Professional Documents
Culture Documents
Planning
d r. A n o m S u a r d i k a
SpOG(K)
L/O/G/O
Responsible
Healthy
Have Faith
Advanced
Independent
insightful
Harmonic
CONTRACEPTION
CONTRACEPTION
Contraception use is an effort to prevent pregnancy
Trustworthy
No significant adverse effect
IDEAL
IDEAL
Contraception Use
Delay pregnancy
Pil,
Mini IUD,
Simple
approach
Characteristic
High reversibility (no
child)
Relatively high
effectivity, itd
important because
failed contraceptive
means high risk
pregnancy
Stop fertility
Tubektomi / Vasektomi,
Implant,
IUD,
Inj,
Pill,
Simple approach
Characteristic
Characteristic
Enough Reversibility
Effective enough,
acceptor have option
to have more child .
can be use 3-4 years
Not interfere with
breastfeed
Consider
Pil
Injection
To delay pregnancy
Keep distance
between pregnancy
Stop pregnancy
probability
Protect from STD
5
6
7
8
9
10
IUD
Implant
Kondom
Spermisid
+
+
+
As substitute
Decrease sexual
quality
Need medical
assistance
If there any
complaint could
immediately
discontinued its use
High Effectivty
+
+
Natural
Tubectomy/vasec
tomy
+
+
NATURAL METHOD
Natural Method is a means of contraception that
used since long time ago and usually called
Traditional Contraception.
In 3 decade of Family planning in Indonesia this
Natural Contraception not recommended
because have low effectivity and 47% failure rate
Include in Natural way of contraception : Periodic
Abstineence and coitus interuptus
Periodic Abstinence
Prevent sexual intercourse when women
in fertile state
How to know fertile period of women
Measure of Basal temperature
Exist of cervix mucus discharge (Billings
method)
Calendar calculation (Ogino Knaus)
Periodic Abstinence
Advantages:
No need third party assistance.
Can be used to contraceptive and also planning for pregnancy .
Safe and inexpensive .
No need medical examination.
Alternatif method if couple can adapt to other contraception or refusal of contraceptive use
because beliefs
Doesnt affect breastfeeding and no hormonal adverse effect
Increase husband participation in family planning and as a way to intense communication of
marriage relationship
Its better than not using any contraception.
Disadvantages
Low Effectivity.
Need Commitment and discipline, because abstinence in long periode of time.
Can restrict spontaneous sexual activity and psychological stress in marriage.
Not appropriate for a wife with irregular menstrual cycles.
It took 6 to 12 menstrual cycle to determine the actual fertile period
Does not protect against sexually transmitted diseases including HIV/AIDS
HORMONAL CONTRACEPTION
The principle of hormonal contraceptive is by replaced
normal production of the ovarian estrogen and
progesterone with hormonal contraceptive, then
ovulation can be prevented. Thickening cervical mucus
and made sperm cannot penetrate it. Also, by make
endometrium not receptive for ovum fertilization
Hormonal contraception, include:
Pill
Injection
Implant
IUD with progestin
Mini Pill :
How to use
The pills are taken daily one pill at the same time continuously until it runs
out completely. There are several ways to start taking birth control pills, :
Begin on the first day of menstruation.
Starting on the fifth day of menstruation.
Starting in the first week after menstruation.
Start on current day, if certainly not pregnant.
Instructions if you forget to drink a pill:
Forgot to take 1 pill
Immediately drink a pill after recall, by directly taking 2 pills on the same
day, then return to the original schedule
Forgot to take 2 pill
When remember, soon to take 2 pills per day for 2 days and use a back-up
plan (such as the use of condoms).
Advantages
Cheap and easy to use. If not suitable can be immediately discontinued its use.
Suitable for delaying the first pregnancy.
Reduce the use of menstrual pain
Usage of 4 years in a row is useful to prevent anemia, reduces the risk of ovarian
cancer, endometrial cancer and breast benign tumor.
Reduce the symptoms of menopause and the risk of osteoporosis.
Disadvantages:
Requires discipline to use it
Can reduce breast milk (pills containing estrogen).
The return of fertility is a bit late, it took 2 months after cessation of birth control pills.
Can increase the risk of chlamydial genital warts.
