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APGO educational topic number 33 family
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planning of all pregnancies in the
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United States fifty percent are
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unplanned family planning as defined by
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the World Health Organization allows
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individuals and couples to anticipate
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and attain their desired number of
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children and the spacing and timing of
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their births this is achieved through
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use of contraceptive methods and the
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treatment of involuntary and fertility a
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woman’s ability to space and limit her
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pregnancies has a direct impact on our
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health and well-being as well as on the
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outcome of each pregnancy the objectives
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of this video are to describe the
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mechanism of action and effectiveness of
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contraceptive methods describe the
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benefits risks and use for each
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contraceptive method including emergency
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contraception describe barriers to
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effective contraceptive use and to
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reduction of unintended pregnancy
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describe the methods of male and female
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surgical sterilization explain the risks
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and benefits of female surgical
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sterilization procedures let’s start by
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discussing the primary mechanisms of
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action of commonly used contraceptions
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here is a drawing of an ovary releasing
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an egg into the fallopian tube the first
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mechanism of contraception inhibits the
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development and release of this egg from
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the ovaries the oral contraception pill
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patch and ring all work by inhibiting
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ovulation if asian occurs the egg then
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travels in the fallopian tube and the
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second mechanism is the blocking of the
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sperm and the egg from uniting by a
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mechanical chemical or physical barrier
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this could be a male or female condom
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spermicide diaphragm or cervical cap a
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secondary mechanism of some
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contraceptive methods may alter the
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ability of the fertilized egg to implant
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and grow for example if an IUD is used
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as emergency contraception the only 100%
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effective form of contraception is
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abstinence all other methods have
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varying levels of efficacy an important
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concept to review is the difference
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between method failure rate and typical
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failure rate method failure rate refers
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to the inherent chance of failure when
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the method is used correctly 100% of the
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time typical failure rate often higher
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refers to the failure rate when a method
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is used by actual women factoring in
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human error and compliance the decision
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regarding which type of contraception to
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use will include many factors that will
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include more than just Africa
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see let’s use three patients anita
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efekta and contraceptive frame this
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discussion what will factor into their
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decisions regarding contraception cost
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medical history typical bleeding pattern
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availability side effects and/or partner
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participation we need to balance both
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the psychosocial and medical components
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when deciding upon a contraception plan
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let’s now begin app goes review of
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contraception from most to least
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effective number one the long-acting
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reversible contraceptive methods or
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lurks these include the intrauterine
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devices and the implant they are over
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99% effective and there is virtually no
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difference between typical and actual
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failure rates in creator and devices or
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contraceptives are inserted by a
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healthcare provider and the IUD is
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located in the fundal portion of the
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endometrium the strings are trimmed to
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sit outside of the external loss of the
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cervix there are two forms of IUDs the
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copper and the progesterone IUD the
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intrauterine device with the
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progesterone levonorgestrel works
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primarily by thickening cervical mucus
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to prevent sperm from entering the
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uterus there are two devices currently
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available that last for three or five
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years most women will have lighter
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menstrual cycles or may become a man or
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react with these levonorgestrel iud
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the copper IUD works by creating an
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unfavorable environment for sperm to
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fertilize an egg it lasts for ten years
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the most common side effects are heavier
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and crampy ur periods fun fact the IUD
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is the most commonly used contraception
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among female Gynaecologists the implant
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contains the progesterone ido no
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gestural and is a small plastic rod
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about the size of a matchstick that is
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inserted into the upper arm it works by
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inhibiting ovulation it is effective for
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up to three years and the most common
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side effect is irregular bleeding and
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spotting for the duration of the
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insertion all of the LARC methods can be
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removed prior to the official end date
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and there will be a rapid return of
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fertility after removal to baseline so
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the larks are great contraception for
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women who want optimal protection
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against pregnancy but who may or may not
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desire future fertility a like would be
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a great option for our patient efekta
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she is newly married about to start her
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surgical residency and wants to start
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her family after her training is
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complete if future fertility is
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absolutely ruled out as a possibility
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completely and totally then female and
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male sterilization can be considered our
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patient contraceptive wants to see no
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hear no and talk of no further
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pregnancies female and male
