INTRA UTERINE CONTRACEPTIVE DEVICE (IUCD).pptx

Lesson notes on Intrauterine device

1. INTRA UTERINE CONTRACEPTIVE DEVICE (IUCD) By Mrs. I.A. Ogunjimi

2. Types Non-medicated IUCD (first generation) Lippes loop Saf T coil The non-medicated can be inserted and stay in the uterus for 5 years. It is made up of polythene . Saf T coil is usually used for nulliparous client

3. Introduction IUCD is an object inserted in the womb to prevent unwanted pregnancy. They are small flexible devices made of metal or plastic.

4. Lippes Loop There are four types A,B,C&D The sizes are used to identify the different types. SIZE A Has a blue string It is 26.2mm in length The width is 22.2cm It is spiral Bow type & coil type

5. Lippes Loop cont’d SIZE B The string is black in colour Length is 25.2mm Width is 27.4mm SIZE C The string is yellow in colour Length is 27.5mm Width is 30.0mm

6. Lippes Loop cont’d SIZE D Colour is white Length is 27.5mm Width is 30.0mm It was first marketed in 1962

7. Lippes Loop

8. Saf T Coil It is made up of flexible stainless steel. It is not popular hence out of use It is the lippes loop that is common

9. Saf T Coil

10. Medicated IUCD Copper is usually added to IUCD There are many types of IUCD Copper T Cu T 380A Cu T 220c Cu T 380Ag Cu T 380 slim line Cu T 200 B Medicated 200Ag Multiload 375 0r 250Cu Progestasert 38mg- contains only progesterone. It contains 38mg & releases 65Ag every day for one year.

11. Medicated IUCD cont’d The multiload was invented in 1974 in Netherland. CuT 380- It was developed in Canada in 1982 CuT 200 series was developed in USA in 1972

12. Copper T

13. Mechanism of Action of IUCD It prevents fertilization by stimulating a pronounced inflammatory or foreign body response in the uterus (white blood cell will have to play). The concentration of WBC, prostaglandins and enzymes increases rapidly in the uterus and fallopian tubes thereby interfering in the transportation of sperm in the genital tract. This may also change the sperm or the ovum thereby making fertilization impossible. There will be immobilization of sperm resulting in no fertilization There will be increased motility of the ovum in the fallopian tube

14. Mechanism of Action of IUCD cont’d Various types of WBC will consume the sperm in the uterus because the uterus see it as a foreign body. (Numbers 2,3 &4 are new mechanisms newly invented). Increase local production of prostaglandins which inhibit implantation Impairment of implantation by disrupting the proliferative secretion

15. Effectiveness of IUCD The most effective of the IUCD is the medicated and is about 97-99% The non-medicated is less effective & is about 97-98% The effectiveness can be attributed to the size, shape and presence of CuT or progesterone, the age and the parity.

16. Contraindication Absolute Contraindication These set of people must not be given IUCD Intrauterine pregnancy, suspected or not Acute vaginitis Suspected cases of acute PID Abnormal vaginal bleeding of undetermined origin Malignancy of the genital organs

17. Contraindication cont’d 2 . Strong relative Contraindications Cervical or uterine malignancy- need to be diagnosed and treated before inserting IUCD History of ectopic pregnancy- this is because incidence of ectopic pregnancy is higher in patient with IUCD Congenital abnormalities or fibroids- This will interfere with proper placement. IUCD should be placed in the fundus, if there is abnormality, it will lead to malposition.

18. Contraindication cont’d 3. Relative Contraindication IUCD may be used when there is no alternative but with caution and regular monitoring. Anaemia - IUCD worsens anaemic condition Nulliparity - IUCD will usually increase the incidence of infection and if not properly treated will result in infertility. Blood coagulation disorder- uncontrolled bleeding aggravated Severe primary dysmenorrhoea - There is increased intrauterine cramping with IUCD.

19. Contraindication cont’d Copper allergy or Wilson’s Disease Intrauterine depth that is less than 5cm, the uterus will not accommodate IUCD Valvular Heart Disease- This is because she can be susceptible to sub-acute bacteria endocarditis Cervical stenosis If she has more than one sexual partner

20. Factors to Consider in Choosing an IUCD Competence on the part of the nurse, doctor or the inserter Familiarity with the selected IUCD (use the one you are familiar with)

21. Guideline for Timing the IUCD There are some basic principles: Confirm that your client is not pregnant Confirm that there is no pelvic infection During normal menstrual cycle Immediately after evacuation of an incomplete abortion if there is no infection Six weeks post partum Three months after a successfully treated pelvic inflammatory disease Three months after caesarean section

