Handout Maternity Nursing Contraception

Barrier Methods -for contraception and protection against STI, HPV, HSV, HIV Spermicides (F.R 20%-50%) Inserted high into the vagina to make contact with cervix. Nonoxynol-9 ● reducing sperm’s mobility toward cervical os, targeting flagella and the body. ●most common in U.S. ●surfactant that destroys sperm’s cell membrane ●>2x a day as lubricant in anal sex will increase risk for HIV transmission and can cause lesions ●to be avoided by women who have high risk for HIV and other STI Intravaginal Spermicides ●non Rx Inserted 15mins before coitus and not 1hr before Condoms (F.R. F♀= 21% M♂=15%) -thin stretchable sheath that covers the penis before coitus and removed after ejaculation -Protection for GCT and HIV -Non Rx/OTC Male: Single use ECP- must be available to prevent breakage or slippage 3%5% Made with: latex rubber-break with oil-based lubricants (water-based and silicone is recommended) Polyurethane-under reasearh Natural membrane (animal tissue)- Cecum (lamb) has small pores in which HepaB, HSV and HIV can enter. Vaginal Stimulation-male condoms are contoured and rippled, thin construction increases heat transmission and sensitivity Female: Single use -lubricated vaginal sheath made with polyurethane and has flexible ringsat both ends -inserted in the vagina and anchored in the cervix -Oil-based OK! And water based is used as silencer Caution! Don’t use m and f condoms @ the same time =friction=breakage=pregnancy Diaphragms FR=16% Made with silicone or latex Prevent migration of sperm blocking cervix Washable, reusable inspected for holes and tears Added with Spermicidal before insertion Rx needed Fitting is required Shallow, dome-shaped with flexible rim blocking the cervix 1. Coil Spring 2. Arcing Spring 3. Wide Seal Rim Largest fit without noticing it!!! Yearly GyneExam-for refitting (20% weight gain/loss abdominal/pelvic surg. Post-partum 2years-must be replaced Disadvatage: reluctance of insertion and removal 6hours before-it must be worn Messy!! Foreplay interruption Not good for women with poor vaginal muscle tone and recurrent UTIs, pelvic relaxation (uterine prolapse), large cystocele,latex allergy Proper placement-behind the pubic symphysis blocking the cervix Worn in empty bladder Side Effects: Tissue irritation TSS 6-8hr after coitus removed! Menses-don’t use it!

Cervical Caps FR= Nulliparas-16% Mutiparous-32% 3sizes=one size fits all, varying(2) Latex free rubber/silicone Soft Domes and brims Blocking the cervix (jxn of cervix and vaginal fornices) not <6hrs no >48hrs removal requires less spermicide than diaphragm can be inserted hours before coitus w/o additional spermicide Factors that interfere in wearing: angle of the uterus vaginal muscle tone cervical shape Bad candidates: Abnormal pap test result No appropriate size Difficulty of placing and removing the device TSS Hx Vaginal/Cervical infection Allergies in spermicide and latex Contraceptive sponge; Small, roud polyurethane sponge that contains nonoxynol-9 spermicide. Fits to the Cervix(concave) of ALL! Polyester Loop- removal of the sponge Moistened with h2o before insertion 24hr-protection 6hr-left inside after coitus 24-30hr=TSS

Hormonal Methods Combined estrogen-progestin contraceptives ORAL CONRACEPTIVES (FR= almost 100%) COCs-Combined Oral Contraceptives Inhibition of Ovulation= by suppressing the action oh the hypothalamus and anterior pituitary gland, leading to inappropriate secretion of FSH and LH Alteration of Endometrium Maturation=less favorable site for implantation COCs Examined before undergoing pill-intake (yearly) Should be taken at the same time each day. (1-4days of ingestion) endometrium sloughs and bleeds (23days) as a result of hormone withdrawal Progestin-will make the cervical mucus remain thick Cervical Mucus Thickening= under the influence of progesterone making an unsuitable environment for sperm penetration. Monophasic Pills- provide fixed dosages of estrogen and progestin Multiphasic Pills - (bi/tripahsic oral contraceptives) – alters the amount of progestin and sometimes the amount of estrogen within each cycle Monophasic and Multiphasic Pills- reduce the total dosage of hormones in a single cycle without sacrificing contraceptive efficacy. Advantages Acceptable-not diretly related to coitus User will be confident thus improvement in sexual response Convinient- predictable menstrual period Decreased menstrual blood loss and decrease IDA Regulation of Menorrhagia and irregular cycles