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sterilization czar permanent procedures
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to prevent pregnancy
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they are both over 99% effective male
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sterilization is an outpatient procedure
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where the right and left vas deferens
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are ligated to prevent sperm from
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entering the rest of the seminal fluid a
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semen analysis has collected three to
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four months and 20 ejaculate
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after this ectomy to make sure that no
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viable sperm is present there are two
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types of female sterilization procedures
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a tubal ligation is when the fallopian
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tube is ligated with clips or rings or a
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small segment of the fallopian tube is
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removed this can be performed
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laparoscopically or during the immediate
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postpartum time this can be performed
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through a small mini laparotomy incision
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the second option is hysteroscopic tubal
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occlusion this procedure is performed
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vaginally either in the operating room
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or in clinic metal coils are inserted
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into the fallopian tubes and scar tissue
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develops effectively blocking the tubes
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to ensure that the tubes are fully
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occluded women need to have a history of
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cell pinga Graham performed three months
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after the procedure the risks of female
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sterilization include increased risk of
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ectopic pregnancy with a 10-year
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cumulative probability of ectopic
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pregnancy after tubal ligation of 7.3 /
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regret is another risk after
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sterilization risk indicators for regret
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about decision for sterilization include
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age less than 25 sterilization at the
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time of caesarean section low parity
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minority status change in marital status
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low access or incomplete information
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about the procedure or making the
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decision under pressure from a spouse or
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because of medical indication there are
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also non contraceptive benefits of tubal
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ligation that include decreased lifetime
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risk of ovarian cancer and some
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protection against public inflammatory
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disease let’s move next number three the
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depo-provera injection this is a
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progesterone injection that lasts for
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three months and is about 97% effective
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women return to clinic every three
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months to receive the shot many women
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become amenorrhea con depo-provera and
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it can take several months for fertility
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to return after terminating this method
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it is important to counsel patients at
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the average weight gain with the
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but Provera shot is 10 pounds number for
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estrogen progesterone contraceptives
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these methods are 92% effective at
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preventing pregnancy these include the
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oral contraception pills the patch and
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the vaginal ring all of these
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contraceptions require daily weekly or
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monthly action from the patient
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contraindications to using estrogen
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containing contraception include
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migraine with aura history of blood
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clots personal history of breast cancer
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or liver disease for women over age 35
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this list is expanded to include women
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who smoke have hypertension or have
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migraines next up number 5 are the
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barrier methods of contraception which
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include male and female condoms
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diaphragms and spermicide their rates of
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efficacy are variable ranging from 71 to
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84 percent on typical use due to the
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potential for user error male and female
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condoms and abstinence are the only
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forms of contraception that also worked
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to protect against sexually transmitted
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infections let’s move on to other
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options for contraception natural family
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planning can be effective for highly
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motivated patients with equally
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motivated partners this method involves
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selective abstinence during the time in
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a woman’s cycle when she is most fertile
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ovulation are measured by the calendar
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or by symptoms such as basal body
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temperature or cervical mucus
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breastfeeding is another form of natural
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family planning in order to have
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effective inhibition of ovulation a
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woman must breastfeed every three hours
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and remain amenorrhea progesterone only
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forms of contraception are safe to use
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while breastfeeding we will conclude
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this video with a discussion of
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emergency contraception emergency
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contraception may be used for women
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after unprotected sexual intercourse the
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mechanisms of action are preventing
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ovulation and fertilization Plan B
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involves two pills of 0.75 milligrams of
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levonorgestrel Plan B one step consists
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of one pill of 1.5 milligrams of Libra
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nor gesture all ideally these should be
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taken within 72 hours of unprotected
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intercourse but can be taken up to 120
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hours after unprotected intercourse the
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failure rate for Plan B is 1.1 percent a
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prescription only formulation Ella uses
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the selective progesterone receptor
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modulator ulipristal acetate 30
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milligrams this can be used up to 120
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hours after
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protected intercourse as well the copper
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IUD can also be used as an option for
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emergency contraception and has a
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failure rate of approximately 0.1% this
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concludes the fqo video on family
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planning we have discussed the
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mechanisms and potential contraception
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options for our patients it is important
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to consider the patient as a whole when
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deciding upon a contraception plan
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[Music]