WEST BENGAL NURSING COUNCIL
Final Year General Nursing & Midwifery (3 Years) Examination, June 2026
Subject – Midwifery & Gynaecological Nursing (Paper: I)
SUBJECTIVE | Full Marks – 75 | Time Allowed – 3 hours
Answer the following questions.
5. (a) Define the term Puerperium. (b) What are the physiological changes that take place in the reproductive organs in normal Puerperium? (c) Mention the common complications that may arise during Puerperium. (d) Write down the preventive measures that can reduce the Puerperal Sepsis. (2+6+3+4=15)
Or, (a) What are the indications of Caesarean Section? (b) Write down the post-operative care of a mother with Caesarean Section for 1st 48 hours. (c) Enlist the advice to be given to the mother with Caesarean Section during discharge. (3+7+5=15)
6. (a) Define Infertility. (b) What are the causes of Infertility? (c) Enlist the investigations required for Infertility treatment. (d) What are the social problems arise due to infertility? (2+5+5+3=15)
7. (a) What is Asphyxia Neonatorum? (b) Write down the management of Asphyxia Neonatorum. (2+8=10)
8. Write short notes (any three): (5×3=15)
(a) Prevention of anaemia in pregnancy (b) Postnatal exercise (c) Prostaglandin (d) Nurses’ responsibilities to newborn undergoing phototherapy (e) Temporary family planning methods for female.
ANSWERS:
5 (a) Definition of Puerperium: Puerperium is defined as the period following childbirth during which the body tissues, specifically the pelvic organs, revert back approximately to their pre-pregnant state, both anatomically and physiologically. This period begins as soon as the placenta is expelled and lasts for approximately 6 weeks.
5(b)Physiological Changes in Reproductive Organs in Normal Puerperium
The primary retrogressive change during the puerperium is involution, where the genital organs return to their nonpregnant state.
Uterus:
Size and Weight: Immediately after delivery, the uterus is firm and weighs about 1,000 g, measuring approximately 20 cm in length,12cm breadth and 7.5 cm3 thickness. By the end of 6 weeks, it regresses to almost its nonpregnant size and weighs about 60 g.
Muscles: The number of muscle fibers does not decrease; rather, there is a substantial reduction in the size of individual myometrial cells through autolysis of the protoplasm by collagenase and proteolytic enzymes, induced by the withdrawal of estrogen and progesterone.
Blood Vessels: Arteries at the placental site constrict and undergo thrombosis, hyalinization, and fibrinoid endarteritis, eventually being replaced by new vessels.
Endometrium: The superficial part of the decidua becomes necrotic and is cast off in the lochia. Regeneration of the endometrium begins by the 7th day from the gland mouths and interglandular stromal cells, completing by day 16, except at the placental site, which takes about 6 weeks.
Lower Uterine Segment: Immediately after delivery, it is thin and flabby but takes a few weeks to revert to the normal isthmus shape.
The rate of involution can be assessed clinically by noting the height of fundus, following delivery the fundal height is 5.5inch. First 24 hours level is same there after 0.5 inch decrease every 24 hrs, by second week, uterus becomes pelvic organ.
Cervix: The cervix contracts slowly. For a few days, the external os admits two fingers, narrowing to admit only a fingertip by the end of the first week. It never fully reverts to the nulliparous state.
Vagina: The vagina takes 6–10 weeks to involute. Rugae partially reappear by the 3rd week, but the introitus remains permanently larger than in the virginal state. Hymen is lacerated and represented by nodular tag: carunculae myrtiformes.
Lochia: This is the vaginal discharge occurring for the first fortnight of puerperium, originating from the uterine body, cervix, and vagina. It evolves through three stages:
- Lochia rubra (Red): Lasts 1–4 days; consists of blood, shreds of fetal membranes, and decidua, vernix caseosa, lanugo, meconium.
- Lochia serosa (Yellowish Pink / pale brown): Lasts 5–9 days; contains fewer RBCs, leukocytes, wound exudate, and mucus, microorganisms.
- Lochia alba (Pale White): Lasts 10–15 days; contains decidual cells, leukocytes, and mucus, fatty and granular epithelial cells, microorganisms.
Average discharge first 5-6 days is 250ml.
5(c) Common Complications of Puerperium :
The puerperium can be complicated by various conditions, classified as immediate, early, or delayed emergencies,
Puerperal Sepsis and puerperal pyrexia: Infection of the genital tract within 6weeks. Symptoms: fever, foul-smelling lochia, abdominal pain, malaise.
