mode of action: ligation of vas deferens , done in

office under local incision in the upper outer aspect of each scrotum

Unlike tube ligation vasectomy is not immediately effective therefore patient should use another form of contraception until azoospermia confirmed by semen analysis ( usually in 6-8 wks)

Effectiveness:safe,simpler,more effective Side effects :rarely ,slight bleeding ,slight

infection, Rxns to sutures, antisperm antibodies, but no long term side effects for vasectomy

Adv: safe and less expensive

vasectomy