بحث كامل حول وسائل منع الحمل السنة الثانية متوسط

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في مجال التنسيق العصبي الهرموني ( التكاثر) أغلب الوضعيات الإدماجية التي قد يتطرق لها الأساتذة تتعلق بموانع الحمل , لذا إليكم بحثا كاملا و مفصلا عن موانع الحمل للدكتور نجيب ليوس مع بعض الحذف و التعديل أرجو أن يفيدكم لأخذ بعض المعلومات قد تستذكرونها في حل الوضعيات الإدماجية .

تقسم طرق منع الحمل إلى ثلاث طرق رئيسية:-

1- الطرق الميكانيكية.

2- العلاج الهرموني.

3- الطرق الجراحية.

أولا:- الطرق الميكانيكية:

اللولب الرحمي

طريقة شائعة جدا و فعالة و يتم خلالها زرع اللولب و هو عبارة عن اله بسيطة مصنوعة من البلاستيك و قطع نحاسية صغيرة داخل الرحم لمنع انغراز الأجنة و كذلك يقوم بتفاعلات داخل الرحم تقلل من نشاط الحيوان المنوي و وصوله إلى قناة فالوب و هناك أيضا اللولب الهرموني الذي يحتوي على هرمون البروجيسترون الذي يساعد في علاج الدورة المصحوبة بآلام شديدة ويقلل كمية الدم النازف أثناء الدورة الشهرية.

طريقة العد أو الحساب

هنا يتم الاعتماد على تحديد موعد الإباضة و بمنع الجماع خلال هذه الأيام يمكن منع الحمل و يمكن تطبيق هذه الطريقة مع النساء اللواتي تكون الدورة لديهن منتظمة كل 28-30 يوم و يتم تحديد موعد الإباضة بعدة طرق:-

*ارتفاع درجة حرارة الجسم بيوم الإباضة نصف درجة عن درجة الحرارة المعتادة.

*تغيرات في لون و سماكة إفرازات عنق الرحم.

*استخدام بعض طرق الفحص (Kits) بأخذ عينة من البول و فحص نسبة هرمون (LH) الذي يكون مرتفعا في يوم الإباضة.

و يتم الامتناع عن الجماع ثلاثة أيام قبل و ثلاثة أيام بعد الإباضة و هذه الطريقة لا تنطبق على السيدات المرضعات أو اللواتي دورتهن غير منتظمة.

3- الواقي الذكري و الأنثوي

من الطرق المتوفرة جدا و الرخيصة نسبيا لمنع الحمل, و هو أيضا يقلل من انتقال بعض الأمراض الجنسية و كذلك يتوفر الواقي الأنثوي الذي يكون محتويا على حلقة مطاطية من إحدى جهاته توضع داخل المهبل قبل الجماع.

4- الحلقة البلاستيكية

و هذه أيضا تقوم بمنع وصول الحيوانات المنوية خلال عنق الرحم و يتم تركيبها و تحديد قياسها من قبل الطبيب المختص, و يفضل استخدام بعض المستحضرات التي تقتل الحيوانات المنوية معها لزيادة فعاليتها.

5- مستحضرات قتل الحيوانات المنوية

توجد بعدة أشكال منها الكريمات و الجل و البخاخ و كذلك التحاميل المهبلية لكن لا ينصح باستخدامها بمفردها و يفضل استخدامها مع الطرق الأخرى لمنع الحمل لزيادة الفعالية

ثانيا:- العلاج الهرموني:-

1) حبوب منع الحمل-

و تعمل هذه الحبوب على إيقاف عملية الإباضة عن طريق إعطاء هرمونات الاستروجين و البروجيسترون بكميات و جرع

بسيطة تساعد على تثبيط هرمونات الغدة النخامية و بذلك يتم إيقاف عملية نمو البويضات و يتوفر العديد من أنواع حبوب منع الحمل يختلف فيها تركيز هرموني الاستروجين و البروجيسترون و تقسم إلى نوعين:-

* الحبوب المختلطة : و تحتوي على الاستروجين (اثينيل استرايدول) و هرمون البروجيسترون بتفاوت جرعة الاستروجين بين 20-50 مايكرو غرام حيث تعتبر الحبوب التي تحتوي على تراكيز قليلة من هذا الهرمون أكثر أمانا حيث أن أكثر الأعراض الجانبية التي تؤثر على الشرايين و القلب تكون مرتبطة بهذا الهرمون و هناك تحضيرات مختلفة لهذه الأنواع منها اللونين و الثلاثة ألوان و منها ذا ت اللون الواحد و هذا يعني أن جرعة هذه الهرمونات تتغير خلال الشهر الواحد لتكون مشابهة إلى حد كبير لتراكيز الجسم بالصورة الطبيعية و بهذا ينظم الدورة الشهرية بصورة أفضل.