Subinvolution: Impaired or retarded involution of the uterus. Leads to prolonged lochia, irregular bleeding.
Urinary Complications: Urinary tract infection (UTI), retention of urine, and incontinence.
Breast Complications: Breast engorgement, cracked/retracted nipples, mastitis, breast abscess, and lactation failure.|
Venous Thromboembolism: Deep vein thrombosis and pulmonary embolism.
Secondary Postpartum Hemorrhage: Delayed hemorrhage occurring between the 8th and 14th day.
Psychiatric Disorders: Puerperal psychosis and postpartum depression, postpartum blue
Perineal complications: Wound infection Episiotomy breakdown Hematoma formation.
Gastrointestinal Problems: Hemorrhoids, postoperative ileus (c-section).
Complications After Cesarean Section: Wound infection, Wound dehiscence, Endometritis, Adhesion formation
5(d) Preventive Measures of Puerperal Sepsis
Puerperal sepsis is a wound infection that can be largely prevented through careful measures taken before, during, and after labor.
Antenatal Prophylaxis:
Improve the nutritional status of the pregnant woman to raise hemoglobin levels.
Eradicate any septic foci such as skin or throat infections.
Intranatal Prophylaxis:
Maintain full surgical asepsis during delivery.
Screen high-risk patients for Group B Streptococcus.
Administer prophylactic antibiotics at the time of cesarean section to reduce wound infection and endometritis.
Avoid traumatic vaginal delivery and hemorrhage.
Postpartum Prophylaxis:
Maintain aseptic precautions for at least 1 week after delivery until genital tract wounds heal.
Restrict the number of visitors.
Use sterilized sanitary pads.
Isolate infected mothers and babies.
5 or a Indications for Caesarean Section
Indications are broadly categorized into absolute and relative.
Absolute Indications (Vaginal delivery is impossible):
Central Placenta Previa: Where the placenta covers the internal os.
Contracted Pelvis or Cephalopelvic Disproportion (Absolute): Severe disparity between the fetal head and maternal pelvis.
Pelvic Mass: Tumors like cervical or broad ligament fibroids causing obstruction.
Advanced Carcinoma Cervix. Vaginal Obstruction: Atresia or stenosis.
Relative/Common Indications (Vaginal delivery may be unsafe): Failed induction.
Previous Cesarean Delivery: Especially with recurrent indications (contracted pelvis) or history of two or more previous CDs.
Fetal Distress: Non-reassuring fetal heart rate (FHR).
Dystocia: Failure to progress in labor due to inefficient uterine contractions, large fetus, or small pelvis.
Antepartum Hemorrhage: Placenta previa or abruptio placentae.
Malpresentation: Breech, transverse lie (shoulder), or brow presentation.
Medical Disorders: Uncontrolled diabetes, heart disease, or severe pre-eclampsia/eclampsia.
Bad Obstetric History: Recurrent fetal loss, on maternal request.
5 or b) Post-operative Care of C-Section
Post-operative care involves monitoring the mother during the immediate recovery phase and subsequent days.
First 24 Hours (Day 0):Observation: Periodic checks of pulse, blood pressure, amount of vaginal bleeding, and uterine retraction for the first 6–8 hours.Fluids: Intravenous infusion (Sodium chloride or Ringer’s lactate) is continued until 2.0–2.5 liters are infused. Blood transfusion is given if blood loss was above average (approx. 0.5–1.0 L) or if the mother is anemic.
Medications: Oxytocics: Oxytocin (5 units IM/IV) or Methergine (0.2 mg IM)/ misoprostol 600mcg is administered to maintain uterine contraction.
Analgesics: Pethidine hydrochloride (75–100 mg) is given for pain relief.
Antibiotics: Prophylactic antibiotics are given to prevent infection.
Ambulation: The patient is encouraged to move legs and ankles to minimize thrombosis. She may sit up or get out of bed to void urine if her condition permits.
Breastfeeding: The baby is put to the breast after 3–4 hours or sooner once the mother is stable and relieved of pain.
Subsequent Days (Day 1 onward):
Diet: Oral feeding (plain water/tea) starts on Day 1. Light solid diet is given on Day 2 once bowel sounds are active.
Bowel Care: Lactulose may be given if bowels do not move spontaneously.
Stitch Removal: Abdominal stitches are usually removed on Day 5 (transverse incision) or Day 6 (longitudinal incision).
or 5 (c) Discharge Advice for C-Section
The patient is usually discharged on the day following stitch removal (5th to 6th post-operative day) if fit. Advice includes:
General Health: Continuation of supplementary iron therapy to improve general health.