22. Guideline for Timing the IUCD cont’d IUCD should not be used if there is: Offensive vaginal discharge Offensive lochia Dyspareunia Pain on pelvic examination (means there is cervical erosion)

23. Equipments for IUCD Insertion A pair of sterile gloves Sponge holding forceps Speculum- Cuscos or Sims Artery forceps for holding the IUCD (optional) Vulsellum or tenacullum Uterine sound Tegar’s cervical dilator IUCD with inserter and the introducer

24. Equipments for IUCD Insertion cont’d A pair of scissors Hibitane or Savlon Sterile gauze Cotton swabs (sterile) Sanitary pad Hibitane cream Angle poise lamp or touch light

25. Procedure for IUCD Insertion Read the IUCD pack instruction before insertion Collect necessary equipment Prepare the client mentally and physically so that she will relax Tell her to empty her bladder Perform careful bimanual examination To rule out pregnancy To rule out infections To locate the position of the uterus Switch on the angle poise lamp Put on your gloves Clean the vulva with antiseptic lotion

26. Procedure for IUCD Insertion Lubricate the speculum with hibitane cream Insert the speculum Inspect the cervix Clean the cervix Grab the anterior tip of the cervix Sound the uterus with uterine sound Load your IUCD under sterile techniques with the nylon tape hanging out of the edge The IUCD insertion must be under sterile technique The interval between the loading and insertion should not be more than a minute, otherwise, the IUCD will lose its shape. When this happens, the effectiveness is reduced.

27. Procedure for IUCD Insertion cont’d Insert the IUCD by pushing the inner plunger into the outer barrel and this is referred to as PUSH TECHNIQUE. Insert the IUCD by retracting the outer barrel over the plunger referred to as WITHDRAWAL TECHNIQUE, used for CuT Remove the plunger and the barrel clip, the string, if too long, trim it to 5cm Remove the speculum Tidy up the client Then try and clean the examining finger of the client Ask the client to feel the string before leaving the examination room

28. How to Check IUCD Insertion Tell the woman to wash her hand She should try to reach the vagina with the index and middle fingers to locate the string Warn her not to pull on the string so as not to dislodge the IUCD

29. Post Insertion Instruction Tell the client that post insertion menses may be heavy Give her information card Tell her that IUCD does not offer protection against STD and AIDS, thus, she should avoid multiple partners. She should check the string after insertion.

30. Instruction after Insertion How often the client should check string: Middle way between periods Check it before intercourse Check it after each menstrual period She should check it after the following symptoms Cramping in the lower abdomen Spotting between periods or spotting after intercourse If client gets pregnant, she should report to the hospital as soon as possible so as to get IUCD removed If she wants it removed anytime for any reason whatsoever, she should report or come to the clinic Instruct her that if strings is not felt before intercourse, she should check for string in squatting position.

31. When Client Should Report to Clinic for Follow-up She should see the healthcare provider when she sees any of these signs: P - When period is late, if there is abnormal spotting or bleeding A -Abdominal pain or pain during intercourse I- Increased temperature, fever, chills and all these denote infections, likely signs of gonorrhoea , abnormal vaginal discharge N - Not feeling well or noticeable foul smelling vaginal discharge S - Strings missing, shorter or longer She should return 6 weeks after insertion and 3 monthly for check up even when there is no problem. After 3 months, client should report for annual checkup.

32. Advantages Highly effective 99% (for medicated) No systemic side effect It is nearly always reversible Does not interfere with sexual intercourse It does not require day to day actions It is relatively cheap It does not influence milk volume or composition (breastfeeding)

33. Non-contraceptive Advantages It can be used to prevent or treat Alzheimer’s syndrome It can be used to bring or induce menstruation in women with amenorrheoea due to long use of hormonals The progestin or progesterone bearing or release in IUCD can decrease menstrual blood loss to those with heavy menses or chronic dysmenorrhoea

34. Disadvantages There can be : I ntrauterine pregnancy Tubal pregnancy Expulsion Malposition Pelvic infection Abnormal bleeding Infertility More cramps and pain during monthly period Prolonged and heavy monthly bleeding

35. Side Effects Spotting, bleeding, anaemia - Once these occur and is getting out of hand, remove IUCD Endometriosis

36. Complications Expulsion of IUCD Pregnancy while on IUCD Bleeding Uterine perforation Pelvic infection Pain

37. Removal of IUCD Equipment needed include: Speculum Angle poise lamp Sponge holding forceps Put in your speculum Locate the IUCD G et hold of the string and remove gently Make patient comfortable and clear away equipment

38. Show to the client after removal Clean up the patient Allow her to rest Inform her pregnancy is an immediate possibility Tell her to come back for another method anytime she is ready. Give prescribed medication such as PCM and flagyl .

39. t Thank you for listening