Reduced incidence of dysmenorrhea and premenstrual syndrome (PMS) Protection against endometrial/ovarian cancer Reduced the incidence of benign breast disease Improve Acne Protection agaist the development of fxnal ovarian cyst and salpingitis Decrease risk for ectopic pregnancy Perimenopausal women will experience regular bleeding cycle, and regular hormonal pattern Disadvantages: Conraindicated to women with: Hx of thromboembolic disorders Cerebrovascular and coronary artery disease Breast cancer or other estrogen-dependent tumors Impaired liver fxn Liver Tumor Smoking habit 35y/o 10sticks/day Headache with focal neurologic disorder Surgery with prolonged immobilization (legs) Hypertension (160/100) DM with vascular disease Side effects of High Dose of Estrogen and Progesterone Stroke MI Thromboembolism Hypertension Gallbladder disease Liver tumors Estrogen Excess Nausea Breast tenderness Fluid retention Chloasma Estrogen Deficiency Early spotting (days 1-14) Hypomenorrhea Nervousness Athropic vaginitis =dyspareunia/painful coitus Progestin Excess Increased appetite Tiredness Depression Breast tenderness Vaginal yeast infection Oily skin and scalp Hirsutism Post pill amenorrhea Progestin Deficiency Late spotting and breakthrough bleeding (days 15-21) Heavy flows with clots Decreased breast size BLEEDING IRREGULARITIES -most common side effect of COCs Don’t simultaneously take COCs with Anticonvulsants= barbiturates, oxcarbazepine, phenytion, phenobarbial, felbamate, carbamazepine, primidone and topiramate Systemic anti-fungals: griseofulvin Antituberculosis drugs: Rifampicin and rifabutin Anti-HIV protease inhibitors ORAL CONTRACETIVES 9-DAY REGIMEN (FR=<2%) Levonorgestrel - ethinyl esradiol (Sesonale)- FDA2003 approved -contains estrogen and progestin taken in 3month cycles of 12 weeks of active pills followed by 1 week in active pills. -13 week menstruation will occur -Rx needed, taken on daily schedule

TRANSDERMAL CONTRACEPTIVE SYSTEM (FR=2% in women weighing 198 lbs.) -Rx needed -Each patch delivers continuous levels of norelgestromin(progesterone) and ethinyl estradiol -Intact skin @ upper outer arm, upper torso (front and back excdg. the breast, lower abdomen, buttock - Once a week for 3weeks and 1 week without a patch and withdrawal bleeding occurs. -action, efficacy, contraindications,skin reaction and side-effects is the same as COCs. VAGINAL CONTRACEPTIVE RING (FR= under 2%) -Rx needed -flexible ring (made with ethylene vinyl acetate copolymer) -worn in the vagina for continuous levels of etonorgestrel (progesterone) -3weeks worn in the vagina followed by 1 week without ring (withdrawal bleeding occurs) - No fitting required Some wearers will experience Vaginitis Leucorrhea Vaginal discomfort Sex discomfort- the ring should not be removed for any longer than 3HOURS -SIMILAR TO COCs PROGESTIN-ONLY CONTRACEPTIVES -inhibits ovulation, thickening and decreasing the amount of cervical mucus, thinning the endometrium and altering cilia in the uterine tubes. ORAL PROGESTIN (MINI PILL) (FR=8%) Contain low dose of progestin Irregular vaginal bleeding INJECTABLE PROGESTINS (FR=3%) Depot medroxyprogesterone acetae (DMPA or DepoProvera 150mg IM @ deltoid G. Maximus G23 needle 2.5cm4cm long. 5days-administration is initiated 11-13weeks-Administration Advantages: ssame contraceptive effect like COCs Long-lasting effect 4x/year of injection Side-effects: increased mineral –density Weight gain Lipid changes Increased for venous thrombosis and thromboembolism Irregular vaginal spotting Decreased Libido Breast Changes Disadvantages: Low protection against STI, HIV Delay in return to fertility 18months IMPLANTABLE PROGESTINS Norplant system *6 flexible, non bridgeable polymeric silicone (Silastic Capsules) SC=contains levonorgestrel 5-7 years of contraception Wt. and age-factor that determines the span Inner aspect of the non dominant upper arm Action: prevents (not all) ovulatory cycles and thickens cervical mucus. Advantage: long lasting effect, reversible IRREGULAR BLEEDING-most common side effect Others= headache,nervousness nausea, skin changes and vertigo Implanon-rod implant