Infant Care: Instructions regarding breastfeeding and care of the newborn.
Rest and Activity: Procedures for a gradual return to day-to-day activities.
Contraception: Guidance on family planning. Non-lactating women should start contraception after 3 weeks, while lactating women should start 3 months after delivery.
Follow-up: A postnatal check-up is advised after 6 weeks. The patient should report immediately if complications like fever, pain, or bleeding arise
6a. What is Infertility?
Infertility is defined as a failure to conceive within one or more years of regular unprotected coitus.
• Primary Infertility: Denotes couples who have never been able to conceive
• Secondary Infertility: Indicates a previous pregnancy (regardless of outcome) but failure to conceive subsequently
6b Causes of Infertility
Infertility can result from male factors, female factors, or a combination of both.
A. Causes of Male Infertility:
Endocrinal Disorders: Pituitary failure (tumor, radiation), hypothalamic dysfunction, hyperprolactinemia, thyroid disorders, and adrenal hyperplasia. Gonadotropin deficiency.
Anatomic Disorders: Congenital absence of vas deferens, undescended testis, hypospadias, or obstruction of the vas deferens.
Abnormal Spermatogenesis: Chromosomal abnormalities (e.g., 47 XXY), mumps orchitis, cryptorchidism, or exposure to chemicals/radiation.
Abnormal Motility: Absent cilia, varicocele, or antibody formation.
Sexual Dysfunction: Retrograde ejaculation, impotence, or decreased libido.
Toxins: Drugs, smoking, and radiation.
Genetic factors: Y chromosome deletions, single gene mutation
Surgery: Herniorrhaphy, Vasectomy, bladder neck surgery.
B. Causes of Female Infertility:
Ovarian Factors:
◦ Dysovulatory/Anovulation: Caused by PCOS, hyperprolactinemia, hypothalamic or pituitary insufficiency, or thyroid/adrenal disease.
◦ Premature Ovarian Failure (POF): Early depletion of follicles before age 40.
◦ Luteal Phase Defect: Corpus luteum insufficiency.
ovarian tumor, ovarian resistance, premature ovarian failure.gonadal dysgenesis
Tubal and Peritoneal Factors:
◦ Tubal blockage or spasm, salpingitis, peritubal adhesions, or previous tubal surgery/sterilization, endosalpingeal damage, polyps within lumen.
◦ Pelvic endometriosis.
Uterine Factors:
◦ Fibroids, chronic endometritis (TB), synechiae (adhesions), or congenital malformations.
◦ Un favourable endometrium for nidation.
Cervical Factors: Chronic cervicitis, presence of antisperm antibodies, stenosis, or scanty/abnormal vaginal mucus. Second degree uterine prolapse, acute retroversion of uterus
Vaginal Factors: Atresia, septum, or narrow introitus.
Pelvic factors: Inflammatory disease, appendicitis, uterine adhesions, endometriosis
Combined Factors: Advanced age (over 35), infrequent intercourse, anxiety, and immunological factors, use of lubricants during intercourse. Dyspareunia, apareunia.
6c Investigations for Infertility
Investigations aim to identify the underlying cause in both partners.
A. Female Investigations:
• History and Examination: Includes menstrual history cycle duration, medical/surgical: pelvic surgery history including tb, sti,pid, abd surgery, and pelvic examination to assess the uterus and adnexa.
General exam: obesity/too thin, underdeveloped secondary sexual character, HTN,DM, gynecological exam: vaginal infection, length of cervix, uterus size shape, any discharge.
• Diagnostic Tests for Ovulation:
◦ Basal Body Temperature: Indicates thermogenic effect of progesterone.
◦ Pelvic Ultrasonography: Monitors follicle maturation and rupture.
◦ Hormone Estimation: Serum progesterone, LH, FSH, estradiol, prolactin, and thyroid function tests.
◦ Endometrial Biopsy: Assesses secretory changes.
• Tests for Tubal Patency and Uterine Cavity:
◦ Hysterosalpingography (HSG): Detects tubal blocks or uterine abnormalities like fibroids or synechiae.
◦ Laparoscopy: Direct visualization of pelvic organs and chromotubation to test tubal patency.
◦ Insufflation Test (Rubin Test): Checks patency of fallopian tubes.
◦ Hysteroscopy: Visualizes the uterine cavity.
