{"id":133,"date":"2020-08-12T20:50:09","date_gmt":"2020-08-12T20:50:09","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=133"},"modified":"2021-05-09T20:44:20","modified_gmt":"2021-05-09T20:44:20","slug":"33-family-planning","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/overview\/33-family-planning\/","title":{"rendered":"33. Family Planning"},"content":{"rendered":"<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/IEffOROmkbQ\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration = 9:29<\/p>\n<input type='hidden' bg_collapse_expand='69e9b57d804cb1040163160' value='69e9b57d804cb1040163160'><input type='hidden' id='bg-show-more-text-69e9b57d804cb1040163160' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b57d804cb1040163160' value='Hide Transcript'><button id='bg-showmore-action-69e9b57d804cb1040163160' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b57d804cb1040163160' ><\/p>\n<p>00:00<br \/>\nAPGO educational topic number 33 family<br \/>\n00:02<br \/>\nplanning of all pregnancies in the<br \/>\n00:05<br \/>\nUnited States fifty percent are<br \/>\n00:06<br \/>\nunplanned family planning as defined by<br \/>\n00:09<br \/>\nthe World Health Organization allows<br \/>\n00:11<br \/>\nindividuals and couples to anticipate<br \/>\n00:13<br \/>\nand attain their desired number of<br \/>\n00:15<br \/>\nchildren and the spacing and timing of<br \/>\n00:17<br \/>\ntheir births this is achieved through<br \/>\n00:19<br \/>\nuse of contraceptive methods and the<br \/>\n00:21<br \/>\ntreatment of involuntary and fertility a<br \/>\n00:23<br \/>\nwoman&#8217;s ability to space and limit her<br \/>\n00:26<br \/>\npregnancies has a direct impact on our<br \/>\n00:27<br \/>\nhealth and well-being as well as on the<br \/>\n00:29<br \/>\noutcome of each pregnancy the objectives<br \/>\n00:31<br \/>\nof this video are to describe the<br \/>\n00:33<br \/>\nmechanism of action and effectiveness of<br \/>\n00:35<br \/>\ncontraceptive methods describe the<br \/>\n00:37<br \/>\nbenefits risks and use for each<br \/>\n00:39<br \/>\ncontraceptive method including emergency<br \/>\n00:40<br \/>\ncontraception describe barriers to<br \/>\n00:43<br \/>\neffective contraceptive use and to<br \/>\n00:45<br \/>\nreduction of unintended pregnancy<br \/>\n00:46<br \/>\ndescribe the methods of male and female<br \/>\n00:49<br \/>\nsurgical sterilization explain the risks<br \/>\n00:52<br \/>\nand benefits of female surgical<br \/>\n00:54<br \/>\nsterilization procedures let&#8217;s start by<br \/>\n00:56<br \/>\ndiscussing the primary mechanisms of<br \/>\n00:58<br \/>\naction of commonly used contraceptions<br \/>\n01:00<br \/>\nhere is a drawing of an ovary releasing<br \/>\n01:03<br \/>\nan egg into the fallopian tube the first<br \/>\n01:05<br \/>\nmechanism of contraception inhibits the<br \/>\n01:07<br \/>\ndevelopment and release of this egg from<br \/>\n01:09<br \/>\nthe ovaries the oral contraception pill<br \/>\n01:12<br \/>\npatch and ring all work by inhibiting<br \/>\n01:14<br \/>\novulation if asian occurs the egg then<br \/>\n01:18<br \/>\ntravels in the fallopian tube and the<br \/>\n01:20<br \/>\nsecond mechanism is the blocking of the<br \/>\n01:22<br \/>\nsperm and the egg from uniting by a<br \/>\n01:24<br \/>\nmechanical chemical or physical barrier<br \/>\n01:26<br \/>\nthis could be a male or female condom<br \/>\n01:29<br \/>\nspermicide