Jadella Implant is a form family planning which comes in two silicon rods,implan subdermal Over the years it release progestin to prevent ovulation thus prevent pregnancy
2. CONTENT
Brief Introduction
What is It
Component/Structure
Release Rate of Levonorgestrel
Pre-clinical Evaluation
Mechanism of Action
Efficacy/Fertility
Subjective Symptoms
Timing of Insertion
Implant Insertion Technique
Comparison - New Hormonal Implants
Monthly Stat for Implants -MGH
Summary
3. Brief Introduction
Implants are approved in more than 60 developed and
developing countries and are currently being used by
millions of women worldwide 1
. Owing to their high
contraceptive efficacy (which begins almost immediately
after insertion), low rate of complications and side-effects,
possibility of long-term use following a single intervention
and the rapid return of fertility after removal.
Contraceptive implants are good candidates for inclusion in
the method mix offered by family planning programmes,
especially in under-resourced setting 2
.
1. Ref: Contraceptive implants come of age. Progress in Reproductive Health Research 2003; No. 61. Geneva; World
Health Organization (www.who.int/reproductive-health/hrp/progress/61/news61.htm (accessed 1 September 2008).
2. Boostra H, Duran V, Weaver K. Norplant and the boom or bust phenomenom. IPPF Medical Bulletin October
1999;33:3–4.
4. Countries using Implant
Burundi
Ethiopia
Ghana
Malawi
Mali
China
Indonesia
Kenya In Progress (n=20)
Under Review (n=10)
Nepal
Pakistan
Rwanda
Tanzania
Uganda
Argentina
Bangladesh
Bolivia
Brazil
Burkina Faso
Chile
Colombia
Dominican
Republic
Ecuador
Fiji
India
Mexico
Mozambique
Nigeria
Peru
Russia
South Africa
Sudan
Venezuela
Zimbabwe
REGISTERED (n=6)
Sierra Leone
Madagascar
Zambia
5. Levonorgestrel subdermal implants provide effective long
term contraception.
Implants are a good choice of contraceptive method in
women who desire effective contraception, but who are
unable to, or prefer not to, comply with an oral regimen or
injection.
Implants maybe used to postpone
1st pregnancy
Space pregnancy
Provide long-term contraception when desired
family size is reached
What is it?
6. Long-Acting & Permanent Methods
The advantages that implants and other methods such as
the IUD offer over other contraceptive methods is that they
are not user-dependent in the way that condoms, injectables
& combined oral contraceptives (COC) are 3
.
Ref. 3.Russell J. Contraceptive failure in the United States. Contraception 2004;70:89–96.
7. Components
Implants is a set of two flexible cylindrical implants
consisting of a dimethylsiloxane/ methylvinylsiloxane
copolymer core enclosed in thin-walled silicone tubing.
Each rod contains 75 mg of the progestin levonorgestrel.
The core of each rod is a mixture, half of levonorgestrel,
half of the elastomer.
The rods are sealed with polydimethylsiloxane adhesive &
sterilized.
Each rod is approximately 2.5 mm in diameter & 43 mm in
length 4
.
Ref. 4. Harold Nash, and Sandra Waldman. Jadelle ィ Levonorgestrel Rod Implants:.A
Summary of Scientific Data and Lessons Learned from Programmatic Experience Irving
Sivin,
8. Medical adhesive
43mm thin-walled silicon tubing
levonorgestrel & Siloxane copolyme
12.5mm
Components
Session IV A, Slide #3
Implanon Applicator
9. Structure
The sole active ingredient in the rods is levonorgestrel (-)-13-
ethyl-17-hydroxy-18,19-dinor-17α-pregn-4-en-20-yn-3-one.
It has a molecular weight of 312.45 and the structural formula.
Medical grade silicone rubber materials, including the type
used in Jadelle, have been employed in various implantable
devices for humans since 1950 4
.
Silicone rubber implant have be employed in various
implantable device
Prosthetic devices
Heart valves
Drainage tubes
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Ref. 4. Harold Nash, and Sandra Waldman. Jadelle ィ
Levonorgestrel Rod Implants:.A Summary of Scientific Data and
Lessons Learned from Programmatic Experience Irving Sivin,
10. Release Rate of Levonogestrel
Diffusion of Levonogestrel from the rods produces a continuous
low dose of the progestin and is is delivered directly into
interstitial fluids from the subcutaneous implants
After placement of Jadelle rods,levonorgestrel concentrations
reach a maximum level within 2-3 days after implant
Decline rapidly over the 1st month both due to a decrease in the
rate of release & because of decreased circulating levels of sex
hormone binding globulin (SHBG), a protein that binds
levonorgestrel.
Jadelle/Day Dosage/Rate Remarks
1 month 100g/day
12 months 40g/day
24 months 30g/day -stabilizing thereafter
11. Pre Clinical Evaluation
Levonorgestrel implant is a totally synthetic &
Biologically active Progestin- does not contain
estrogen- a subdermal contraceptive implant
A double silicon rods preload in a sterile disposable
applicator to facilitate easy & rapid insertion
Release of Levonorgestrel sufficient to prevent
conception within 24hrs after implant
Effective role for 5 years
12. Mechanism Of Actions
At least 3 mechanism are active in preventing pregnancy
1. Ovulation inhibition- by suppressing of
gonadotrophins (LH&FSH) secretion
2. Thickening of the cervical mucus
-increase viscosity of the cervical
mucus that preventing passage of
sperm into the uterus
3. Decrease endometrial
thickening during the use of
implants.
13. Efficacy/Fertility
It is convenient, safe, and over 99% effective
Prevents against pregnancy for up to 5 years, can be
removed @ anytime
Return to fertility rapidly after removal.