B. Male Investigations:
History taking of age duration of marriage, and proven fertility, sexual history, social history,
Medical history: STI, mumps orchitis after puberty, Dm, recurrent chest infection.
Reproductive exam: Inspection and palpation of genitalia, testicular volume, varicocele.
• Semen Analysis: The first step; assesses sperm count, motility, and morphology.
• Hormonal Testing: Serum FSH, LH, testosterone, prolactin, and TSH.
• Ultrasonography: Transrectal USG to visualize seminal vesicles and prostate.
• Testicular Biopsy: Differentiates primary testicular failure from obstruction in azoospermia.
• Sperm Function Tests: Postcoital test (sperm survival in cervical mucus) and sperm penetration assay.
• Immunological Tests: To detect sperm agglutinating or immobilizing antibodies.
Genetic testing. Vasogram for ejaculatory duct obstruction.
6d Social Problems Arising Due to Infertility
1. Marital Stress Increased tension between husband and wife, Decreased intimacy or emotional distance, Blame and guilt within the relationship, Increased risk of marital conflict or divorce.
2. Social Stigma: Infertile couples, especially women, face negative social attitudes Society may label the woman as “barren” Family and community pressure increases emotional burden
3. . Family Pressure: Continuous questioning from relatives about pregnancy In-laws may blame the woman regardless of actual cause Pressure for repeated medical tests and treatments
4. Psychological Problems: Stress, anxiety, depression Feelings of inadequacy, low self-esteem Guilt, hopelessness, and emotional breakdown Emotional isolation from friends and family
5. Economic Problems: High cost of infertility treatment (IVF, IUI)Financial burden due to repeated investigationsLoss of income if one partner stops working to focus on treatment
6. Social Isolation, Domestic Violence, Gender Discrimination, Impact on Family Structure
7a. Asphyxia Neonatorum: Definition
Definition Perinatal asphyxia (Asphyxia Neonatorum) is a condition occurring during pregnancy and labor where impaired placental gaseous exchange results in fetal hypoxemia (low oxygen), hypercarbia (excess carbon dioxide), and metabolic acidosis.
7b. Line of Management of Newborn with Asphyxia
The management follows a definitive resuscitation protocol. Ideally, a pediatrician or neonatologist should be present.
1. Immediate Steps and Assessment
• Delayed Cord Clamping: Should be done for 60–90 seconds to support transfusion.• Initial Stabilization: Dry the infant immediately and place them under a radiant heater. Position the head in the midline with the neck slightly extended. Clear the mouth and oropharynx using a suction bulb.
• Assessment: Evaluate respiratory effort (apnea or regular breathing) and heart rate.
◦ If the infant is breathing regularly with a heart rate >100 bpm, routine care is provided.
◦ If cyanotic, supplemental oxygen is given.
2. Ventilatory Resuscitation (Bag and Mask)
• Indication: If the heart rate is <100 bpm, or there is apnea or irregular respiration.
• Action: Initiate Positive Pressure Ventilation (PPV) with a bag and mask using 100% oxygen. A soft mask must seal around the mouth and nose.• Monitoring: Use pulse oximetry and ECG. If there is no improvement after 30–40 seconds, intubation is indicated.
3. Chest Compressions
• Indication: If the heart rate remains <60 bpm despite adequate ventilation and intubate the baby.
• Technique: Compress the sternum to one-third of the chest diameter at a rate of 90 compressions per minute.
• Coordination: Coordinate with ventilation at a ratio of 3:1 (3 compressions to 1 breath).
• Stop Condition: Discontinue compressions when the heart rate rises above 60 bpm.
4. Medications
• Epinephrine: Indicated for persistent bradycardia (<60 bpm) despite ventilation and compressions. Dosage is 0.1–0.3 ml/kg (1:10,000 dilution) given IV or endotracheally. It can be repeated every 3–5 minutes.
• Volume Expansion: If there is acute bleeding, pallor, or shock, normal saline boluses (10 ml/kg) are infused via an umbilical venous catheter over 5–10 minutes.
5. Post-Resuscitation Care
• Temperature Control: Maintain core temperature between 36.5°C and 37.5°C. Glucose: Maintain blood glucose >45–50 mg/dL.Support: Oxygen saturation should be maintained at 90–95%. Antibiotics may be started if infection is suspected.
Prophylactic Management of Perinatal Asphyxia
Prevention focuses on identifying risk factors and managing labor carefully to avoid hypoxia.
