Gynaecology Pg No 215 -218 (Infertility&Contraception)

Hormonal Contraceptives

• Mala N (Pill): Contains Ethinylestradiol (30 mcg) and Levonorgestrel (150 mcg)
• Mala N Distribution: Provided free of cost in India

Intrauterine Devices (IUCDs)

• IUCD Generations:
  • 1st Generation: Lippes loop
  • 2nd Generation: Copper IUCD
  • 3rd Generation: Hormonal IUCD (mirena)
  • 4th Generation: Frameless IUCD

Copper T 380 A (Paraguard)

• Device Shape: T-shaped
• Copper Surface Area: 380 mm²
• Copper Release: 50 mcg per day
• Lifespan: 10 years

Multiload 375

• Copper Location: Vertical stems of the device
• Stem Design: Bent arms with spurs (for reduced expulsion)
• Thread Material: Nylon
• Lifespan: 5 years

Mirena (LNG 20)

• Active Ingredient: Levonorgestrel (LNG)
• Usage: Management of Abnormal Uterine Bleeding (AUB) and endometrial hyperplasia without atypia.
• Dosage: Releases 20 mcg/day
• Lifespan: 5 years
• Mechanism of Action (MOA): Prevents implantation (not anovulation)

Gynefix IUCD

• Classification: 4th generation IUCD
• Other Names: Copper fix IUCD/Flexiguard
• Suitable for: Nulliparous females
• Composition: Copper cylinders with nylon thread
• Placement: Sutured to myometrium
• Side Effects: Irregular bleeding, endometrial atrophy on continuous use leading to amenorrhea
• Advantages: Less pain, lower expulsion rate

Implanon

• Implant Type: Single rod
• Etonogestrel Content: 68mg (released at 60 mcg/day)
• Insertion Site: Non-dominant arm (medial side)
• Optimal Insertion Time: D-D menstrual cycle
• Contraception if inserted after Day 2: Additional contraception required for 3 days
• Classification: Long-acting reversible contraceptive (LARC)
• Availability: Not free of cost in India

Nexplanon

• Barium Sulfate in Stem: Present
• Radiopaque: No

Essure

• Device Composition: Coiled device with outer and inner cylinders
  • Outer Cylinder: Nickel + Titanium
  • Inner Cylinder: Stainless steel
• Insertion Location: Intramural/Interstitial part of fallopian tube (via hysteroscopy)
• Tubal Occlusion:
  • Occurs by inflammation (3 months)
  • Confirmed by HSG after 3 months
  • Alternative contraception needed up to 3 months
• Success Rate: 99%

Infertility and Contraception

• LARC (Long-acting reversible contraceptives): Implants, IUCDs, Injectables

Techniques for Fallopian Tube Surgery

Irving Method

• Steps:
  • Proximal tube portion is buried in the myometrium
  • Distal portion is ligated

Uchida's Technique

• Steps:
  • Hydrodissection: Saline injection into mesentery to demarcate muscular layers
  • Proximal tube end is ligated
  • Distal tube end is ligated and sutured along the mesentery

Madlener Technique

• Steps: Base of tube is ligated and the tube is crushed
• High Failure Rate

Kroener Surgery (Fimbriectomy)

• High Failure Rate, particularly for failure of oocyte pick-up

Failure Rate & Recanalization Chances

• Table summarizing: Failure rates and recanalization chances for different techniques

Surgical Contraceptives

Laparoscopic Tubal Ligation

• Most common method of ligation
• Fallope Ring Application: In the isthmus of the fallopian tube.
• Contraindications:
  • Postpartum period
  • 2nd trimester abortion

Mini Lap Technique

• Steps:
  • Loop made in isthmus of fallopian tube
  • Loop occluded with single/double ligature
  • Loop is cut

Mini Lap Techniques (Most Common)

Pomeroy

• Ligature type: Chromic catgut
• Absorbability: Absorbable
• Dissolution: Takes time to dissolve

Modified Pomeroy

• Ligature type: Plain catgut
• Absorbability: Absorbable
• Dissolution: Dissolves quickly

Parkland technique

• Steps:
  • Double ligation made in the loop of the isthmus
  • Loop is cut
• Advantages: Immediate separation of two ends of the tube

Notes

• The document contains diagrams illustrating surgical instruments and procedures.
• The diagrams depict different techniques used in tubal ligation, including rings, loops, and instruments like clamps and forceps.
• The diagrams show step-by-step procedures.