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Gii thiu 1 phng php nga thai mi

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Thuc trnh thai cha HORMONEThuc trnh thai cha HORMONE

Thuc trnh thai kt hpThuc trnh thai kt hpestrogen+progestogenestrogen+progestogen

Vin ung

Tim hng thng

Vng t trong m o

Ming dn trnh thai

Thuc trnh thai ch cThuc trnh thai ch cProgestogenProgestogen

Vin ung Tim di da

Cy di da Dng c t trong t

cung

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EVRA RTHEVRA

EVRA (*)6mg Norelgestromin(NGMN) + 0.600 mg ethinylestradiol (EE)

Sn xut ti c .

c chun y ti 69 qucgia v M

Th nghim lm sng Vit Nam s dng EVRAsn xut ti c

ORTHO EVRA (*)6mg Norelgestromin(NGMN) + 0.750 mgethinyl estradiol (EE)

Sn xut tiPUERTO

RICO

Ch c chun y ti M

(*) The patches are manufactured at different companies, using a slightly different manufacturing process

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Ming dn Evra:20 cm2; 4,5 x 4,5 cm

Hm Lng:6 mg norelgestromin (NGMN)

0,6 mg ethinyl estradiol (EE)

Thnh phnThnh phn

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Cht tan trong m thm qua da d dng

Cht tan trong nc khng thm qua

da

Gia cc t bo lp

sng ca da c cckhe h nhiu chtm.

Cc cht tan ctrong m thm qua

cc khe ny d dng.

Evra thm qua daEvra thm qua da

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Tun1Tun1 Tun 2Tun 2 Tun 3Tun 3 Tun 4Tun 4

Ming 1

Chu k 28 ngy

Tun 5Tun 5

Bt u chu k miBt u chu k mi

Chu k 28 ngyChu k 28 ngy

Cch dng thun tinCch dng thun tin

Ming 2 Ming 3

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Bn v tr c th dn* Tc dng iu tr tng ng nhau* thay ming dn bt c lc no trong ngy

V tr thun tin nht:* t c xt,t m hi

V tr dn EvraV tr dn Evra

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Ngay

N

ongd

oEEtrungb

inh(pg/mL)

0.90.80.70.60.50.4

100

90

80

50

30

20

Nong

do

NGMNtru

ngb

in h

(ng/mL)

0.31 2 3 4 5 6 7 8 9 101112

NGMN Evra

70

60

40

10

1314151617181920

1.01.11.21.3

Dan miengdau tien

Ngay 8:Mieng thu 2

Ngay15:

ngay can dan miengthu 3

EE Evra

Quen thay miengdan 2 ngay

Liu thuc duy tr n ngy th 9

Abrams LS, Skee DM, Wong FA, Anderson NJ, Leese PT. Pharmacokinetics of norelgestromin and ethinylestradiol from two consecutive contraceptive patches.J Clin Pharmacol. 2001;41:1232-1237.

Ngay 18: danmieng 3

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May 2009

u hng ngy 200 mcg norelgestromin35 mcg ethinyl estradiol

Ch s Pearl ton b v s tht bi ca phng php Ci thin ra mu/ra huyt thm git Tc dng ph

EvraEvra

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c ch hiu qu s phng

non.c ch s pht trin nonnang (khi dng ng cch vc khi dng 9 ngy/1 mingdn)

Gim nhy c t cung, cntr s xm nhp ca tinhtrng.

Gim nhy ni mc tcung, lm ni mc t cung

khng thch hp cho s lmt ca hp t.

C ch tc dng ca EvraC ch tc dng ca Evra

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Pearl Index

So snh vi Mercilon:Evra Mercilonn= 844 656

S TH c thai : 4 2

Pearl index: 0.88 0.56Tun th: 94.4% 87.8%

Ra mu

gia k/thm git 14% 15%

Hedon B, Helmerhorst FM, Cronje HS, Shangold G, Fisher A, Creasy G, and the EVRA 003 Study Group.

Comparison of efficacy, cycle control, compliance, and safety in users of a contraceptive patch vs an oral contraceptive.Int J Gynecol Obstet. 2000;70 (suppl 1):78.

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Hiu qu trnh thaiHiu qu trnh thaixut sc 99%!xut sc 99%!(dng ng cch)(dng ng cch)

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Tun th dngTun th dngthuc cao!thuc cao!

Tun th hon hoTun th hon hotrn 88.2% s chu ktrn 88.2% s chu k

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T l thay ming dn

Cc nghincu Nghin cu atrung tm ti M Nghin cu sdng khi vn ngnhiu

Tng s ming dn sdng

70.552 4.877 87

Thay ming dn do bonghon ton

1.8% 1.7% 1.1%

Thay ming dn do bongmt phn

2.9% 2.6% 0%

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dnh cao! dnh cao!1,8% trng hp1,8% trng hp

ming dn bong raming dn bong rahon tonhon ton ( phi thay( phi thayming khc)ming khc)

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%% ngng dng do tcngng dng do tcdng ph:dng ph:

Bun nn:Bun nn: 1,7%1,7%

Nhc u:Nhc u: 1,1%1,1%

Cng ngc:Cng ngc: 1,9%1,9%

Phn ng ti ch dn:Phn ng ti ch dn:1,9%1,9%

Sibai BM, Odlind V, Meador ML, Shangold GA, Fisher AC, Creasy GW. A comparative and pooledanalysis of the safety and tolerability of the contraceptive patch (ORTHO EVRA/Evra).FertilSteril. 2002;77(suppl 2):19S-26S.

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Rat thch

Thch

Khong thch lam

Rat thch

Thch

Khong thch lam

12%12%

23%23%

3%

38%

23%

Phn hi ca ngi dngPhn hi ca ngi dng

>60% thch/rt thch!>60% thch/rt thch!

