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Current Concepts in Contraception and Women’s Health
Swaraj Batra, Anjali Tempe, Leena Wadhwa
SECTION 1: DEMOGRAPHIC PATTERNS OF FAMILY WELFARE IN INDIA AND WORLD
CHAPTER 1:
Demographic Profile of India
CHAPTER 2:
Demographic Profile of the World
SECTION 2: CONTRACEPTION
CHAPTER 3:
Natural and Barrier Methods of Contraception
NATURAL METHODS OF FAMILY PLANNING
Mechanism of Action of Natural Family Planning Methods
Use/Effectiveness of NFP Methods
Advantages
Disadvantages
Fertility Awareness-based Methods
Effectiveness
1. Rhythm Method/Calendar Method
Standard Days Method (SDM)
Cycle Beads and the Standard Days Method
The Two Day Method
2. Basal Body Temperature (BBT) Method
How to Use?
Advantages
Disadvantages
3. Cervical Mucus Method
How to Use?
Advantages
Disadvantages
4. Symptothermal Method
How to Use?
Failure Rate
Lactational Amenorrhea Method
Mechanism of Action
Counseling
Indications
Contraindications
Advantages
Disadvantages
Effectiveness
Withdrawal Method
Mechanism of Action
Instructions for using Coitus Interruptus
Effectiveness
Advantages
Disadvantages
Contraindications
Abstinence
Indications for Abstinence
CONCLUSION
BARRIER CONTRACEPTIVES
Types of Barrier Methods
Condoms
History and Development
Male Condom
Types and Distribution
Types of Condoms
Animal Membrane
Types of Condoms Available in India
Government of India: Scheme
Free Distribution Scheme
Social Marketing Scheme (1968)
Technique of Use
Taking Off a Condom
Condom Care
Errors in Condom Use
Advantages
Disadvantages
Efficacy
Female Controlled Barrier Methods
Female Condom
Characteristics of Female Condom
Technique
Advantages
Disadvantages
Efficacy
Cervical Occlusive Cap
Types
History and Development
Diaphragm
Technique
Advantages
Disadvantages
Efficacy
Cervical Cap
Technique
Advantages
Disadvantages
Efficacy
Other Caps
Relatively Newer Cervical Cap
Lea's Shield
FemCap
Contraceptive Sponge
Advantages
Disadvantages
Spermicides
History and Development
Technique
Advantages
Disadvantages
Efficacy
CONCLUSION
CHAPTER 4:
Intrauterine Devices (IUDs)—Old and New
INTRODUCTION
History
Types of IUDs
The First Generation of Copper IUDs
The Second Generation of Copper IUDs
Characteristics of Widely Used Intrauterine Devices
Hormone-releasing IUDs
Mechanism of Action of IUDs
Selection of Patients for Intrauterine Contraception
WHO Category 1
WHO Category 2
WHO Category 3
WHO Category 4
Time of Insertion
Side Effects
Efficacy
CONCLUSION
CHAPTER 5:
Combined Oral Contraceptives (COCs)
CHAPTER 6:
Progesterone Only Pill (POP) and Others
CONCLUSION
INJECTABLE CONTRACEPTIVES
Progestogen Only Injectable Contraceptives (POIC)
Mechanism of Action
Efficacy
Continuation Rates
Advantages
Side Effects
Indications for Safe use of POIC
COMBINED INJECTABLE CONTRACEPTIVE (CIC)
Mode of Administration
Switching over from Other Methods
Mode of Action
Effectiveness
Indications for CIC Use
Contraindications for CIC Use
WHO Medical Eligibility Criteria
Side Effects
Limitations
Advantages
CENTCHROMAN
CHAPTER 7:
Contraceptive Implants, Patches and Vaginal Rings
INTRODUCTION
Contraceptive Implants
Mechanisms of Action
Technique of Insertion
Technique of Removal
Side Effects and Safety Profile
Metabolic Effects of Contraceptive Implants
Other Effects
TRANSDERMAL CONTRACEPTIVE PATCH (FIG 7.3)
Structure
Technique of Application
Activities not Affecting the Adhesive Quality
Side Effects
VAGINAL RINGS
Efficacy of Vaginal Ring
Pharmacokinetics
Mechanisms of Action
Insertion and Use
New User
Switching from another Contraception
Extended Use
Post MTP or Spontaneous Abortion
Safety Profile
Adverse Effects
Reasons for Discontinuation