Not recommended for women over 40 years old because it would affect body
metabolism balance
Adverse Effect:
Nausea and vomiting.
Dizziness/headache.
Pain/tense and increase in breasts size.
Increased appetite/weight changes in the 3 part of body (hips, buttocks,
thighs).
Feeling lethargic, weak, not excited in work.
Decrease In Breast Milk.
High blood pressure.
Acne.
Brown spots on the face.
Varicose Veins.
Vaginal Discharge.
Menstrual disorders
Contraceptive Inj.
Indication :
Cant use the other methods because of health reasons.
Want to get a long-term contraceptive protection.
Want to breastfeed, while in need to have birth controlled
Contraindication:
In Pregnancy, because it can cause a miscarriage.
Just had a baby, less than 2 months, because the hormone injection may
slow healing of placental site.
Suffering from severe depression.
Had breast cancer or cancer of the genitals.
Experience vaginal bleeding of unknown cause, it probably symptoms of
cancer
Contraceptive Inj.
Advantages:
High effectiveness with failure rate less than 1%.
Practical, selectively, and secure because repeated use after 3 months.
Does not affect breast milk.
Can decrease the possibility of anemia.
Not limited to age
Disadvantages:
Disruption of menstrual pattern. Acceptors are sometimes experienced a menstrual
irregularity, spotting or bleeding, even 50% of women are not have menstruation after
injection three times.
Cant stop immediately if there is a complaint and it took many months to restore its
fertility. Most women have to wait 4-5 months after stopping the injection.
Increased body weight up to 5 kg.
Acceptors should be returned to health provider to have repeated injecton
Contraceptive Inj.
Adverse Effect :
Menstruation delayed.
Weight gain.
Headache accompanied by
disturbances of vision.
Infection at injection site.
Lower abdominal pain.
Bleeding caused by injections.
Implant
These tools are planted by doctors or midwives under
the skin surface through a small incision in the arm with
in local anesthesia
Implants work by releasing levonorgestrel / progestins in
low speed and constant into the body for 2-5 years. The
progestin hormone will prevent ovulation, thicken
cervical mucose so inepenetrable by sperm, halt the
endometrial cycle so that the ovum that has been
fertilized cant infiltrate it
Implant
Ideal implant :
In the first week of menstruation (max 5-7 days after 1st day of
menstruation).
At 7 days postpartum.
Previously were pill acceptors, can substitute to implants
immediately after stop taking birth control pills.
For previous inj. acceptors, implants use in the last week before the
inj scheduled.
Previous implant acceptors, can immediately proceed with new
implants at the same time when the old implants removed. When
swelling does occur, the new implants can be used in the old place
or in the same place with a different direction, but can also be
attached in a different place
Implant
Advantages:
High effectiveness, the failure rate is theoretically only 0.2% and, practically only 1-3%.
Do not suppress the production of breast milk.
Practical and effective.
There is no forgotten factor
Help prevent anemia.
Can be used for clients that do not match with estrogen use.
Used in a prolonged period of between 2-5 years.
Fertile state back soon after cessation of use.
Disadvantages:
Implant
Adverse Effect
No Menstruation.
Severe,prolonged Bleeding
Implants were lost or not palpable.
Nausea, dizziness, anxiety, headaches followed by blurred vision
IUD Progesterone
This contraceptive IUD is same with others, it's just
copper on the rod contains hormones levonorgestrel /
progestasert
Brands of Progesterone-IUD :
Progestasert Alza-T shaped, contains 35 mg of the hormone
progesterone and barium sulfate, with the effectiveness is 18
months.
LNG-20, contains 46-60 mg of levonorgestrel, the effectiveness
is 5 years.
IUD Progesterone
Advantage : Reduce blood volume during menstruation.
Decreased up to 40% compared to before IUD use.
Disadvantage : Progesterone IUD is more expensive
than the IUD without hormones; its effectiveness is only
18 months; often cause spotting or bleeding in the
middle of the menstrual cycle; LNG-20 can cause
menstruation to cease; the risk of ectopic pregnancy is
higher.
