Intrauterine Contraceptive Device - IUCD

It contains the concept, history, different types, mechanism of action, insertion, ideal IUD candidate, contraindication, failure rate, advantage and disadvantage.

1. INTRA UTERINE CONTRACEPTIVE DEVICE (IUCD)

2. Learning points History Introduction Types of IUCD Mechanism of Action Ideal IUD Candidate Contraindications Time of Insertion Advice after Insertion Failure rate & restoration of fertility Advantages & disadvantages

3. What is IUCD? It is a small, flexible, plastic device that contains either metal e.g. copper or hormones e.g. progesterone, which when placed inside the uterus, prevent the birth of the child. Concept: Derived from Arabs – By controlling conception in camels by introducing a small spherical stone into each horn of the uterus.

4. History 1929 = Grafenberg , German Gynecologist  Used a core of silkworm gut encircled by German Silver ring successfully in preventing conception. 1934 = Mr . Ota , Japan  Introduced a gold plated silver ring, with a disk in the center, attached by three spokes (Ota ring) 1959 = Oppenheimer (Israel) & Ishihama (Japan)  Published the excellent results of IUDs, discovered by Grafenberg & Ota. 1960 = Margulies spiral was launched, a plastic device, impregnated with barium sulfate, a radioopaque substance. 1960 = Dr Jack Lippe (USA)  Introduced Lippes Loop, very popular for two decades in India 1970 = It was modified by adding copper, have strong antifertility effect, widely used now a days under NFWP. 1990 = Further modified and improved by impregnating the IUDs with slow releasing hormones.

5. Introduction IUD is a small, stiff but flexible, nontoxic, polyethylene plastic frame, incorporated with barium sulfate , to make it radiopaque and prevents conception by acting as a foreign body when inserted into the uterus of the women, through vagina. Has two strings Made up of nylon Hang through the opening of the cervix into the vagina To check by the user to know whether it is in situ To remove it by pulling when pregnancy is desired

6. Types of IUCD

7. Types of IUCD

8. First Generation IUDs Inert, non-medicated devices E.g., Lippes Loop Double S-shaped , serpentine device, made up of polyethylene, non-toxic, non-tissue reactive material, incorporated with barium sulfate . Two nylon transcervical threads – attached to lower end of the loop.

9. First Generation IUDs Four size – A, B, C, D Latter being the largest , recommended for multiparous women . India = 2 sizes available – 27.5 and 30 mm. To identify = Smaller one – black thread, Bigger one – Yellow thread Limitations = More side effects & higher expulsion rate ( 19 per HWY )

10. Second Generation IUDs 1970 = Metallic copper has a strong antifertility effect. Addition of copper to IUD = Made it possible to develop smaller and safer than Lippes Loop. Minimizing the side effects & expulsion rate

11. Second Generation IUDs

12. Second Generation IUDs The number = Indicates the surface area of the copper in sq. mm on the device. Nova T and Copper T 380 Ag = Distinguished by a silver core over which is wrapped the copper wire. All Cu T and Multiload devices = Effective for at least 5 years except Cu T 380A (10 year)

13. Third Generation IUDs Also ‘T’ shaped device Made up of permeable, polymer membrane incorporated with a slow releasing progesterone hormone (Progestasert, Levonorgestrel 20 g/day) – LNG20 . Progestasert Contains natural progesterone hormone Released in uterus slowly over a period of 1 year @ 65 g daily Regular replacement is necessary every year. Levonorgestrel 20 g/day Contains potent synthetic hormone. Releasing 20  g/day Effective for 3-5 years. Compared to Copper device, expulsion rate and side effects are low but more expensive

14. Mechanism of Action of IUCD

15. Mechanism of Action

16. Insertion of IUCD

17. IUCD Insertion

18. Ideal IUD Candidate Women in the reproductive age Given birth to at least one child Not having multiple sexual partners No history of pelvic disease Normal menstrual period Willing to check IUD tail regularly Has access to follow up

19. C/I for IUD

20. Time of Insertion Make sure the female is not pregnant At any time during the menstrual cycle Ideal time = After 5 th day and before the 10 th day of menstrual period Called “ Intermenstrual Insertion ” After pregnancy - Chances of expulsion and perforation are high within 1 st week of pregnancy Convenient time 6-8 weeks after pregnancy

21. Time of Insertion Depending on the time of insertion it is classified as;

22. Instruction after IUD insertion Must feel for the thread in the vagina – every month Must report if it is not felt or expelled out or cause any problem Must report for routine examination – 1 & 2 years after insertion Removal of IUD after its lifespan is over If she became pregnant & if she desires the pregnancy – Remove the IUD to avoid infection & spontaneous abortion. If she became pregnant & if she does not want the pregnancy – MTP is done.

23. Advantages

24. Disadvantages (SE & Cx )