Gynaecology Pg No 215 -218 (Infertility&Contraception)
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Questions and Answers

What is the active ingredient in the Mirena IUCD?

  • Levonorgestrel (correct)
  • Ferrous fumarate
  • Ethinylestradiol
  • Copper

    • Copper T 380 A has a lifespan of 5 years.

    False

    What is the mechanism of action of the Mirena IUCD?

    Prevents implantation.

    Mala N contains __ mcg of Ethinylestradiol.

    <p>30</p> Signup and view all the answers

    Match the following IUCDs with their characteristics:

    <p>Copper T 380 A = T-shaped device with 10 years lifespan Multiload 375 = Device with bent arms for reduced expulsion Mirena = Hormonal IUCD releasing 20 mcg/day Lippes loop = 1st generation IUCD</p> Signup and view all the answers

    What is the primary function of Gynefix IUCD?

    <p>To prevent pregnancy</p> Signup and view all the answers

    The Implanon implant contains a higher dose of etonogestrel compared to the Nexplanon implant.

    <p>False</p> Signup and view all the answers

    What is the success rate of the Essure procedure for tubal occlusion?

    <p>99%</p> Signup and view all the answers

    The Implanon implant is inserted on the __________ arm.

    <p>non-dominant</p> Signup and view all the answers

    Match the following contraception methods with their key features:

    <p>Gynefix IUCD = Used in nulliparous females Implanon = Single rod implant Essure = Coiled device for tubal occlusion Nexplanon = Not radiopaque</p> Signup and view all the answers

    Which technique involves injecting saline to create a clear demarcation of the muscular layers?

    <p>Uchida's Technique</p> Signup and view all the answers

    The Madlener Technique involves ligating the distal part of the fallopian tube without any additional procedures.

    <p>False</p> Signup and view all the answers

    What is a common issue associated with Kroener Surgery regarding oocytes?

    <p>Failure of oocyte pick-up</p> Signup and view all the answers

    The __________ method is noted for having the least failure rate in fallopian tube surgery.

    <p>Cautery</p> Signup and view all the answers

    Match the following surgical techniques with their characteristics:

    <p>Irving Method = Proximal tube buried in myometrium Uchida's Technique = Includes hydrodissection Madlener Technique = Tubal crushing Kroener Surgery = High failure in oocyte pick-up</p> Signup and view all the answers

    Which method is the most commonly used for tubal ligation?

    <p>Laparoscopic tubal ligation</p> Signup and view all the answers

    The ring method of tubal ligation can be used during the post-partum period.

    <p>False</p> Signup and view all the answers

    What is the main purpose of the Mini lap technique?

    <p>To occlude and cut a loop in the isthmus of the fallopian tube.</p> Signup and view all the answers

    In the Pomeroy technique, the ligature is made using ____________________.

    <p>chromic catgut</p> Signup and view all the answers

    Match the following tubal ligation techniques with their key characteristics:

    <p>Pomeroy = Uses chromic catgut Modified Pomeroy = Uses plain catgut Parkland = Immediate separation of tube ends Mini lap = Loop occluded and cut</p> Signup and view all the answers

    Study Notes

    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
    Technique Failure Rate Recanalization
    Cautery Least Most
    Uchida
    Irving Most
    Modified Pomeroy Most
    Pomeroy Most
    Clips/Rings
    Others Least

    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.

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    Description

    Explore the various types of hormonal contraceptives and intrauterine devices (IUCDs). This quiz covers important details such as device characteristics, usage, and lifespan. Test your knowledge on contraceptive methods and their efficacy in family planning.

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