WHO Eligibility Criteria for Contraceptive Rings
Category 1
Category 2
Category 3
Category 4
CHAPTER 8:
No Scalpel Vasectomy
NO-SCALPEL VASECTOMY (FIGS 8.1 TO 8.19)
Anesthesia in Vasectomy
OCCLUSION TECHNIQUES
INLINE METHOD OF VAS OCCLUSION
Effectiveness
Complications
Long-term Effects
Comprehensive Studies of Disease Incidence
Antisperm Antibodies
Prostate Cancer
Postvasectomy Pain Syndrome
Mortality
Vasectomy Regret and Reversal Regret
Reversal
Innovations
CHAPTER 9:
Permanent Method of Contraception in Females
SELECTION OF CASES
COUNSELING
Different Methods of Sterilization
Postpartum Minilaparotomy
Laparoscopic Sterilization
Concurrent Sterilization at Cesarean Section or Manchester Operation or Laparotomy done for Other Abdominal Operations
Interval Minilaparotomy
Vaginal Tubal Ligation
Hysteroscopy
Surgical Methods of Tubal Occlusion
Modified Pomeroy's Procedure
Parkland Technique
Complications of Tubal Ligation
Disadvantages
Recent Advances in the Sterilization Techniques
Contraindications
Advantages
Complications
Noncontraceptive Benefits of Tubal Ligation
CHAPTER 10:
Contraception in High-risk Women
INTRODUCTION
Diabetes Mellitus
Hormonal Contraceptives
Recommendations
Cardiovascular Diseases
Liver Disorders
HIV and AIDS
Recommendations
Epilepsy
Recommendations
Migraine
Recommendations
Obesity
Recommendations
Drug Interactions
Other High-risk Situations
Previous Cesarean
Lactation
Adolescent Age Group
Perimenopausal Age Group
Gestational Trophoblastic Disease
Contraception in Patients with Malignancy
Breast Cancer
Endometrial, Ovarian and Cervical Cancer
World Health Organization Eligibility Criteria for Contraceptive Use
CONCLUSION
CHAPTER 11:
Emergency Contraception
DEFINITION
INTRODUCTION
History
Compositions and Preparations
Mechanism of Action
Indications
Contraindications
Suitable Clients
Counseling
Method of Administration
Follow Up
Side Effects
Efficacy and Failure Rates
Salient Features of EC
Ethical, Legal and Social Issues
Future and Directions of Research
CHAPTER 12:
Male Contraception: An Insight into the Recent Developments
INTRODUCTION
Regulation of Spermatogenesis
HORMONAL CONTRACEPTIVES
Testosterone Preparations
Testosterone-progestogen Combinations
Estrogens in Male Contraception
GnRH Agonists
GnRH Antagonists
Selective Androgen Receptor Modulators (SARMs)
Adverse Effects and Long-term Considerations
Current Status of Steroid Hormones as Contraceptives
NON-HORMONAL AGENTS
Testicular Targets
Targeting Sperm Motility or Sperm-egg Fusion
HORMONAL CONTRACEPTIVE VACCINES
LHRH based Vaccines
LH/LH Receptor Vaccines
LH Vaccines
LH Receptor Vaccines
FSH based Vaccines
FSH Receptor base Vaccines
Future Prospects
NON-HORMONAL VACCINES
Epididymal Antigens
Spermatic Antigens
CONCLUSION
CHAPTER 13:
Recent Advances in Contraception
SECTION 3: HEALTH ISSUES AND NATIONAL PROGRAMS FOR WOMEN
CHAPTER 14:
Adolescent Health
INTRODUCTION
HEALTH PROBLEMS IN ADOLESCENTS
ONGOING NATIONAL PROGRAMS FOR ADOLESCENT HEALTH
12 by 12 Initiative
Overall Goals
Objectives
Important Components
THE ADOLESCENT HEALTH INITIATIVE IN RCH II
Components of RCH II
THE ADOLESCENT HEALTH INITIATIVE
Goal
Objectives
The Delhi Cabinet: Ladli Scheme
Kishori Shakti Yojna
University Talk AIDS Program
Mahila Samakhya Program
CHAPTER 15:
National Rural Health Mission (NRHM)
GOALS
STRATEGIES
Core Strategies
Supplementary Strategies
PLAN OF ACTION
Component (A): Accredited Social Health Activists
Component (B): Strengthening Sub-centers
Component (C): Strengthening Primary Health Centers
Component (D): Strengthening Chcs for First Referral Care
Component (E): District Health Plan
