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PSM MBBS > Demography, family planning > Flashcards

Demography, family planning Flashcards

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1
Q

Annual growth rate

Malthusian model

A

AGR=(crude birth rate-crude death rate)/10

0.5-1% is moderately growing
India 1.2%
1% ➡️ doubling time 70 years
Malthusian model

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2
Q

Dependency ratio

A

(No of dependent population)/(No of independent population)*100

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3
Q

Demographic trap

A

Demographic trap is difficulty to decline the birth rate because of decline rate (and increase in birth rate)
It is seen in stage II

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4
Q

Sex ratio

Female deficit syndrome

A

Sex ratio =(no of females)/1000 males
Female deficit syndrome:
Decrease in no of female population
It leads to ecological imbalance

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5
Q

Effective literacy rate

A

(People who can read and write age >7 yr)/(total population of age >7 yr)*100

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6
Q

General fertility rate

A

Live birth/WRA*1000

Women in reproductive age group

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7
Q

Total fertility rate

A

(No of live birth ASFR)/WRA*1000
Women is reproductive age group
Assuming age specific fertility pattern

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8
Q

Age specific fertility rate

A

(No of children in a specific age group)/(total no female in that age group)*1000

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9
Q

Gross reproduction rate

A

(Total no of daughters ASFR)/ WRA * 1000

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10
Q

Net reproduction rate

A

(No of daughters ASFR and ASMR) / WRA * 1000
The most refined/sensitive/best epidemiological indicator
Best indicator for growth of population
Best indicator for family planning implementation services

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11
Q

Crude birth/death rate

A

(No of births or deaths in an area in a year)/ mid year population of same year *1000

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12
Q

Child women ratio

A

(No of children of 0-4 years)/WRA * 1000

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13
Q

Survey systems

A
  1. Civil registration systems
  2. Sample registration system
  3. National family health survey
  4. District level household survey
  5. Census
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14
Q

Planned family

A
  1. 1st child is after 20 years of the mother’s age
  2. Minimum of 3 years between 2 children
  3. Limited size of collagen (2 or 3)
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15
Q

Requirements of stable population

A
  1. CPR of 60%
  2. TFR of 2.1
  3. NRR of 1
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16
Q

Male condoms

A

Latex
Failure rate: 2 or 3 to 40 HWY (hundred women years)
M/C side of failure: incorrect usage

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17
Q

Female condoms

A

Polyurethane
Prelubricated with silicone
Failure rate: 4 or 5 to 20 HWY
Less effective in preventing pregnancies and STDs compared to male condoms

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18
Q

Diaphragm

A

Dutch cap
Not recommended under the National family planning program
Used before intercourse and left for 6 hours post coital ➡️ chance of toxic shock syndrome
Failure rate: 6-12 HWY

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19
Q

IUDs

A 
1. 1st generation:
 Lippes loop, Graffenberg’s ring
2. 2nd generation:
 CuT-220, CuT-380, CuT-380
 Nova T 
 Multiload device-
  •CuT 375
  •CuT 250
3. 3rd generation: hormonal
 LNG-20, Progestasert
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20
Q

3rd generation IUDs

A 
1. Mirena (LNG-20) 
 For 7-10 years
 Levonorgestrel 
 20 mcg progesterone/day
 Lowest failure rate
2. Progestasert:
 For 1 year
 Natural progesterone
 Loading dose 38 mg ➡️ 65 mcg/day
 Lowest expulsion rate
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21
Q

Second generation IUD

A
  1. CuT-220, CuT-380- used nowadays
  2. CuT-380 applicable for 10 years
  3. Nova T ➡️ for 5 years
  4. Multiload device-
    •CuT 375
    •CuT 250 for 3-5 years
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22
Q

Mechanism of action of IUD

Study These Flashcards
A

Inhibits fertilization
Highly effective: 0.5-1.5 failure rate
1. Askers biochemical environment of cervical mucus
2. Thickens cervical mucus
3. Foreign body reaction ➡️ implantation 🔽

23
Q

Absolute contraindications of IUD

Study These Flashcards
A
  1. 🤰
  2. Undiagnosed vagina bleeding
  3. PID
  4. Cervical cancer
  5. Carcinoma of genital tract
  6. Previous ectopic pregnancies
24
Q