diaphragm or cervical cap a<br \/>\n01:31<br \/>\nsecondary mechanism of some<br \/>\n01:33<br \/>\ncontraceptive methods may alter the<br \/>\n01:35<br \/>\nability of the fertilized egg to implant<br \/>\n01:37<br \/>\nand grow for example if an IUD is used<br \/>\n01:40<br \/>\nas emergency contraception the only 100%<br \/>\n01:43<br \/>\neffective form of contraception is<br \/>\n01:45<br \/>\nabstinence all other methods have<br \/>\n01:47<br \/>\nvarying levels of efficacy an important<br \/>\n01:50<br \/>\nconcept to review is the difference<br \/>\n01:51<br \/>\nbetween method failure rate and typical<br \/>\n01:53<br \/>\nfailure rate method failure rate refers<br \/>\n01:55<br \/>\nto the inherent chance of failure when<br \/>\n01:57<br \/>\nthe method is used correctly 100% of the<br \/>\n01:59<br \/>\ntime typical failure rate often higher<br \/>\n02:02<br \/>\nrefers to the failure rate when a method<br \/>\n02:03<br \/>\nis used by actual women factoring in<br \/>\n02:06<br \/>\nhuman error and compliance the decision<br \/>\n02:08<br \/>\nregarding which type of contraception to<br \/>\n02:10<br \/>\nuse will include many factors that will<br \/>\n02:12<br \/>\ninclude more than just Africa<br \/>\n02:13<br \/>\nsee let&#8217;s use three patients anita<br \/>\n02:16<br \/>\nefekta and contraceptive frame this<br \/>\n02:18<br \/>\ndiscussion what will factor into their<br \/>\n02:21<br \/>\ndecisions regarding contraception cost<br \/>\n02:23<br \/>\nmedical history typical bleeding pattern<br \/>\n02:26<br \/>\navailability side effects and\/or partner<br \/>\n02:29<br \/>\nparticipation we need to balance both<br \/>\n02:31<br \/>\nthe psychosocial and medical components<br \/>\n02:33<br \/>\nwhen deciding upon a contraception plan<br \/>\n02:35<br \/>\nlet&#8217;s now begin app goes review of<br \/>\n02:38<br \/>\ncontraception from most to least<br \/>\n02:40<br \/>\neffective number one the long-acting<br \/>\n02:42<br \/>\nreversible contraceptive methods or<br \/>\n02:44<br \/>\nlurks these include the intrauterine<br \/>\n02:47<br \/>\ndevices and the implant they are over<br \/>\n02:50<br \/>\n99% effective and there is virtually no<br \/>\n02:53<br \/>\ndifference between typical and actual<br \/>\n02:55<br \/>\nfailure rates in creator and devices or<br \/>\n02:57<br \/>\ncontraceptives are inserted by a<br \/>\n02:59<br \/>\nhealthcare provider and the IUD is<br \/>\n03:01<br \/>\nlocated in the fundal portion of the<br \/>\n03:03<br \/>\nendometrium the strings are trimmed to<br \/>\n03:05<br \/>\nsit outside of the external loss of the<br \/>\n03:07<br \/>\ncervix there are two forms of IUDs the<br \/>\n03:09<br \/>\ncopper and the progesterone IUD the<br \/>\n03:12<br \/>\nintrauterine device with the<br \/>\n03:13<br \/>\nprogesterone levonorgestrel works<br \/>\n03:15<br \/>\nprimarily by thickening cervical mucus<br \/>\n03:17<br \/>\nto prevent sperm from entering the<br \/>\n03:19<br \/>\nuterus there are two devices currently<br \/>\n03:21<br \/>\navailable that last for three or five<br \/>\n03:23<br \/>\nyears most women will have lighter<br \/>\n03:25<br \/>\nmenstrual cycles or may become a man or<br \/>\n03:27<br \/>\nreact with these levonorgestrel iud<br \/>\n03:29<br \/>\nthe copper IUD works by creating an<br \/>\n03:32<br \/>\nunfavorable environment for sperm to<br \/>\n03:34<br \/>\nfertilize an egg it lasts for ten