Rt thch

Thch

Khng thchlm

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Bt u dng EVRALn u dng thuc nga thai ni tit

Phng php bt uCn lm

Ngy thay mingdn Bin php trnh

thai h tr

Bt uNGY KINH

U TIN

Dn ming Evrau tin vo ngyu tin kinh nguyt

Dn ming dnEVRA u tin trongvng 24 gi u c

kinh

Cng mt ngyhng tun (trtun 4: khng

dn)

Khng cn

Bt uNGY CHNHT

Dn ming Evra vongy ch nht

Dn ming dnEVRA u tin vongy Ch nht utin sau khi c kinh

Ch nht hngtun (tr tun 4

khng dn)

Cn thit cho 7ngy u tin

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Bt u dng EvraChuyn t thuc ung nga thai ni tit

Phng php bt u

Cn lm Ngy thay mingdn

Bin Php ngathai h tr

Bt uNGY KINH

U TIN

Hon thnh chuk dng thucung

Dn ming dnEVRA u tin

trong vng 24 gi

u c kinhnguyt sau dng

thuc ung

Cng mtngy hng

tun (tr tun

4: khng dn)

Khng cn

Bt u

NGY CHNHT

Dn ming EVRA

u tin vo ngyCh Nht

Dn ming dn

EVRA u tinvo ngy ChNht u tin saukhi c kinh nguytsau dng thucung

Ch nht hng

tun (tr tun4: khng dn)

Cn thit cho 7

ngy u tin

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Qun thay ming dn EVRATNH HUNG CN LM NGY THAY MiNG

DNBiN PHP NGA THAI

PH TR

Qun dnming dn

Vo ngy u tinca chu k mi(ngy th 1)

Dn cng sm cng ttkhi nh ra

Ly mc l ngy dnming dn ln ny(khc vi trc)

Cn thit cho 7 ngy utin ca chu k mi ny

ming dntrn da hn 7ngy

Vo gia chu k

(ngy th 8 hocngy th 15)

Khng qu 2 ngy(48 gi)

G b ming dn c,dn ming mi ngay

Nh trc Khng cn thit

Qu 2 ngy (48 gi) G b ming dn c,

dn ming mi ngay.By gi ly mc ngyth 1 l ngy ny

Ly mc l ngy dn

ming dn ln ny(khc vi trc)

Cn thit cho 7 ngy u

tin ca chu k mi ny

Cui chu k (ngyth 22)

G b ming dn cngay khi nh ra

Nh trc Khng cn thit

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Ming dn Evra bong ra

TNH HUNG CN LM NGY THAY MINGDN

BIN PHP NGATHAI PH TR

Ming dnbong ra mtphn hoc rira

Ko di di 1ngy (24 gi)

Dn li phn b bong,hoc thay vo v tr

ming dn mi

Nh trc Khng cn thit

Ko di hn 1ngy (24 gi) hockhi khng chcchn thi gianbong/ri

G b ming dn c,dn ming mi ngay.

By gi ly mc ngy 1l ngy ny

Ly mc l ngy dnming dn ln ny(khc vi trc)

Cn thit cho 7ngy u tin ca

chu k mi ny

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So snh Evra v thuc ung nga thai

Thuc ung : mi ngy 1 vin k t ngy u thy kinh, lin tc trong 21 ngy. Ngh 7 ngy khngung thuc

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3

Cch ung

Evra: Dn 1 ming Evra vo ngy u kinh nguyt lin tctrong 7 ngy, thay cc ming k tip sau 7 ngy. Ngh 7ngy khng dn Evra.

Ngy u tin thy kinh7 ngy ngh khngdng thuc

7 ngy ngh khngdn Evra

Ung tip vmi

1 vin cho mi ngy: ung 21 ln/chu k dng thuc

Dn Evra mi1 ming dn cho 7 ngy, dn 3 ln/chu k dng thuc

S h E th th i

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So s nh Evra v thu c u ng ng a thai(Mercilon)

Thuc ung

Nu b tiu chy, i ma trong vng 4 gi sau khi dng thuc, vin thuc ny c th cha c hp thu hon ton vo c th.

Trng hp ny nn ung thuc tip tc nh t hng l ng thi phi dng bin php nga thai ph t r trong 7 ngy

Trng hp b tiu chy, i ma sau khi dng thuc

Evra:

Vic phng thch cc hormon trong

Evra khng b nh hng khi bnb tiu chy hay b bun nn

Khng cn bin php nga thai ph

tr.

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So snh Evra v thuc ung nga thai

Thuc ung

Di 12 gi: ung vin thuc qun, vin k tip ung theo gi thng l, khng cn bin php nga thai ph tr

Trn 12 gi: : ung ngay vin ca ngy hm trc, vin hm nay vn ung vo gi thng . Cn c 7 ngy ung thuc khng gin on v dng bin phpnga thai trong 7 ngy khi ung thuc.

Qun dng thuc

Gia chu kEvra:

Di 48h: Dn ming dn tip ngay khinh ra v KHNG CN dng binphp nga thai ph tr.

Trn 48 gi: Dn ming dn Evra tiptheo v xem ngy dn ny l ngythay ming dn v bt u mt chuk dng thuc mi ( dn lin tip 3ming trong 3 tun ) dng thm binphp nga thai ph tr trong 7 ngy.

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Thn trng

Ph n trn 35 tui c ht thuc

Cn nng trn 90 kg

C cc bnh suy gan,cao huyt pTrm cm nng

Tiu ngBnh nhn b ung th c quan sinhsn v v

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CHN THNH CM N