intrauterine contraceptive devices ( iucds)
Post on 15-Jul-2015
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Classification
• Non- medicated IUCDs: Lippes loop• Medicated copper containing IUCDs :
Cu T-380 A, Multiload – 375, Cu T-200, Multiload – 250
• Hormone containing IUCDs : Levonorgestrel intrauterine system (LNG – IUS), progestasert
1. A 32 year old woman, P2L2 has come to the hospital for advice on contraception. She is a model and couldn’t tolerate excessive weight gain. When asked about her menstrual history, she says that she soaks through a pad every 2 to 3 hours and she has to get up in the middle of the night to change her pad. She also has severe cramps. She said she doesn’t prefer taking pills because she has never been able to remember to take a pill daily.
What is the best method of contraception?
a)Depot- medroxyprogesterone acetate
b)Progestin- only pill (minipill)
c) Combined oral contraceptive pills
d)Levonorgestrel - IUS
2. A 26 year old woman, G3P3 comes to the hospital to get a copper T inserted. On examination, she is found to have ascites and splenomegaly. Signs of chronic liver disease were also found. On slit lamp examination :
Would you proceed with the copper T insertion?
3. Lalitha is a married 30-year-old mother of one infant child. She and her husband both wish to delay having a second child. Lalitha is currently breastfeeding. She had an occurrence of pelvic inflammatory disease (PID) in her early-20’s. She heard about IUCDs from a community health worker and has come to the clinic to learn more about them.
During your meeting, Lalitha wants to learn more about IUCDs and asks the following question:
Ideal candidate for IUCD
• Normal uterus• Parous• Low risk for STD• Monogamous • Don’t wish to have baby for few years• Want to avoid surgical sterilisation • Willing to check IUCD thread• Assess – follow up, treatment
6.Untreated acute cervicitis, vaginitis, including bacterial vaginosis, until infection is controlled
4. It is now 6 months since Yamuna had her IUD inserted. During a visit 3 months ago, Yamuna had complained of a heavy bleeding and cramping during menses. She was also concerned about the IUD expulsion. You had examined her and confirmed that the IUD is still in place and reassured her about the side effects. Today, she has returned to the clinics and complains of fever, purulent vaginal discharge, lower abdominal pain, and pain during sexual intercourse. She has checked the threads after each menses since her last visit and had felt them each time.
Answer :• Complication if untreated • Partner also treated• Abstinence from sexual intercourse until
treatment completed• Use other contraceptive method
5. Sudha, a P1L1 has had her IUCD for three months. She is returning to the clinic and complains that she still has cramping, especially during menses, and heavy bleeding during her periods.
2. PELVIC INFECTION(PID)
Risk :• Low overall• Higher (first 20 days)• Extremely rare (> 20 days)• Gonorrhea/chlamydia• Similar to risk of PID
in women with
gonorrhea and chlamydia
who are not using IUCD
How to reduce the risk of PID?
• Don’t insert IUCD if :- High risk of STIs- Clinical symptoms and signs of STI • Aseptic technique• Follow-up visit at 3 to 6 weeks
Perforations
• Incidence 1 in 1000• IUCD, the inserter tube, the sound, or other
gynecological instrument • Withdrawal technique (less common)• Postpartum between 72 hours and 6 weeks
4. Expulsions
• During menstruation• Factors contributing to expulsion :
1.Provider’s skill
2.Age, parity
3.Time since insertion
4.Timing of insertion
Intrauterine Pregnancy
• Spontaneous abortion (most common)• Removed• Increase risk of preterm labour (if left in place)
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