1. IUCD Dr. Sharon D. Rasquinha

2. Intrauterine contraceptive device : • Learning objectives : • Define an IUCD • Enumerate the type of IUCD • Describe the mechanism of action. • Enumerate their advantages and disadvantages • Indications/contraindications and complication • List the criteria for selection of a client for IUCD • Describe the technique • Other uses of IUCD

3. IUCD are small flexible devices made of plastic or metal or in combination meant for insertion into uterus cavity for contraception. • Grafenberg ring • 1960 Lippes loop • Frames are made of polyethylene, (P-Ethylene vinyl acetate) • Impregnated with barium sulphate – radio opaque • All IUCD have nylon tail

4. TYPES : Three generations • First generation : Lippe’s loop • Second generation : Contain copper • CuT 200, multiload 250 • CuT 380A, CuT 220c, Nova T, multiload 375 • Third generation : Hormone containing – P LNG • Open / closed • Copper IUCD are of several types N • No against the designation of each device denotes the surface area of copper in mm2 • Copper T 220c and CuT 380A are available in NFPP • CuT 200 are effective for five year • CuT 380A – 10 years

5. Hormone releasing IUCD • Acts as a delivery system for the hormones. • Beneficial to women with menorrhagia. Progestasart : • T shaped device made of ethylene vinyl acetate copolymer • Vertical shaft is fitted with a capsule contain 38mg of progesterone. • 65mg/day • To be replaced every year.

6. Levonorgestrel devices : • LNG 20 mirena, Levonova emiley • Delivers 20mg of LNA/day • Replaced every 5 years • MOA : Blocks sperm migration. • Spermicidal effect of lysocomal activation • Accelerated lirbal motility. • makes end hostile to implantation.

7. Advantages : • Effective soon after insertion • Not linked to sexual activity • Not interferes with intercourse • No need for constant motivation • No risk of drug interaction • Does not affect breast feeding • Removal of device is easy • Return of fertility is noted soon after removal • No systemic side effects

8. Disadvantages : • Do not protect from STD

9. Complications : • Cramps syncopal attacks • Perforation • Expulsion • Menorrhagia • Infection

10. Indications : • Parous women in R. age breast feeding mothers as postcoital contraception C/I : • Suspected pregnancy • Abnormalities GT • PID • Cervicilin/vaginities • Genital bleeding • Uterine pathology • Severe anemia • Previous h/o EP • Multiple sexual partners

11. Time of insertion • Post menstrual • Postnatal – 6 weeks • Post placental • After an abortion 1 trimester • MTP

12. Technique of insertion • Post insertion advice • Missing CuT threads

13. IUCD – an effective reversible long term c. method. Each device has a Nylon thread attached to lower end. • They have a life of 3-5 years. 50g of cu is eluted daily in the uterus. • Copper T 380A – paraguard – 10 years • Progestasart is T shaped has 38mg of progesterone. 65mg of hormone is released daily. • Forms thick plug of mucus – prevents sperm penetration • Required yearly replacement.

14. Mirena : • contained 52mg of LNG – releasing 20mg daily. • Life of 5 years FR of 0.1 – 0.4 HWY • Frameless IUCD and fibroblast releasing 14mcg P daily for 3 years. • Gyneflex is 3-4cu long, 12mm in width adapts to the shape of uterine cavity. • It contained 6 copper beads on monofilament poly propylene thread. Thread is knotted at one end which is fixed to the fundus. • Ensure device within the intramural portion of FT

15. Patient selection : • Low risk for STD • Multiparous • Monogamous relationship • Desirous of long term reversible method, but not permanent method. • Unhappy / unreliable user of ocp.

16. Uses : • Contraception • Post coital contraception • Following excision of uterine septum. Asherman’s syn. • Hormonal in menorrhagia. • In women on tamoxifen for breast ca. Mirena can counteract Endo hyperplasia.

17. C/I : • Suspected pregnancy • PID • Presence of fibroids • Severe anemia • Diabetic • Heart disease • Previous ectopic • Scarred uterus • Avoid in unmarried / nullipara • Septate uterus

18. During / soon after period • After MTP • Immediate PP • 24 hr. of delivery • 6 weeks PN

19. MOA : • Foreign body in uterus renders irrigation of spermatozoa difficult. • FB provokes uterine contractility thro’ PG’s, decreased tubal peristalsis. • Leucotytic infiltration in endo. Macrophages engulf the fertilized egg. • Released copper brings about certain enzymatic and metabolic change in endometrial tissue. • Progesterone carrying devices alters the cervical mucus which prevent sperm penetration, endometrial atrophy.

20. Complication : • Immediate : • Difficulty in insertion • Vasovagial attack • Uterine cramps

21. Early : • Expulsion (2-5%) • Perforation (1-2%) • Spotting, menorrhagia • Dysmenorrhea • Vaginal infects • Actinomycosis

22. Late : • PID • Pregnancy • Ectopic pregnancy • Menorrhagia

23. Misplaced IUCD : • Causes are – uterus has enlarged thro’ preg. • Threads have curled up • Perforation has occurred • Expelled out