years<br \/>\n03:36<br \/>\nthe most common side effects are heavier<br \/>\n03:38<br \/>\nand crampy ur periods fun fact the IUD<br \/>\n03:41<br \/>\nis the most commonly used contraception<br \/>\n03:43<br \/>\namong female Gynaecologists the implant<br \/>\n03:46<br \/>\ncontains the progesterone ido no<br \/>\n03:48<br \/>\ngestural and is a small plastic rod<br \/>\n03:50<br \/>\nabout the size of a matchstick that is<br \/>\n03:51<br \/>\ninserted into the upper arm it works by<br \/>\n03:54<br \/>\ninhibiting ovulation it is effective for<br \/>\n03:57<br \/>\nup to three years and the most common<br \/>\n03:58<br \/>\nside effect is irregular bleeding and<br \/>\n04:00<br \/>\nspotting for the duration of the<br \/>\n04:01<br \/>\ninsertion all of the LARC methods can be<br \/>\n04:04<br \/>\nremoved prior to the official end date<br \/>\n04:06<br \/>\nand there will be a rapid return of<br \/>\n04:07<br \/>\nfertility after removal to baseline so<br \/>\n04:10<br \/>\nthe larks are great contraception for<br \/>\n04:11<br \/>\nwomen who want optimal protection<br \/>\n04:13<br \/>\nagainst pregnancy but who may or may not<br \/>\n04:15<br \/>\ndesire future fertility a like would be<br \/>\n04:18<br \/>\na great option for our patient efekta<br \/>\n04:20<br \/>\nshe is newly married about to start her<br \/>\n04:22<br \/>\nsurgical residency and wants to start<br \/>\n04:23<br \/>\nher family after her training is<br \/>\n04:25<br \/>\ncomplete if future fertility is<br \/>\n04:27<br \/>\nabsolutely ruled out as a possibility<br \/>\n04:29<br \/>\ncompletely and totally then female and<br \/>\n04:31<br \/>\nmale sterilization can be considered our<br \/>\n04:33<br \/>\npatient contraceptive wants to see no<br \/>\n04:36<br \/>\nhear no and talk of no further<br \/>\n04:38<br \/>\npregnancies female and male<br \/>\n04:40<br \/>\nsterilization czar permanent procedures<br \/>\n04:42<br \/>\nto prevent pregnancy<br \/>\n04:43<br \/>\nthey are both over 99% effective male<br \/>\n04:47<br \/>\nsterilization is an outpatient procedure<br \/>\n04:48<br \/>\nwhere the right and left vas deferens<br \/>\n04:50<br \/>\nare ligated to prevent sperm from<br \/>\n04:52<br \/>\nentering the rest of the seminal fluid a<br \/>\n04:54<br \/>\nsemen analysis has collected three to<br \/>\n04:56<br \/>\nfour months and 20 ejaculate<br \/>\n04:58<br \/>\nafter this ectomy to make sure that no<br \/>\n05:00<br \/>\nviable sperm is present there are two<br \/>\n05:02<br \/>\ntypes of female sterilization procedures<br \/>\n05:04<br \/>\na tubal ligation is when the fallopian<br \/>\n05:06<br \/>\ntube is ligated with clips or rings or a<br \/>\n05:08<br \/>\nsmall segment of the fallopian tube is<br \/>\n05:10<br \/>\nremoved this can be performed<br \/>\n05:12<br \/>\nlaparoscopically or during the immediate<br \/>\n05:14<br \/>\npostpartum time this can be performed<br \/>\n05:15<br \/>\nthrough a small mini laparotomy incision<br \/>\n05:18<br \/>\nthe second option is hysteroscopic tubal<br \/>\n05:21<br \/>\nocclusion this procedure is performed<br \/>\n05:22<br \/>\nvaginally either in the operating room<br \/>\n05:24<br \/>\nor in clinic metal coils are inserted<br \/>\n05:27<br \/>\ninto the fallopian tubes and scar tissue<br \/>\n05:28<br \/>\ndevelops effectively blocking the tubes<br \/>\n05:30<br \/>\nto ensure that the tubes are fully<br \/>\n05:33<br \/>\noccluded