Relative contraindications of IUD

Study These Flashcards
A
  1. Previous history of PID
  2. Congenital malformations
  3. Cervical discharge
  4. Anemia
  5. Menorrhagia
  6. Unmotivated females
25
Adverse effects of IUD
1. Pain 2. Bleeding 3. PID 4. Ectopic pregnancy 5. Perforation 6. Expulsion 7. 🤰 with IUD in situ ➡️ abortion, if not: • thread visible ➡️ pull out • thread not visible ➡️ sepsis ➡️ evacuate the uterus
26
Chemical classification of hormonal contraceptives
``` 1. Pregnane: Medroxy progesterone acetate Megestrol 2. Estrane: Norethisterone Lynestrenol Ethynodiol diacetate 3. Gonane: levonorgestrel ```
27
Physical classification of hormonal contraceptives
``` 1. Oral pills: Combined oral Progesterone only Post coital Long acting Male 💊 2. Depot formulations: Injectable Implants ```
28
Combined oral pills | Examples and composition
``` Mala N: National program (free) 21 tablets Mala D: social marketing scheme 21 + 7 (ferrous fumarate 60 mg) 21 ➡️ levonorgestrel 0.15 mg and ethinyl estradiol 0.03 mg ```
29
Combined oral pills | Mechanism and effectiveness
``` Mechanism: 1. Disrupts hypothalamus-pituitary axis 2. Stoppage of OCP after 21 days leads to withdrawal bleed (less amount of bleeding) ➡️ less chance of anemia Effectiveness: More effective than IUD ```
30
Adverse effects of OCPs
``` 1. Metabolic: Obesity, hypertension, dyslipidemia 2. Cardiovascular: Atherosclerosis 3. Carcinogenic: Cervical, breast, HCC 4. Liver diseases, slight inhibition of lactation 5. Ectopic 🤰 in progesterone only pills ```
31
Benefits of OCPs
1. Regulation of menstrual cycles 2. Contraceptive benefits 3. 🔽 benign breast disease, fibroadenoma 4. 🔽 Ca ovary, endometrium, ovarian cyst 5. 🔽 PIDs 6. 🔽 iron deficiency anemia
32
Absolute contraindications of OCPs
1. Ca breast, genital cancers 2. 🤰 3. Severe liver disease 4. Thromboembolism, DVT 5. Cardiac abnormalities 6. Congenital hyperlipidemia 7. Undiagnosed vaginal bleed
33
Relative contraindications to OCPs
1. Age >40 2. Smoker 🚬 , age >35 3. Diabetes mellitus, gall stone 4. Epilepsy migraine
34
Progesterone only injectables
``` 1. DMPA Depot medroxy progesterone acetate: 150 mg IM, 3 monthly, >35 year old 2. NET-EN norethisterone enatiate: 200 mg, 2 monthly 3. Depo Sub Q Provera 104: DMPA sc. 4. Antara program: MPA 150 mg IM, 3 monthly ```
35
Combines injectables
1. Cyclo provera 2. Cyclofem 3. Mesigyna
36
Contraindications of progesterone only injectables
1. Undiagnosed vaginal bleeding 2. Genital malignancy of Ca cervix 3. 🤰
37
Implants
Subdermal Commonly used in India is Norplant Made of silastic capsules R2: 2 rods containing 35 mg LNG
38
Post coital/emergency contraception
``` 1. IUDs Best and most effective Within 5 days 2. LNG 1.5 mg single dose within 72 hours 3. Mifepristone (RU-486) 10 mg within 72 hours ```
39
Gossypol
Male contraceptive Inhibition of spermatogenesis Natural product - Chinese plant (cotton seed) S/E: azoospermia
40
Centchroman | Brand name: Chhaya
Non-hormonal contraceptive Mechanism: Selective Estrogen Receptor Modulator SERM It has 30mg of methoxychroman hydrochloride Chemical responsible: ormeloxifene Can be used against dysfunctional uterine bleeding
41
Centchroman | dose
Twice weekly for 3 months, followed by once weekly till required If a female misses a dose in more than 2 days, alternate contraception is used, followed by normal schedule
42
Centchroman contraindications
1. PCOD 2. Lactation 3. Hepatic disease 4. Cervical hyperplasia 5. Hypersensitivity
43
Natural method of contraception
1. Coitus interruptus 2. Calendar 📆 /rhythm method • cycle of beads • persona: a digital device Check hormonal levels in the morning urine 3. Abstinence 4. Basal body temperature 5. Cervical mucus thickening (Billing method)
44
Tubectomy
Can be done as a mini laparoscopic procedure Incision size: 2.5-3 cm Done under local anesthesia Can be done in mass sterilization camps/PHC/ village level
45
Vasectomy
``` Most common type: Non-scalpel vasectomy No hematoma 🔽 passion 🔼 user friendly NSV on India is funded by UNFPA (United Nations Fund for Population Activities) ```
46
Complications of non-scalpel vasectomy
``` 1. Operative complications: Pain, local infection 2. Hematoma 3. Sperm granules: Appears 10-14 days past operation Reasoned spontaneously 4. Spontaneous recanalisation (0-6% chance) 5. Auto immune response: not harmful 55% antigen antibodies ```
47
Vasectomy | failure
Failure rate: 0.15 HWY M/C reasons: • Operative • Non-compliance to post operative advice People who have undergone vasectomy should use alternate contraception for a period of 8-9 weeks or 30 ejaculations
48
ESSURE
Permanent method of contraception A micro filament stent, micro essure is inserted into Fallopian tube Technique is called Essure technique Process: a tubal blockage is created After 6 weeks, hysterosalpingography is done to confirm sterilization
49
Reasons for MTP
``` S. Social: unmarried, poor H. Humanitarian: rape victim E. Eugenic: genetic F. Failure of contraception T. Therapeutic: maternal ```
50
Who can perform MTP | Where can it be performed
Any MBBS doctor who is a registered medical practitioner and has: • at least 6 months residency in obg • at least 25 cases of MTP under supervision • a degree/diploma in og Any healthcare centre with facility to do emergency laparotomy or major gynecology surgeries
51
How to perform MTP | When
<6 weeks: Ideal MTP Misoprostol + mifepristone >6 weeks: Medical or surgical methods based on doctors opinion It is usually done within 12 weeks of gestation >12 weeks to <20 weeks MTP is done only after consultation with 2 doctors Consent is required
52
Failure rate of contraception measures
Life table analysis: Observe the females in reproductive age group to analyze any accidental pregnancies Pearls index: =(no of accidental pregnancies) / (total no of women years exposure) *100
53
Contraception of choice
1. Unmarried sexual active 👱🏽‍♀️: barrier method > OCP 2. Married nulliparous 👱🏽‍♀️ who wants to delay 👶: OCP 3. Married 👱🏽‍♀️, mother of one, wants to delay 2nd 👶: IUD 4. ‘3.’ but she is obese, has DM, dose not prefer IUD: • educated - Chaaya • uneducated - Antara 5. Married👱🏽‍♀️ with 3 children, wants to delay 4th child: Tubectomy > cheaper vasectomy

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