计划生育课件

计划生育Contraception&FamilyPlanning

意义

控制人口数量

提高人口质量

计划生育内容

⑴

晚婚：按法定年龄推迟3年以上结婚为晚婚。⑵晚育：按法定年龄推迟3年以上生育为晚育。⑶节育：包括避孕、绝育⑷优生优育：提高人口素质受孕必备条件⑴正常精子

输卵管壶腹部受精卵着床

⑵成熟卵子（孕卵）

⑶通畅的生殖管腔⑷子宫内膜同步改变避孕

激素避孕hormonalcontraceptives

：口服短效、长效、长效避孕针、缓释系统

非激素避孕：non-hormonalcontraceptives宫内节育器、外用避孕药具、自然避孕法、免疫避孕、黄体生成激素释放激素类似物避孕。紧急避孕

Emergencycontraceptives第一节激素避孕

hormonalcontraceptives

一、激素避孕机制

1.抑制排卵

Preventovulationbyinhibitinggonadotropinsecretion.

抑制下丘脑的促性腺激素释放激素因而使垂体的促卵泡素和促黄体素分泌受抑制而不发生排卵。2.对生殖器官的直接作用（1）改变宫颈粘液性状：Theprogestincomponentthickenthecervicalmucus,retardingspermpenetration

宫颈粘液变粘稠量减少、不利于精子穿透。（2）改变子宫内膜形态与功能：Theendometriumchangesbothinfunctionandinmorphology.It’snotsuitableforthefertilizedeggtoimbed.避孕药中孕激素干扰了雌激素效应，子宫内膜增殖受抑制；腺体及间质提早发生类分泌期变化，不适于孕卵着床。（3）改变输卵管的功能Changethefunctionofthetube二、激素避孕远期安全性1.长期服用甾体激素避孕药与生殖器肿瘤2.长期服用甾体激素避孕药与日后生育3.长期服用甾体激素避孕药与子代发育4.长期服用甾体激素避孕药与人体三大代谢

三、IndicationandcontraindicationsofOCIndications:

Anyreproductive-agedwomanContraindicationsPatientswithseverediseasesofimportantorgans,suchashepatitis,cardiovasculardisease.Patientswithendocrinediseaseorblooddisease(thromboembolicdisease).Patientswithmalignanttumor,uterinediseasePatientsolderthan45yearsorwithhypomenorrhea.Smokingandolderthan35years.Maycauseprematureovarianfailure,myocardialinfarctionLactatingwomanlessthanhalfyearafterdelivery.四、OCSideEffectsandmanagementNauseaBreasttendernessMenstrualchangesWeightgainHeadache五、激素避孕临床应用种类类型：复方短效口服复方长效口服复方或单方长效针剂缓释系统透皮贴剂NEWMETHODS“ThePatch”

第二节非激素避孕

non-hormonalcontraceptives一、宫内节育器（IUD）避孕机制----杀精毒胚、干扰着床非细菌性炎性反应、前列腺素作用、溶黄体作用、纤溶作用、免疫作用、铜离子作用、孕酮的作用（多环节抗生育作用）HowIUDsacttopreventconceptionisnotknown.ThemostwidelyobservedphenomenonismobilizationofleukocytesinresponsetothepresenceoftheforeignbodyclassificationCopperIUDsMedicine-releasingIUDs副作用：出血、腰酸腹胀并发症：子宫穿孔、节育器异位、节育器嵌顿、感染二、外用避孕药具

barrierContraceptivesCondomsMalelatex,polyurethane,animalskinFemalepolyurethaneDiaphragmsCervicalcapSpermicidesMalecondomTheFemaleCondomTheDiaphragmTheCervicalCapSpermicides三、自然避孕法四、免疫避孕法五、黄体生成激素释放激素类似物避孕第三节紧急避孕Postcoital/emergencycontraception(EC)（一）避孕机制①阻止或延迟排卵②干扰受精或阻止着床（二）方法1、紧急避孕药甾体激素类和非甾体激素类。一般应在无保护性生活后3日内口服紧急避孕药。

Drugs:Takinghormonal/non-hormonalcontraceptiveswithin3daysafterunprotectedsexualintercourse.2、紧急安放带铜宫内节育器一般应在无保护性生活后5日内放入带铜宫内节育器。

IUDs:IUDinsertionwithin5daysafterunprotectedsexualintercourse.第四节输卵管绝育术Tubalsterilization

方法：结扎切断、电凝、钳夹、环套、

药物粘堵输卵管管腔。

途径：可经腹、经腹腔镜或经阴道术后并发症：腹腔内积血或血肿、感染、脏器损伤、绝育失败第五节人工流产INDUCEDABORTION定义：避孕失败的补救措施，采用人工或药物方法终止妊娠。

Inducedabortionisthedeliberateterminationofpregnancyinamannerthatensuresthattheembryoorfetuswillnotsurvive.

SurgicalabortionMedicalabortion方法及对象

1）medicalabortion：adoptedto7weeksgestationRU-486(mifepristone)givenorallyinconjunctionwithaprostaglandin,Comlplicationsincludefailuretoterminateapregnancy,incompleteabortion.

2）负压吸宫术Vacuumaspiration：Earlyabortionadoptedto6to10weeksgestation.3）钳刮术Embryulcia

：Toterminatepregnancy11~14weeksofgestation.4）中期引产InductionofLaborbyIntra-amnioticinstillation(forinitiatingmid-trimesterabortion)5）剖宫取胎术ceaserian：引产禁忌或同时要绝育。并发症Complicationsandmanagementsofartificialabortion

子宫穿孔

人工流产综合反应吸宫不全近期并发症：漏吸术中出血术后感染栓塞宫颈裂伤ArtificialabortionsyndromeSymptoms-bradycardia,arrhythmia,dropinBP,heavysweat,etal.Preventionandmanagement-injectingatropine0.5~1mgpreoperation.Usetheappropriatevacuumpressureandoperatetenderlyduringoperation.IncompleteabortionPartofplacentaand/orfetuscanberemainedintheuterinecavity,mainlyduetotheunskilledoperator.Symptoms-vaginalbleedingformorethan10days.Management-ifthereisnoinfection,scrapingtheuterinecavityASAP;ifthereisinfection,usingantibioticsthenscraping.infectionSymptoms-acuteendometritis,pelvicinflammation.Management-usingprophylacticantibioticsUterineperforationOneofseverestcomplicationsofartificialabortion.Itcanbecausedbytheprobe,sucker,cervicaldilatororforceps.Managements-onceitoccurs,operationshouldbestoppedatonce.Antibiotics/oxytocinshouldbeusedandthepatientshouldbehospitalizedandbeatclosedobservation.Ifwearenotsurewhetherthereareinternalinjuries,laparotomyshouldbeperformed.IntrauterineadhesionMainlyoccursatthecervix.Managements-Dilatingthecervixusingaprobeordilatoranddissolutetheadhesion.Afterthe