PERMANENT FAMILY PLANNING - PowerPoint Presentation

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PERMANENT FAMILY PLANNING

Kenneth

Ruzindana

, MD

Lecturer,

University of

Rwanda College

of Medicine and Health

Sciences

Department

of Obstetrics and Gynecology

Kigali

University Teaching Hospital (CHUK/KUTH)

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Objectives

Define permanent family planning methods

Identify male and female permanent family planning methodsDescribe benefits and risks of permanent family planning methodsExplain the techniques of vasectomy and female sterilizationIdentify misconceptions of permanent family planning methods

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Surgical procedure to permanently and intentionally terminate male and female reproductive function.

Appropriate for men and women who made a

fully

informed and well considered decision.

Successful infertility rates for vasectomy > 98%Most are not reversiblePermanent Family planning include: Vasectomy for menBilateral tubal ligation for women

Definition

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Vasectomy

For men who do not want more childrenTransection and occlusion of the vas deferensAlso called male sterilization, male surgical contraception

Outpatient procedure by local anesthesiaNo interference with sexual performanceOne of the least-used forms of contraception in Rwanda

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Techniques

of Vasectomy

• Scalpel and Non-scalpel• Palpate the vas through the scrotum• Grasp the vas with fingers or forceps• Pull loop of vas and remove segment• Ligate one or both ends of the vas• Bury the proximal stump

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Anatomy of male reproductive

organ

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Indications for Delaying Vasectomy

• Active STIs• Swollen and tender testes• Scrotal skin infection• Bilateral un-descended testes

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Benefits of Vasectomy

Failure is less than 1%Reason for failure can be: • Unprotected intercourse soon (before azoospermia is documented – approx. 3 months) • Failure to occlude the vas (technical errors) • RecanalizationSafer and more effective than tubal ligation0.5 deaths per 100,000 vasectomies

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Complications

of Vasectomy

Side effects are uncommon to very rareBleedingTesticular and scrotal pain lasting for months (Post-vasectomy pain syndrome)Surgical site infectionHematomaSperm Granuloma

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Follow up to Confirm Sterility

80% of patients are

azoospermic after three months and 20 ejaculationsSemen analysis to done 3 months post operatively: during this time, another form of contraception to be used.Vasectomy failure: considered if motile sperm are confirmed on the follow up examination, there have been a sufficient number of ejaculations (>20) and >3 months have elapsed since the procedure.

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Female Sterilization

• For women who do not want more children and/or with medical problem

• Also called tubal sterilization, tubal ligation, voluntary surgical contraception• Occlusion of the tubes in some form

Most widely used globally - 210 million couples and 28% in the US• Least popular in Rwanda – only 0.1%

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Methods

of Tubal Ligation

Pomeroy methodParkland (modified Pomeroy) methodIrving methodUrchida method

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Pomeroy Method

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Parkland Method

The Parkland method is similar to the Pomeroy, but the segment of tube is ligated at two points, instead of jointly as a "knuckle“.

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Urchida Method

Most complex method

Extremely low failure rate

PitfallsBleedingRetraction of the distal segment

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Timing

of Female Sterilization

• At the time of Cesarean section  • Postpartum minilaparotomy: Immediately after delivery or within 24hrs May be done up to 7days later• Interval minilaparotomy (unrelated to pregnancy).• Post abortion

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Minilaparotomy

for Tubal Ligation

Ligation of the fallopian tubes through 3-4cm incision on the abdomen, can be done: • As an outpatient procedure • By local anesthesia and sedationMinilaparotomy following vaginal delivery: • Enlarged uterus, tubes in the mid abdomen, 3-4 cm sub umbilical incisionInterval minilaparotomy: • Short transverse suprapubic incision Uterine elevator used through the vagina

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Indications for Delaying Tubal Ligation

• Current pregnancy

• Less than 6 weeks postpartum• Severe postpartum or post abortion complications• Unexplained vaginal bleeding

• Pelvic inflammatory disease and STIs• Pelvic malignancies

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Benefits of Female Sterilization

• No known side effect• Helps to protect against unwanted pregnancy• Nothing to remember and no worries about contraceptives again

• Significantly reduces risk of pelvic inflammatory disease (PID)• May protect against Epithelial Ovarian Cancers (non contraceptive benefit)

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Risks of Female Sterilization

Few complications• Related with surgery, anesthesia, previous surgery, PID, Obesity, and DM• 1-2 deaths /100,000 cases

• 2 pregnancies per 100 women over 10 years• Possibility of future regret • Young age • Lost a child • Few or no children • Not married/Marital problems

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Counseling on Female Sterilization

Counseling is critical:

• Potential risks • Benefits • Possibility of later regret • Possibility of pregnancy (mostly ectopic)

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Summary

• Permanent methods are irreversible

• Non-scalpel vasectomy in men and bilateral tubal ligation for women are preferred• Permanent methods are the least popular in Rwanda• Detailed counseling is essential• Rare complications - not related to method

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Case

study

• 20 year old woman come to your clinic for family planningShe and her husband decided that tubal ligation is best for them.The couple has one child.

•What important issue would you like to raise during the counseling?•Take 3 minutes to reflect

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Case

study

• 20 year old woman come to your clinic for family planningShe and her husband decided that tubal ligation is best for them.The couple has one child.

•What important issue would you like to raise during the counseling?•Take 3 minutes to reflectPAUSE

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Considerations in the Case

• Check if it is well thought through

• Discuss the possibility of future regret as the method is irreversible• Mention other alternative family planning methodsCase study