women need to have a history of<br \/>\n05:35<br \/>\ncell pinga Graham performed three months<br \/>\n05:36<br \/>\nafter the procedure the risks of female<br \/>\n05:39<br \/>\nsterilization include increased risk of<br \/>\n05:40<br \/>\nectopic pregnancy with a 10-year<br \/>\n05:42<br \/>\ncumulative probability of ectopic<br \/>\n05:44<br \/>\npregnancy after tubal ligation of 7.3 \/<br \/>\n05:48<br \/>\nregret is another risk after<br \/>\n05:50<br \/>\nsterilization risk indicators for regret<br \/>\n05:53<br \/>\nabout decision for sterilization include<br \/>\n05:55<br \/>\nage less than 25 sterilization at the<br \/>\n05:57<br \/>\ntime of caesarean section low parity<br \/>\n06:00<br \/>\nminority status change in marital status<br \/>\n06:02<br \/>\nlow access or incomplete information<br \/>\n06:04<br \/>\nabout the procedure or making the<br \/>\n06:06<br \/>\ndecision under pressure from a spouse or<br \/>\n06:08<br \/>\nbecause of medical indication there are<br \/>\n06:11<br \/>\nalso non contraceptive benefits of tubal<br \/>\n06:13<br \/>\nligation that include decreased lifetime<br \/>\n06:15<br \/>\nrisk of ovarian cancer and some<br \/>\n06:16<br \/>\nprotection against public inflammatory<br \/>\n06:18<br \/>\ndisease let&#8217;s move next number three the<br \/>\n06:20<br \/>\ndepo-provera injection this is a<br \/>\n06:23<br \/>\nprogesterone injection that lasts for<br \/>\n06:24<br \/>\nthree months and is about 97% effective<br \/>\n06:27<br \/>\nwomen return to clinic every three<br \/>\n06:30<br \/>\nmonths to receive the shot many women<br \/>\n06:32<br \/>\nbecome amenorrhea con depo-provera and<br \/>\n06:34<br \/>\nit can take several months for fertility<br \/>\n06:36<br \/>\nto return after terminating this method<br \/>\n06:37<br \/>\nit is important to counsel patients at<br \/>\n06:40<br \/>\nthe average weight gain with the<br \/>\n06:41<br \/>\nbut Provera shot is 10 pounds number for<br \/>\n06:44<br \/>\nestrogen progesterone contraceptives<br \/>\n06:46<br \/>\nthese methods are 92% effective at<br \/>\n06:49<br \/>\npreventing pregnancy these include the<br \/>\n06:51<br \/>\noral contraception pills the patch and<br \/>\n06:54<br \/>\nthe vaginal ring all of these<br \/>\n06:56<br \/>\ncontraceptions require daily weekly or<br \/>\n06:58<br \/>\nmonthly action from the patient<br \/>\n07:00<br \/>\ncontraindications to using estrogen<br \/>\n07:02<br \/>\ncontaining contraception include<br \/>\n07:04<br \/>\nmigraine with aura history of blood<br \/>\n07:05<br \/>\nclots personal history of breast cancer<br \/>\n07:07<br \/>\nor liver disease for women over age 35<br \/>\n07:10<br \/>\nthis list is expanded to include women<br \/>\n07:12<br \/>\nwho smoke have hypertension or have<br \/>\n07:14<br \/>\nmigraines next up number 5 are the<br \/>\n07:17<br \/>\nbarrier methods of contraception which<br \/>\n07:19<br \/>\ninclude male and female condoms<br \/>\n07:21<br \/>\ndiaphragms and spermicide their rates of<br \/>\n07:24<br \/>\nefficacy are variable ranging from 71 to<br \/>\n07:26<br \/>\n84 percent on typical use due to the<br \/>\n07:28<br \/>\npotential for user error male and female<br \/>\n07:31<br \/>\ncondoms and abstinence are the only<br \/>\n07:33<br \/>\nforms of contraception that also worked<br \/>\n07:35<br \/>\nto protect against sexually transmitted<br \/>\n07:36<br \/>\ninfections let&#8217;s