Another Jadelle implant can be inserted immediately
after removal for protection against pregnancy
It is invisible
Can be used without anything else
14. Subjective Symptoms
The cost is K1040-K2080 and around K200-K400
for removal
Headache
Nausea
Breast pain & Mood changes
Others include- pain, itchiness, infection and
expulsion on insertion site
This does not protect you from STDs
15. Timing of Insertion
Should be inserted on day 1-5 during menstrual cycle
Immediately or on week after 1st/2nd trimester
abortion
In Postpartum women
Non BF women immediately or within 6 wks after
labor
BF women should not use implants before 6 wks
after labor.
However,studies have shown no significant effects on the
growth or health of infants whose nursing mothers began
using levonorgestrel implants immediately or 5-7 wks after
childbirth. There is no experience to support the use of
Jadelle earlier than six weeks after childbirth in lactating
women
16. Implant Insertion Technique
Session IV A, Slide #2
One-Rod Implant Insertion:
Required Equipment
• An examination table
• Sterile surgical drapes
(optional) and gloves
• Antiseptic solution
• Local anesthetic, needles,
and syringe
• Implanon applicator
• Skin closure, sterile
gauze, and compresses
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Two rods implant Insertion
Required Equipment
17. Session IV A, Slide #4
Implanon Insertion: Step 1
• Have the client lie on
her back with the arm
that she doesn’t
normally use flexed at
the elbow and
externally rotated.
• Implanon should be
inserted sub-dermally
just under the skin.
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Jadelle Insertion: Step 1
18. Session IV A, Slide #6
Implanon Insertion: Step 3
• Mark the insertion site
with a marker.
• Make 2 marks:
– First, mark the spot where
the rod will be inserted.
– Second, mark a spot a few
centimeters proximal to the
first mark. This second
mark will later serve as a
direction guide during
insertion.
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Jadelle Insertion: Step 2
3 Finger breath Medial Epicondyle
19. Session IV A, Slide #7
Implanon Insertion: Step 4
• Clean the client’s upper
arm with antiseptic
solution. Frame the
insertion area with a
drape that has an
opening (optional).
• Anesthetize the insertion
area with anesthetic
spray or by injecting 2 cc
of 1% lidocaine just under
the skin along the
planned insertion tunnel).
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Jadelle Insertion: Step 4-5
Injection 10cc of 1% Lidocaine just under the skin
20. Session IV A, Slide #8
Implanon Insertion: Step 5
• Remove the needle
shield.
• Stretch the skin around
the insertion site with
thumb and index finger.
Session IV A, Slide #9
Implanon Insertion: Step 6
• Insert the tip of the
needle, at about a
20 degree angle.
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Jadelle Insertion: Step 6
Jadelle Insertion: Step 7
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QuickTime™ and a
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Session IV A, Slide #10
Implanon Insertion: Step 7
• Release the skin.
• Lower the applicator
to a horizontal
position.
Session IV A, Slide #11
Implanon Insertion: Step 8
• Lift the skin with the tip
of the needle, keeping
the needle in the
subdermal connective
tissue.
• While lifting the skin,
gently insert the entire
needle. Keep the
applicator parallel to
the surface of the skin.
Jadelle Insertion: Step 8
Jadelle Insertion: Step 9
22. Session IV A, Slide #16
Implanon Insertion: Step 13
• Verify the presence of the implant by
palpating the site.
• Apply a sterile gauze and wrap the
arm with a pressure bandage.
• Before the client is discharged,
observe her for a few minutes for
signs of bleeding from the insertion
site.
• Fill out the user card and give it to
the client.
• Review post-insertion instructions
and other key messages.
• Dispose of the applicator and syringe
properly.
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Jadelle Insertion: Step 10
23. Sino-implant (II) Jadelle Implanon
Manufacturer Shanghai Dahua
Pharmaceutical
Bayer HealthCare Schering Plough /
Organon
Formulation 150 mg
levonorgestrel
In 2 rods
150 mg
levonorgestrel
In 2 rods
68 mg etonogestrel
In 1 rod
Mean Insertion
& Removal time
Insertion: 2 min
Removal: 4.9 min
Insertion: 2 min
Removal: 4.9 min
Insertion: 1.1 min
Removal: 2.6 min
Labeled
duration of
product use
4 years 5 years 3 years
Trocars Disposable Autoclavable /
Disposable
Pre-loaded
disposable
Cost of implant
(US$)
K17.00 K55.00 K52.00
Cost per Year
(if used for
duration)
K5.20 K12.40 K17.42
New hormonal implants
Comparison of Sino-Implant, Jadelle, Implanon
24. Monthly Stat for Implants
There were total of 102 implants done for the first half of April
2014, MGH 70, Ialibu 28 & MTC 14
1 2
5
10
52
0
10
20
30
40
50
60
TOTAL NUMBER
Extra-uterine
Pregnany
Purperal
Sepsis
Cearean
Section
Para >5 Para 1-4
INDICATIONS
JADELLE IMPLANTS-MGH
Remarks: Positive Response to Jadelle Implants
25. Summary
Contraceptive implant system provides effective,long-
acting, reversible contraception for women.
Two thin, flexible rods made of silicone tubing and filled
with levonorgestrel, a synthetic progestin, are inserted
just under the skin of a woman’s upper,inner arm in a
minor surgical procedure.
Protection from pregnancy is provided within 24 hours,
when insertion is performed during the first week of a
woman’s menstrual cycle.
The woman rapidly returns to her normal fertility when
the implants are removed.
Sub-dermal implantable contraceptives are highly
effective, easy to use and carry a low risk of side-effects.
These features make them a good option for women in
under-resourced settings.
26. You cannot have maternal health without reproductive health. And
reproductive health includes contraception and family planning and
access to legal, safe abortion.
Hillary Clinton quotes