Concept of Norplant – This course is designed to understand the care of pregnant women and newborn: antenatal, intra-natal and postnatal; breast feeding, family planning, newborn care and ethical issues, The aim of the course is to acquire knowledge and develop competencies regarding midwifery, complicated labour and newborn care including family planning.
Concept of Norplant
Norplant consists of 6 sialistic rods insetedsubdermally in the upper arm, which release the progesterone levonogestrel and last for 5 yejrs. Insertion & removal of Norplant must be done by a trained healthcare professional.
A. Advantages of Norplant:
- Highly effective
- Reversible
- Long acting – 5 years
- Blood level remains steady.
- No effect on blood pressure or heart due to absence of estriogen.
- Highly convenient, non-intercourse related.
- Reduction of menstrual disorder-Less heavy bleeding Less anaemia. Less dysmenorrhoea. No ovulation pain.
- No premenstrual tension
- Less PID.
- Less extra-uterine pregnancy
- Less functional ovarian cyst.
- Protection against endometrial Ca, Breast Ca.
- Beneficial effects on sickle cell diseases.
B. Disadvantages:
- After removal, return of fertility need 6-12 months.
- Disturbance of menstrual cycle is so marked and variable.
- Amenorrhoea.
- Weight gain.
- Galactorrhoea.
- Mild androgenic effect: ache.
- Subjective effects- lassitude, depression, vaginal dryness, loss of libido, leg cramps, headache.
- Breast tenderness or pain; mastalgia
Injectable contraceptive
A. Injectable contraceptive:
These are –
1. Depot medroxy progesterone acetate 150 mg (DMPA or Depo provera) Im sinjection lasts around 3 months.
2. Norethisteroneenanthate 200 mg IM only last for 2 months. Most women choose Depo provera
B. Mode of action:
1. Atrophic change in the endometrium, thus prevents implantation
2. Making cervical mucus thick, so sperm cannot enter into the cervix
3. Inhibition of ovulation by suppressing the mid cycle LH Peak.
C. Indication of Depo provera:
1. A short term basis following a pregnancy or abortion (when irregular bleeding is of little account)
2. Long term basis in women for whom other contraceptive are unsuitable or contra indicated
3. Difficulty in remembering to take a pille
4. Painful periods
5. PMS
D. Side effects:
1. Weight gain of around 6 Ib in the 1st year
2. Delay in return of fertility-it may take about 6 months longer to conceive than after stopping COC
3. Persistent menstrual irregularity
4. Very long term use may slightly increase the risk of osteoporosis (because of low estrogen levels).
Complication of Injectable Contraceptive:
1. Irregular bleeding
2. Weight gain
3. Delayed return of fertility
4. Galactorrhoea
5. Enuresis
6. Amenorrhoea
7. Persistent menstrual.
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