move on to other<br \/>\n07:39<br \/>\noptions for contraception natural family<br \/>\n07:41<br \/>\nplanning can be effective for highly<br \/>\n07:43<br \/>\nmotivated patients with equally<br \/>\n07:44<br \/>\nmotivated partners this method involves<br \/>\n07:46<br \/>\nselective abstinence during the time in<br \/>\n07:48<br \/>\na woman&#8217;s cycle when she is most fertile<br \/>\n07:50<br \/>\novulation are measured by the calendar<br \/>\n07:52<br \/>\nor by symptoms such as basal body<br \/>\n07:54<br \/>\ntemperature or cervical mucus<br \/>\n07:56<br \/>\nbreastfeeding is another form of natural<br \/>\n07:58<br \/>\nfamily planning in order to have<br \/>\n08:00<br \/>\neffective inhibition of ovulation a<br \/>\n08:02<br \/>\nwoman must breastfeed every three hours<br \/>\n08:03<br \/>\nand remain amenorrhea progesterone only<br \/>\n08:06<br \/>\nforms of contraception are safe to use<br \/>\n08:08<br \/>\nwhile breastfeeding we will conclude<br \/>\n08:11<br \/>\nthis video with a discussion of<br \/>\n08:12<br \/>\nemergency contraception emergency<br \/>\n08:15<br \/>\ncontraception may be used for women<br \/>\n08:16<br \/>\nafter unprotected sexual intercourse the<br \/>\n08:19<br \/>\nmechanisms of action are preventing<br \/>\n08:20<br \/>\novulation and fertilization Plan B<br \/>\n08:23<br \/>\ninvolves two pills of 0.75 milligrams of<br \/>\n08:26<br \/>\nlevonorgestrel Plan B one step consists<br \/>\n08:29<br \/>\nof one pill of 1.5 milligrams of Libra<br \/>\n08:32<br \/>\nnor gesture all ideally these should be<br \/>\n08:34<br \/>\ntaken within 72 hours of unprotected<br \/>\n08:36<br \/>\nintercourse but can be taken up to 120<br \/>\n08:39<br \/>\nhours after unprotected intercourse the<br \/>\n08:41<br \/>\nfailure rate for Plan B is 1.1 percent a<br \/>\n08:44<br \/>\nprescription only formulation Ella uses<br \/>\n08:47<br \/>\nthe selective progesterone receptor<br \/>\n08:49<br \/>\nmodulator ulipristal acetate 30<br \/>\n08:51<br \/>\nmilligrams this can be used up to 120<br \/>\n08:54<br \/>\nhours after<br \/>\n08:55<br \/>\nprotected intercourse as well the copper<br \/>\n08:57<br \/>\nIUD can also be used as an option for<br \/>\n08:59<br \/>\nemergency contraception and has a<br \/>\n09:01<br \/>\nfailure rate of approximately 0.1% this<br \/>\n09:05<br \/>\nconcludes the fqo video on family<br \/>\n09:07<br \/>\nplanning we have discussed the<br \/>\n09:08<br \/>\nmechanisms and potential contraception<br \/>\n09:10<br \/>\noptions for our patients it is important<br \/>\n09:12<br \/>\nto consider the patient as a whole when<br \/>\n09:14<br \/>\ndeciding upon a contraception plan<br \/>\n09:16<br \/>\n[Music]<\/p>\n<p><\/div>\n<hr>\n","protected":false},"excerpt":{"rendered":"<p>Duration = 9:29<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":46,"menu_order":33,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-133","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/133","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=133"}],"version-history":[{"count":1,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/133\/revisions"}],"predecessor-version":[{"id":2838,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/133\/revisions\/2838"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/46"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=133"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}