1. Antenatal Measures
• Risk Detection: Identify high-risk factors early in pregnancy.
• Corticosteroids: Administer glucocorticoids to the mother if preterm delivery (<34 weeks) is anticipated to mature fetal lungs and reduce intracranial hemorrhage.
• Delayed Cord Clamping: Delay clamping for 60–90 seconds to improve blood volume and support transition.
2. Intrapartum Measures
• Fetal Monitoring: Perform close clinical monitoring or use electronic fetal monitoring (EFM) to detect fetal distress early. Use scalp blood pH assessment if indicated.
• Anesthesia: Use anesthetic agents and sedatives judiciously to avoid depressing the fetal respiratory center .• Delivery Technique: Avoid difficult or traumatic vaginal deliveries.
• Preparation: Ensure the delivery room is equipped for resuscitation
SHORT NOTES:
Prevention of Anaemia in Pregnancy
Definition:
Anemia in pregnancy is a condition in which hemoglobin levels fall below 11 g/dL in the first and third trimesters and 10.5 g/dL in the second trimester. Prevention focuses on adequate nutrition, supplementation, and health education.
Preventive Measures
- Iron and Folic Acid Supplementation: Daily oral iron (60 mg elemental iron) + folic acid (0.5 mg) from early pregnancy until 3 months postpartum.
- Dietary Advice: Encourage intake of iron-rich foods (green leafy vegetables, legumes, eggs, meat, liver) and vitamin C-rich foods to enhance absorption.
- Deworming: Routine anti-helminthic therapy after first trimester if endemic area.
- Health Education: Educate on balanced diet, cooking methods to preserve iron, and avoid tea/coffee with meals.
- Early Detection: Routine hemoglobin estimation at booking and during each trimester.
- Preventive Care: Treatment of infections (malaria, UTI), frequent antenatal check-ups, and spacing of pregnancies.
- Lifestyle Measures: Adequate rest, hygiene, and avoiding excessive physical exertion.
Nurse’s Role
- Counsel mother on importance of supplements and diet.
- Monitor compliance with iron therapy.
- Assess for early signs of anemia (fatigue, pallor).
- Provide education on infection prevention.
- Coordinate with nutritionist or physician for high-risk pregnancies.
Postnatal Exercises
Definition: Postnatal exercises are physical activities started after childbirth to help the mother regain strength, restore muscle tone, and promote overall recovery.
Objectives:• Strengthen abdominal and pelvic muscles• Improve posture and back strength• Enhance circulation and prevent thrombosis• Promote weight reduction• Improve mental well-being and reduce postpartum depression• Facilitate uterine involution
Types of Postnatal Exercises:
1. Breathing Exercises• Deep breathing and diaphragmatic breathing to relax muscles and improve lung expansion.
2. Pelvic Floor Exercises (Kegel’s exercises)• Strengthen pelvic floor muscles, prevent urinary incontinence, and support pelvic organs.
3. Abdominal Exercises• Gentle abdominal tightening, head lifting, and pelvic tilting to restore abdominal tone.
4. Back Strengthening Exercises• Cat-camel stretch, back extension exercises to relieve backache.
5. Leg and Foot Exercises• Ankle rotation, toe movements, and leg lifting to prevent thrombosis and edema.
6. Posture Correction Exercises• Teach correct sitting, standing, lifting, and breastfeeding posture.
7. Walking• Safe and effective aerobic exercise to improve cardiovascular fitness and mood.
Guidelines:• Start gently within 24–48 hours after normal delivery• Avoid strenuous exercises after C-section until 6 weeks• Perform exercises twice daily for 10–15 minutes• Stop exercise if dizziness, heavy bleeding, or pain occurs
Benefits:• Faster recovery and increased energy levels• Reduced back pain and improved muscle tone• Prevention of pelvic floor weakness and prolapse• Better emotional well-being and confidence
Prostaglandin
Prostaglandins (PGs) are lipid derivatives of arachidonic acid acting as local hormones.
Types & Examples
PGE1 – Misoprostol
PGE2 – Dinoprostone
PGF2α – Carboprost, Dinoprost
Group/Category
Uterotonic / Smooth muscle stimulants
Abortifacient / Cervical ripening agents
• Action: PGs promote myometrial contractions and cause cervical ripening by collagenolysis (dissolution of collagen bundles), making the cervix soft and pliable.
Route of Administration
Oral, sublingual, vaginal, rectal, or intramuscular depending on drug type and indication.
