FAMILY PLANNING - PERMANENT METHODS

PERMANENT METHODS OF FAMILY PLANNING

    Family planning is the voluntary planning regarding child birth, by persons or couples i.e., child birth should be according to their desire or choice, not by chance.

By controlling birth through family planning the size of the family can be limited and population growth can be controlled.

It helps individual, saves lives, support family and benefits societies

So fertility regulation can be done by contraception

Contraceptive methods are preventive methods to help women avoid unwanted pregnancies

FAMILY PLANNING

Family planning refers to practices that help individuals or couples to attain certain objectives:

·         to avoid unwanted births

·         to bring about wanted birth

·         to regulate the interval between pregnancies

·         to control the time at which birth occur in relation to the ages of the parent;  and

·         to determine the number of children in the family

CONTRACEPTION

The methods or devices used to prevent pregnancy are called contraception

Contraception means prevention against pregnancy

PERMANENT METHODS OF FAMILY PLANNING (TERMINAL METHODS OR STERILIZATION)

·         Sterilization of man or woman is the permanent method of family planning

·         Vasectomy in case of men

·         Tubectomy in case of women

ADVANTAGES

·         It is one time method

·         Effective protection against pregnancy

·         Less risk of complication

·         Cost effective or free of charge

·         Does not require teaching or training

GUIDELINES FOR STERILIZATION

·         Husband age in between 25 to 50 years

·         Wife age in between 20 to 45 years

·         Must have two living children

·         If the couple has three or more living children the age limit may be relaxed

·         Need consent from spouse

MALE STERILIZATION OR VASECTOMY

1)      STANDARD VASECTOMY OR CONVENTIONAL VASECTOMY

§  Simple operation performed under local anesthesia

§  Clamping and cutting of both vas deferens

§  Cut ends are ligated and folded back to avoid the risk of recanalization

§  It is simpler, faster and less expensive operation

2)      NON-SCALPEL VASECTOMY (NSV)

§  NSV is the latest and most popular technique of male sterilization

§  No incision

§  Puncturing the stretched skin of scrotal sac with a sharp instrument

§  Locating the vas deference

§  Cutting and ligating the tube

ADVANTAGES

v  Permanent, safe and inexpensive

v  Sperm production or hormone output not affected

v  Doesn’t interfere with sexual pleasure

v  Cheaper and simpler than Tubectomy

v  Hospitalization not required

v  Recanalization is possible

v  Can be conducted anywhere

DISADVANTAGES

·         Pain, hematoma in scrotum

·         Local infection

·         Impotency, headache or uneasiness due to psychological fear

·         Spontaneous recanalization in some cases

POSTOPERATIVE ADVICES

Ø  The patient should be told that he is not sterile immediately after operation. So use some other contraceptives till gets the report of no sperm in the semen

Ø  Avoid taking bath for 24 hours after the operation

Ø  Wear T-bandage or scrotal support for 15 days

Ø  Avoid cycling or lifting heavy weight for 15 days

FEMALE STERILIZATIONS

Female sterilization (tubal ligation or Tubectomy) is a surgical procedure in which the fallopian tubes are cut and sealed in order to prevent fertilization

METHODS OF TUBAL LIGATION

1.       OCCLUSION METHODS

a)      PARTIAL SALPINGECTOMY

o   The pomeroy technique is one of the most frequent methods of tubal ligation

o   Tying a small loop of the tube by suture and cutting off the top segment of the loop

o   This can be done via laparoscopy or laparotomy

b)      CLIPS

o   Clamp the tube with a clip to obstruct blood flow and prevent fertilization

o   The clips are introduced in to the abdominal cavity via laparoscopic clip applicator

o   The clipped portion becomes necrosed due to lack of blood supply

c)       FALOPE RINGS

o   Tubal rings encircles a small loop of fallopian tube, block the blood supply, resulting in scarring and prevent passage of sperm or egg

o   The procedure is performed by inserting a laparoscope just under the umbilicus

d)      ELECTROCOAGULATION OR CAUTERIZATION

o   Electric current is used to coagulate or burn a small portion of each fallopian tube

o   The procedure is done via laparoscopy

2.       METHOD OF TUBAL LIGATION BY ENTRY SITES OR ROUTES

    LAPAROTOMY METHOD

a)      POMEROY METHOD

·         An occlusion type procedure in which a part of fallopian tube on each side is elevated to create a loop or knuckle

·         An absorbable  suture is tied around the elevated segment and cutting this segment

·         Pomeroy method is usually performed after delivery by cesarean section

b)      IRVING TUBAL LIGATION

·         Two ligatures are placed around the tube and the segment between ligature is removed

·         One end of the cut tube is sutured in to the back side of uterus and other end is buried in to the tissues underlying the tube

·         This method keeps the cut end healthy and reversal surgery is possible if needed

c)       UCHIDA METHOD

·         The fallopian tube is dissected at the midpoint , one end is ligated and  placed into a sac that has been created

·         The other end is tied and leave freely

·         This method is not using nowadays due to higher failure rate

LAPAROSCOPIC TUBAL LIGATION

v  An incision is made just inside the umbilicus under GA or LA

v  A laparoscope is inserted through the opening

v  An instrument for blocking the tube is introduced through another opening on the side

v  The fallopian tubes are blocked by the application of clips, rings, or cauterization

                       

                            MINILAPAROTOMY

·         Under LA an incision of 2.5 to 3cm is made in lower abdomen(just above the pubic hairline)

·         Lift the fallopian tube through the incision and block them using electro coagulation, clips or rings

·         This is very effective and safe technique and it differs from laparoscopy that no visualizing instrument is inserted

·         This is a good technique for post partum sterilization

                           VAGINAL TUBAL LIGATION (COLPOTOMY)

§  The fallopian tube is drawn out through a small opening made in the vaginal wall and ligate it with suture material

§  This procedure is done under LA and there will be no visible scar

TIMING FOR TUBAL LIGATION

Ø  POST PARTUM OR PUERPERAL TUBAL LIGATION : performed any time within the first three days of child birth

Ø  CESAREAN LIGATURE : procedure is done during cesarean section

Ø  INTERVAL TUBAL LIGATION : procedure is done after three months following delivery or abortion

Ø  CONCURRENT WITH MTP : sterilization is done along with termination of pregnancy

ADVANTAGES OF FEMALE STERILIZATION

ü  Very effective method of contraception

ü  Does not require continuous motivation or supervision

ü  Minimum complications

ü  Less expensive

ü  No interference with sex

DISADVANTAGES

v  Pain and local infections

v  Injury to internal organs

v  Bleeding at the incision site

v  Irregularity of menstrual cycles

 CONCLUSION

-          Permanent methods of family planning is a well-established contraceptive procedure for couples desiring no more children

-          Currently female sterilization account for about 85 percent and male sterilization for 10 to 15 percent in India

-          Permanent methods are most cost effective , one time method and gives effective protection against pregnancy