كيف تعمل الحبوب المختلطة؟؟

يعمل هرمون الاستروجين الموجود في حبوب المانع على رفع مستوى الاستروجين في الدم و بالتالي تثبيط إفراز هرمون FSH في الغدة النخامية و هو المسئول عن نمو البويضات بينما يقوم هرمون البروجيسترون بمنع إفراز هرمون LH الذي يكون مسئولا عن عملية الإباضة.

فوائد حبوب منع الحمل المختلطة:-

تنظيم الدورة الشهرية.

تقليل الآلام المصاحبة للدورة

تقليل كمية الدم و فترة الدورة

4- التقليل من احتمالات الإصابة ببعض أورام الثدي الحميدة و كذلك أكياس المبايض و ظهور مرض البطانة الرحمية الهاجرة و حب الشباب و أحيانا بعض التهابات الحوض.

و هناك بعض الدراسات التي تشير إلى أن هذه الحبوب تقلل نسبة الإصابة بالأورام السرطانية لعنق الرحم و الرحم.

المضار الجانبية:-

1- زيادة الوزن.

2- اضطراب الجهاز الهضمي مثل التقيؤ.

3- تغييرات في الحالة النفسية.

4- ازدياد حجم الثدي و احتقانه و كذلك الآلام الثدي.

5- ازدياد قابلية الدم للتخثر مثل تخثر الأوردة العميقة DVT.

6- الجلطة القلبية خاصة إذا تصاحب استخدام حبوب منع الحمل مع التدخين.

موانع استعمال هذه الحبوب:-

أولا:- موانع إجبارية

 1- أمراض القلب و الشرايين.

 2- أمراض صمامات القلب.

 3- التشوهات الوريدية و الشريانية و الولادية.

 4- ارتفاع ضغط الرئتين.

 5- ارتفاع الشحوم في الدم.

 6- الشقيقة أو الصداع النصفي.

 7- أمراض و أورام الكبد.

 8- الحمل العنقودي.

 9- الأورام التي تتأثر بهرمون الاستروجين.

 10- الالتهابات الحوضية الغير مشخصة.

ثانيا:- موانع اختيارية

1- تاريخ عائلي باحتمالات الاصابة بأحد أمراض الشرايين و الأوردة.

2- التدخين, كبر السن, السمنة المفرطة.

3- السكري.

4- ارتفاع مستوى هرمون الحليب.

الحبوب المفردة:- و هذه الحبوب تحتوي على هرمون البروجيسترون فقط و لذلك تستعمل لتجنب الأضرار الجانبية للحبوب المختلطة, و تعمل هذه الحبوب على منع الحمل و ذلك بمنع عملية التبويض و كذلك تغيير إفرازات عنق الرحم و كذلك تؤثر على بطانة الرحم و بالتالي تؤثر على دخول الحيوانات المنوية إلى رحم المرأة و على انغراز الأجنة.

الأعراض الجانبية:-

1- عدم انتظام الدورة الشهرية.

2- آلام الرأس.

3- اضطرابات معوية و انتفاخ.

4- تأثيرات نفسية و مزاجية.

5- آلام الثدي.

استعمالاتها:-

في جميع الحالات التي يعتبر فيها هرمون الاستروجين محظورا سواء كان اختياريا أم إجباريا.

موانع الاستخدام:-

أولا: موانع إجبارية

1- اشتباه آو تأكيد وجود حمل (لأنها قد تسبب زيادة في بعض الصفات الذكرية عند الجنين الأنثى)

2- النزف الرحمي غير المشخص.

3- بعض أمراض الجهاز الشرياني و القلب المشخصة حديثا.

ثانيا:- موانع اختيارية

1- السمنة المفرطة.

2- سرطان الثدي.

3- الحمل العنقودي.

4- ارتفاع ضغط الدم.

5- تاريخ تكرار حدوث أكياس على المبايض.

6- أمراض الكبد المزمنة.