NON-HORMONAL CONTRACEPTION
IUD (Intra Uterine Device)
Condom
Spermisid Vaginal (Birth Control Tissue)
New Version
Insertion of the IUD can be done at any time when not pregnant, if:
To avoid the occurrence of pelvic infection which usually occurs at the time of
installation of the IUD. There were increased risk of infections in menstruation.
Cervical ostium effacement was same with the menstruation or during mid-cycle,
as long as acceptors not in tense state.
It is easier for acceptor to get service anytime.
Pregnant.
History of pelvic inflammatory disease, and genital diseases.
Risk of benign/malignant tumor on the genitals or in the uterus and the cervix, the
IUD can irritate the area.
The presence of congenital abnormalities of the uterus, IUD is difficult to insert.
Pain or bleeding during menstruation, IUD can aggravate the complaint.
Severe anemic because of the IUD tend to worsen menstrual bleeding.
Often have vagina bleeding with no known cause.
History of rheumatic heart disease or kidney as it can be at risk of complication
Copper allergy due to the IUD generally entwined by copper.
IUD is also not recommended if married couples aged less than 25 years old and
have not had any children; not the type who are loyal and have more than one sexual
partner; had a venereal disease.
Adverse Effect
Pain, Usually lower abdominal pain.
Bleeding, IUD increase menstrual bleed volume 20-50%. Menstrual time also
prolonged
IUD tail undetected.
Infection. IUD usage increased infection risk.
Ectopic Pregnancy, IUD disrupt attachment of embrio.
Pregnant. If IUD acceptor were pregnant, it can maintained . Theres 2 option for
doctor :
If IUD tail seen, IUD expelled. To prevent miscarriage (60% chance),
premature birth, dead fetus, or Low birth weight.
If IUD tail unseen, doctor let IUD intrauterine, with stric observation
Condom
Reason to choose Condom :
Inexpensive, without medical examination
Delay first pregnancy
Sexual intercourse not frequent
Couple have sexual transmitted disease .
Cant use other contraception method because health
reason.
As back-up for other contraceptive method
As emergency contraception
Want to have protection from pregnancy and STD
simultaneously
Condom
Advantage:
Easy, cheap, do not require prescriptions
Can prevent the transmission of sexually transmitted diseases.
Easy to carry everywhere
Disadvantages:
Sometimes disturb sexual comfort.
Should always change new condom every time after intercourse.
Easily torn if wearing it in a hurry.
The failure rate is quite high if too late to wear it
Spermisid Vaginal
Sign
Severe abdominal pain
Pil
+
+
3.
4.
Increase in weight
5.
7.
8.
9.
2.
6.
10.
11.
IUD
+
Injection
Implant
+
+
+
+
+
+
+
PERMANENT
CONTRACEPTION
Vasectomy, i.e. tying, clog, or cutting channels
(vas deferens) so there were no longer sperm in
the semen.
Tubectomy, i.e., binding, clog, or cutting of tuba
falopi so can prohibit the fertilization.
Tubectomy
All acts of closing (cutting, binding,
mounting rings, blockages) on both
channel to the right and left ovarium, so
that the ovum cant pass through the
channel
The way it works: by inhibiting ovum
transfer to uterus and cant be fertilized by
sperm.
ESSURE
A MICROCOIL
Tubectomy
Disadvantages
Risk and adverse effect of surgery
Reference
Mansjoer, Arif. 2000. Kapita Selekta Kedokteran Jilid 1.
Edisi ke-3. Jakarta : Media Aesculapius.
Sarwisiyani, Dike, et al. 2004. Panduan Praktis Memilih
Kontrasepsi. Badan Koordinasi Keluarga Berencana
Kota Surabaya
d r.L/O/G/O
Anom Suardika SpOG(K)
2.
3.
4.
5.
6.
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8.
C O N S U LTATI O N A F T E R P R O C E D U R E
43. Teach clients how to check their own IUD tail
44. Explain to the client what to do when experiencing the side effects of
IUD
45. Notify when a client must come back to the clinic to control
46. Remind returning period. Period of usage Cu T 380 is 10 years
47. Reassure the client that he or she can come to the clinic at any time
when need a medical examination or consultation, or if wants to
remove the IUD
48. Ask client to repeating explanation that has been given.
49. Complete medical record and IUD card for a client.
Thank You
L/O/G/O