Transcript JADELLE - Saddleback College
JADELLE
® JADELLE ® is the registered trademark of Leiras Oy for two-rod subdermal levonorgestrel implants. Norplant ® is the registered trademark of The Population Council for subdermal levonorgestrel implants.
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What is JADELLE ® Two Silastic 7 rods containing 75 mg of levonorgestrel (LNG) which are inserted just under the skin (subdermal) of a woman’s upper arm.
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JADELLE ® : Mechanisms of Action Suppress ovulation Decrease tubal motility Change endometrium Thicken cervical mucus
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4 0 0 3 0 0 p g / m l 2 0 0 1 0 0 0 0 Comparison of Mean Levels of Levonorgestrel J A D E L L E N o rp la n t-2 6 1 2 1 8 M o n t h 2 4 3 0 3 6 Source: Sivin et al 1997.
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JADELLE ® : Contraceptive Benefits
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Highly effective (0.05
1,2 pregnancies per 100 women during the first year of use) Rapidly effective (< 72 hours) Long-term method (up to 3 years protection) Pelvic examination not required prior to use Does not interfere with intercourse Does not affect breastfeeding 1 Perfect-use estimate is equal to typical-use estimate.
2 Trussell et al 1998.
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JADELLE ® : Contraceptive Benefits
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Immediate return of fertility on removal Few side effects Client needs to return to clinic only if problems No supplies needed by client Can be provided by trained nonphysician (nurse or midwife) Contain no estrogen
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JADELLE ® : Noncontraceptive Benefits
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Decreases ectopic pregnancy May decrease menstrual cramps May decrease menstrual bleeding May improve anemia Protects against endometrial cancer Decreases benign breast disease Protects against some causes of PID
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JADELLE ® : Limitations
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Causes changes in menstrual bleeding pattern (irregular bleeding/spotting) in most women Requires trained provider for insertion and removal Woman must return to healthcare provider or clinic for insertion of another set of rods or removal
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JADELLE ® : Limitations
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Woman cannot stop whenever she wants (provider dependent) Effectiveness may be lowered when certain drugs for epilepsy (phenytoin and barbiturates) or tuberculosis (rifampin) are taken Cost-effectiveness dependent on length of use Does not protect against STDs (e.g., HBV, HIV/AIDS)
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Who Can Use JADELLE ® Women:
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Of any reproductive age Of any parity including nulliparous women Who want highly effective, long-term protection against pregnancy Who are breastfeeding (
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6 weeks postpartum) Who are postpartum and not breastfeeding Who are postabortion
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Who Can Use JADELLE ®
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Women:
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With desired family size who do not want voluntary sterilization With histories of ectopic pregnancy Who have blood pressure < 180/110, blood clotting problems of sickle cell disease With moderate to severe menstrual cramping Who smoke (any age, any amount) Who prefer not to or should not use estrogen Who cannot remember to take a pill every day
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JADELLE ® : Who Should Not Use (WHO Class 4) JADELLE ® should not be used if woman:
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Is pregnant (known or suspected) Has unexplained vaginal bleeding (only if serious problem suspected)
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Has breast cancer Source: WHO 1996.
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What is JADELLE® Two Silastic7 rods containing 75 mg of levonorgestrel (LNG) which are inserted just under the skin (subdermal) of a woman’s upper arm.
Source: WHO 1996.
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Cost-effectiveness dependent on length of use Does not protect against STDs (e.g., HBV, HIV/AIDS) Who Can Use JADELLE® JADELLE ® Women: can be used safely in women who:
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Of any parity including nulliparous
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Have hepatitis (asymptomatic and carriers) women Have high blood pressure (< 180/110)
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Will have surgery (with or without prolonged bed rest) Who are breastfeeding ($ 6 weeks
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Have valvular heart disease (including symptomatic)
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Who are postpartum and not breastfeeding Who are postabortion
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When to Insert JADELLE ®
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Anytime during the menstrual cycle when you can be reasonably sure the client is not pregnant Days 1B7 of the menstrual cycle Postpartum:
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after 6 months if using lactational amenorrhea method (LAM)
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after 6 weeks if breastfeeding but not using LAM immediately or within 6 weeks if not breastfeeding Postabortion (immediately or within the first 7 days)
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JADELLE ® : Infection Prevention Recommendations
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Wash client’s entire arm and hand with soap and water prior to antiseptic prep.
Use sterile or high-level disinfected instruments, surgical gloves and other items.
After use, decontaminate all items.
Place disposables (needle and syringe) and waste items in a puncture-proof container prior to disposal.
Clean and final process reusable items by sterilization (or high-level disinfection).
Source: Tietjen, Cronin and McIntosh 1992.
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JADELLE ® : Ten Most Frequently Reported Conditions Side Effects Vaginal Discharge Headache Pelvic Pain Weight Increase Dizziness Breast Pain Genital Itching Nervousness Cervicitis Nausea Percentage of Women 24.3
23.5
16.7
12.0
10.7
8.3
8.2
7.7
7.5
6.7
Source: Sivin et al 1997.
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JADELLE ® : Treatment of Common Side Effects Side Effects Irregular or heavy bleeding Headache Weight change Breast tenderness Breast discharge Acne Management Check for gynecologic problem Counseling and reassurance COCs, NSAIDs or oral estrogens Nonnarcotic analgesics Diet history, advice and exercise Support bra Decreased nipple stimulation Diet, cleansers and topical antibiotics
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JADELLE ® vs. Norplant ® : Comparison of Removal Times Type of Implant JADELLE
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Norplant 7 N 165 162 Time (Mean
SD) 4.9
3.5 minutes 10.4
7.9 minutes Source: Sivin et al 1997.
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JADELLE ® : Client Instructions
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Keep incision area dry for 48 hours.
Keep pressure bandage on for 48 hours and leave Band-Aid 7 on until incision heals (3 –5 days).
Bruising, swelling and tenderness at insertion site are common.
Routine work can be done immediately. Avoid bumping the area, carrying heavy loads or applying unusual pressure to incision site.
After healing, area can be touched and washed with normal pressure.
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JADELLE ® : General Information
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Contraceptive effectiveness begins 72 hours after insertion and stops soon after removal.
Changes in menstrual bleeding patterns are common.
Certain drugs may reduce effectiveness of implants. Tell your provider if you start any new drugs.
Removal of rods is necessary 3 years after insertion.
After removal, the fibrous sheath may be felt.
Use a condom if at risk for STDs.
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JADELLE ® : Warning Signs Return to clinic if any of the following occur:
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Delayed menstrual period after several months of regular cycles (may be sign of pregnancy) Severe lower abdominal pain
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Heavy bleeding Pus or bleeding at insertion site Infection at insertion site Expulsion Migraine headaches
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