2) حقن البروجسترون:-

تحتوي هذه الحقن على هرمون البروجيسترون طويل المفعول و هو مدرو كسي بروجيستون استيت و مادة نوراثيستيرون انانثيت و تعطى هذه الحقن بالعضل و بجرعة 150 ملغم كل 12 أسبوع و تقوم هذه الحبوب بمنع عملية الاباضة.

الأعراض الجانبية:

1- قد تعمل هذه الإبر على تثبيط عملية الاباضة لمدة سنة واحدة بعد استخدامها و لهذا لا ينصح باستخدامها لمنع الحمل لفترات قصيرة ا ذا كانت السيدة ترغب بالحمل بعد مدة ليست بطويلة.

2- ازدياد الوزن و كذلك ازدياد نسبة هشاشة العظام.

3- انقطاع الدورة لفترات طويلة و أحيانا ضعف الدورة الشهرية و عدم انتظامها.

3) مستحضرات البروجيسترون تحت الجلد

كبسولات خاصة تحتوي على عبوات خاصة تفرز هرمون البروجيسترون بصورة بطيئة و لفترة محدودة تتكون من 6 كبسولات تحتوي على هرمونLevenorgestril يفرز بجرعة 30-35 مايكرو غرام خلال 24 ساعة و لمدة 18 شهر أي سنة و نصف.

يتم زرع هذه الكبسولات تحت التخدير الموضعي في منطقة الساعد و يتم إزالتها أيضا تحت التخدير الموضعي و لا تتطلب تداخل جراحي كبير.

تظل هذه الكبسولات تعمل لمدة 5 سنوات و تعود الخصوبة الطبيعية كسابق وضعها بإزالتها مباشرة و هي طريقة أمنة و بنسب فشل ضعيفة جدا.

و من الطرق الحديثة لمنع الحمل هي استخدام كبسولات أو أشرطة خاصة تزرع تحت الجلد عند الرجل تحت التخدير الموضعي في أعلى اليد تقوم بإفراز نوعين من الهرمونات هما هرمون التيستوستيرون و البروجيستين أي هرمون ذكري و أنثوي يعمل الهرمون الأول على تثبيط أنتاج الحيوانات المنوية وذلك بتأثيره على الغدة النخامية أما الهرمون الثاني فهو يعمل على الخصية مباشرة لتقليل الإنتاج و يستعيد الجسم قابليته على الإنتاج بعد إزالتها بحوالي 12 أسبوع.

ثالثا:- الطرق الجراحية:-

أولا: تعقيم المرأة

تعتمد هذه العملية على قطع الطريق الموصل بين الحيوان المنوي والبويضة مع الاحتفاظ بالدورة الشهرية و انتظامها إذ أن البويضة التي يكون حجمها بحجم نقطة القلم لا زالت تنزل من المبايض في موعدها المحدد كل شهر لذلك لن تحس المرأة أي تغيير.

تتم هذه العملية بثلاث طرق:-

1-عملية فتح بطن مصغرة عن طريق فتحة صغيرة في البطن تحت التخدير العام و يتم إغلاق قناتي فالوب بعدة وسائل منها

*الخياطة

*القطع باستئصال قطعة صغيرة من الانبوب و ربط الطرفين.

*الكي و إغلاق الأنبوب.

*استعمال الحلقات البلاستيكية أو الكلابسات.

2- التنظير البطني و هذه الطريقة اقل ايذاءا للمريضة و تغلق الأنابيب بنفس الطريقة السابقة.

3- في حالات قليلة تعمل هذه العمليات عن طريق المهبل إما بالمستشفى أو بعض العيادات المختصة.

ثانيا:- تعقيم الرجل

تتم هذه العملية بقطع القناة الناقلة و بذلك يقطع الطريق الذي يؤدي إلى خروج الحيوانات المنوية من الخصيتين إلى السائل المنوي و يمكن إجراء ذلك تحت التخدير الموضعي أو العام و من الممكن الوصول إلى القناة الناقلة بسهولة حيث تقع تحت الجلد مباشرة و يتم استئصال قطعة من الأنبوب و لا تستغرق هذه العملية سوى 15 دقيقة.

و يمكن التأكد من نتائج العملية بأجراء فحصين للسائل المنوي بينهما 4 أسابيع و نتيجة الفحصين خلوهما من الحيوانات المنوية و هذا عادة يستغرق حوالي 16-18 أسبوع.

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