Component (F): Converging Sanitation and Hygiene under Nrhm
Component (G): Strengthening Disease Control Programs
Component (H): Public-Private Partnership for Public Health Goals, Including Regulation of Private Sector
Component (I): New Health Financing Mechanisms
Component (J): Reorienting Health/ Medical Education to Support Rural Health Issues
INSTITUTIONAL MECHANISMS
ROLE OF PANCHAYATI RAJ INSTITUTIONS (PRI)
ROLE OF NGOs IN THE MISSION
MAINSTREAMING AYUSH
FUNDING ARRANGEMENTS
TARGETS TO BE ACHIEVED
National Level
Community Level
MONITORING AND EVALUATION
MAMTA SCHEME
Introduction
Services under MAMTA
Eligibility Criteria
Other Benefits under MAMTA
Payment Schedules
CHAPTER 16:
Maternal Health and Women's Empowerment
INTRODUCTION
Reproductive Health Approach
ESSENTIAL COMPONENTS OF RCH PROGRAM
MAJOR ELEMENTS OF RCH PROGRAM
STRATEGY
Bottom-up Planning Community Need Assessment (Target Free Approach)
Abolition of Contraceptive Targets
Motivator Fee
Action Plan
Indicators
Evaluation
Comments
Decentralized Participatory Planning and Implementation
Strengthening Infrastructure
Integrated Training Package
Improved Management
RCH PACKAGE OF SERVICES
Package for Mothers
Other New Services
Package for Couples
Package for Children
Interventions
Monitoring and Evaluation
Program Interventions in Selected States/Districts
SPECIAL SCHEMES UNDER RCH PROGRAM
RCH Camps
Immunization Strengthening Project
Training of Traditional Birth Attendants (Dais)
Border District Cluster Strategy
Integrated Management of Neonatal and Childhood Illnesses (IMNCI)
Janani Suraksha Yojana
Funding of the RCH Program
Reproductive and Child Health ll
Components of RCH-II
Maternal Health Component of RCH II
Guiding Principles
Objectives
Strategies
First Referral Units (FRUs) for Comprehensive Emergency Obstetric Care
Package of Services
Behavior Change Communication (BCC) and Community Mobilization Strategies
Other Measures
Provide Skilled Care to Pregnant Women at the Community Level
Safe Medical Termination of Pregnancy
Community Level
Facility Level
Comments
RTI and STI Component of RCH II Objectives
Strategies
Community Level
Facility Level
Operational Research
NATIONAL POLICY FOR THE EMPOWERMENT OF WOMEN (NPEW) 2001
Introduction
Goal
Objectives
POLICY PRESCRIPTIONS
Social Empowerment of Women
LEGISLATION
Gender Sensitization
Panchayati Raj Institutions
Partnership with the Voluntary Sector Organizations
CHAPTER 17:
Reproductive Tract Infections (RTIs) in Gynecology
CHAPTER 18:
Prevention of Parent-to-child Transmission (PPTCT) and Post-exposure Prophylaxis (PEP) Guidelines
PREGNANCY AND HIV
MOTHER TO CHILD TRANSMISSION (MTCT)
Risk Factors For MTCT
PRE-PREGNANCY COUNSELING
MANAGEMENT OF PREGNANCY IN HIV POSITIVE WOMEN
WHO Based Guidelines
Antenatal Care
Intrapartum Care
Breastfeeding
NATIONAL AIDS CONTROL PROGRAM (NACP) GUIDELINES FOR PPTCT
Screening
Pre-test Counseling
Testing Strategy
Post-test Counseling
Intrapartum Care
Postpartum Care
Infant Feeding
ALTERNATIVE ARV PROPHYLAXIS REGIMES
Contraception
Post-exposure Prophylaxis (PEP) (Flow charts 18.1 and 18.2)
Basic Regimen
Alternate Basic Regimens
Expanded Regimen
COUNSELING
Follow Up Testing
CHAPTER 19:
National Cancer Control Program
CANCER EPIDEMIOLOGY/BURDEN OF CANCER IN INDIA
NATIONAL CANCER CONTROL PROGRAM (NCCP)
Basis of Control Strategy
Plan of Action
For primary prevention:
Treatment Facilities
Organizational Structure of NCCP
Planning and Budget
IMPLEMENTATION OF THE NCCP
Vaccines for Protection Against Cancer
NATIONAL CANCER REGISTRY PROGRAM (NCRP)
Cancer Atlas
NATIONAL AND INTERNATIONAL AGENCIES INVOLVED IN CANCER CONTROL IN INDIA
ICPO
IARC
Cervical Cancer Screening Projects