• Indications:
Induction of labor (PGE2, PGF2α)
They are used for induction of abortion (MTP) and expulsion of hydatidiform mole.
In later pregnancy, they are used for cervical ripening (PGE2 gel) and induction of labor.
PGE1 (Misoprostol) is also used for the management of atonic postpartum hemorrhage (PPH).
Nurse’s Responsibilities
- Check baseline vitals and fetal heart rate.
- Monitor uterine contractions for frequency, duration, and intensity.
- Ensure correct dose, route, and timing.
- Watch for hyperstimulation or tetanic contractions.
- Monitor for adverse effects: nausea, vomiting, diarrhea, fever, hypotension.
- Keep resuscitation equipment ready.
- Document drug administration and maternal-fetal response.
Contraindications
Cephalopelvic disproportion (CPD),Malpresentation (breech, transverse lie), Previous classical C-section or uterine surgery, Placenta previa, vasa previa, Fetal distress before induction
Nurse’s Responsibility to Newborn Undergoing Phototherapy
When a newborn undergoes phototherapy for hyperbilirubinemia, the care provider must ensure the treatment is effective and safe. Responsibilities and monitoring protocols include:
1. Eye Protection: Cover eyes with clean, properly fitted eye pads and change them regularly.
2. Protect Genitals: Cover genital area to prevent potential light-related risks.
3. Maintain Thermoregulation: Monitor axillary temperature every 2–4 hours to prevent hypo/hyperthermia.
4. Monitor Hydration: Assess urine output, moistness of mucous membranes, and daily weight; provide extra fluids if ordered.
5. Maintain Skin Care: Keep baby naked except diaper, change diaper frequently, observe for rashes or burns.
6. Positioning: Change position every 2 hours to ensure maximum light exposure and prevent pressure areas.
7. Monitor Bilirubin Levels: Collect blood samples as ordered to evaluate therapy effectiveness.
8. Ensure Effective Light Source: Maintain correct distance between baby and phototherapy unit; check bulbs/tubes functioning.
9. Prevent Interruption: Keep baby under light continuously except during feeding and hygiene care.
10. Parent Education: Explain purpose, safety, expected changes (loose green stools, increased urine), and reassure parents.
11. Monitor Side Effects: Watch for dehydration, diarrhea, bronze baby syndrome, skin irritation, temperature instability.
12. Documentation: Record vitals, bilirubin levels, intake-output, observations, duration of therapy, and parental teaching.
Temporary Family Planning Methods (Short Note)
Definition: Temporary or spacing methods are contraceptive methods used to delay pregnancy or maintain adequate spacing between births without permanent loss of fertility.
1. Barrier Methods:
• Male Condom: Prevents sperm entry into vagina; also protects against STIs.
• Female Condom: Lines the vaginal canal, preventing sperm entry.
• Diaphragm/Cervical Cap: Covers cervix; used with spermicides.
Advantages: Easy to use, reversible, STI protection (condoms).
Disadvantages: May break or slip; requires correct and consistent use.
2. Hormonal Methods:
• Combined Oral Contraceptives (COCs): Contain estrogen + progestin; inhibit ovulation.
• Progestin-Only Pills (POPs): Safe during breastfeeding; thicken cervical mucus.
• Injectables (DMPA): Every 3 months; suppress ovulation.
• Implants: Subdermal rods releasing progestin for 3–5 years.
Advantages: Highly effective, safe, reversible.
Disadvantages: Irregular bleeding, weight changes, requires compliance.
3. Intrauterine Contraceptive Devices (IUCDs):
• Copper-T 380A: Works for 10 years; causes sperm immobilization.
• LNG-IUS (Mirena): Releases levonorgestrel; reduces menstrual bleeding.
Advantages: Long-term, reversible, cost-effective.
Disadvantages: Pain, spotting, risk of expulsion, PID (rare).
4. Natural Methods:
• Fertility Awareness Method: Avoid intercourse in fertile period.
• Basal Body Temperature Method
• Cervical Mucus Method
• Lactational Amenorrhea Method (LAM): Effective for 6 months if exclusive breastfeeding + amenorrhea.
Advantages: No hormones, free, safe.
Disadvantages: Less effective, requires discipline.
5. Emergency Contraception:
• Levonorgestrel (1.5 mg) within 72 hours.
• Copper-T IUCD within 5 days.
Mechanism: Prevents ovulation or fertilization.
6. Other Methods:
• Spermicides: Chemicals that immobilize sperm; used with diaphragm/condom.
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