Breast Cancer Screening Projects
LIST OF REGIONAL CANCER CENTERS IN INDIA
CHAPTER 20:
Bone Health in Women
INTRODUCTION
DIAGNOSIS OF OSTEOPOROSIS
OSTEOPOROSIS: CLINICAL FEATURES AND BURDEN OF THE DISEASE
HOW TO PREVENT OSTEOPOROSIS AND MAINTAIN GOOD BONE HEALTH
Lifestyle
Calcium and Vitamin D
Calcium
Vitamin D and Sunshine
Other Nutrients
TREATMENT OF OSTEOPOROSIS
Postmenopausal Hormone Replacement Therapy with Estrogen
Raloxifene
Calcitonin
Teriparatide
CHAPTER 21:
Pre-conception and Prenatal Diagnostic Techniques (PC PNDT) Act—A Step Towards Combating Female Feticide
INTRODUCTION
Magnitude of the Problem
Reasons
Implications
Corrective Measures
Legal Initiatives
Preconception and Prenatal Diagnostic Techniques (Prohibition of sex selection) Act
Determination of Sex Prohibited
The Preconception and Prenatal Diagnostic Techniques [prohibition of sex selection] Rules
Role of Medical Professionals
Social Movement
SUMMARY
CHAPTER 22:
Medical Termination of Pregnancy (MTP)—Methods, Rules and Regulations
INTRODUCTION
Indications
Consent of Abortion
Qualification of Doctors
When MTP can be Done
Where MTP can be Performed
Punishment on Contravention (Amendment 2002)
DECISION-MAKING AND COUNSELING
PRE-ABORTION PROCEDURES
History
Clinical Examination
Laboratory Tests
FIRST TRIMESTER ABORTION METHODS
Surgical Methods
Suction Evacuation
Advantages (Table 22.2)
Drawbacks
Steps
Complications Immediate
Surgical
Anesthetic
Intermediate
Late
Menstrual Regulation
Advantages
Disadvantages
Manual Vacuum Aspiration (MVA)
Advantages
Dilatation and Evacuation
Steps
Medical Methods
Prerequisites for Medical Abortion
Drugs and their Pharmacology Mifepristone and Misoprostol
Regimen for Medical Abortion
Methotrexate and Misoprostol
Side Effects of Medical Methods
Contraindications
SECOND TRIMESTER ABORTION METHOD
Medical Methods
Intrauterine Instillation of Hypertonic Solution
Extra-amniotic
Intra-amniotic
Complications
Prostaglandins
Routes of Administration
Advantages
Disadvantages
Oxytocin
Surgical Methods
Dilatation and Evacuation
Hysterotomy
Hazards
Immediate
Remote
Postprocedural Care
CONCLUSION
CHAPTER 23:
Assisted Reproductive Technology (ART) Guidelines
SEMEN BANKS
Other Issues/considerations
Categories of Infertility Care Units
Primary (Level 1A) Infertility Care Units
Primary (Level 1B) Infertility Care Units
Secondary (Level 2) Infertility Care Units
Tertiary (Level 3) Infertility Care Units
Proposals Under Consideration by the Ministry
SECTION 4: BIOSTATISTICS
CHAPTER 24:
Biostatistics
INTRODUCTION
Types of Study Designs (Fig. 24.1)
Sampling
TESTS OF STATISTICAL SIGNIFICANCE
Errors in Hypothesis Testing
Two types of errors (Type-I and Type-II error)
CALCULATING THE SAMPLE SIZE
VALIDITY AND RELIABILITY OF A TEST (TABLE 24.1)
Sensitivity and Specificity
Positive and Negative Predictive Value
RELATIVE RISK AND ODDS RATIO (TABLE 24.2)
Relative Risk
Attributable Risk
Odds Ratio (OR)
CALCULATING STRENGTH AND TYPE OF RELATIONSHIPS
Association
Correlation
Correlation Coefficient
Spearman's Rank Correlation
Regression
Types of Regression
Simple and Multiple Regressions
Logistic Regression
STATISTICAL METHODS USED FOR DATA ANALYSIS
25:
Appendices
WHO Categories for Temporary Methods
Simplified 2-Category System
WHO Categories for Female Sterilization and Vasectomy
WHO Medical Eligibility Criteria for Starting Contraceptive Methods
New or Redefined Conditions and Criteria described by 2003 WHO Expert Working Group
Drug Interactions
Drugs that affect liver enzymes
Medical Eligibility Criteria Considered by the 2003 WHO Expert Working Group for IUDs
INDEX
TOC
Index
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