Mirena evo insertion

CONTRACEPTION- MENORRHAGIA

1. Mirena IUCD, new inserter AHMED ZAKI, MD, MRCOG Head of OB/GYN Department Chairman of Scientific Committee Bakhsh Hospital

2. Contraceptive museum

3. Dr. Lippe in Yr.2000 at world congress

4. First generatin I.U.C.D.is Lipes loop Second generation I.U..C.D.is Copper T-200 Third generation I.U.C.D.is Gyne -T 380 With 4 years Intra uterine life

5. . 4 th generation IUCD

6. Mirena IUCD Menorrhgia Contraception HRT Endometriosis Reproductive benefits

7. Mirena ® old inserter Open the sterile package completely. Release the threads. Rotate the inserter so that the centimeter scale is upwards (Fig. 1a). Check that the arms of the system are in horizontal position (Fig. 1b). Holding the slider in the furthest position, pull on the threads to draw the IUS system into the insertion tube (Fig. 2a). If the knobs at the ends of the arms do not meet properly (Fig. 2b), release the arms by pulling the slider back to the mark. Re-load the product by aligning the open arms on a sterile surface (Figure 1a). Return the slider to its furthermost position and pull on both threads. Check for proper loading (Fig. 2b). Fix the threads in the cleft at the near end of the inserter shaft (Fig. 3). Figure 1a Figure 1b Figure 2a Figure 2b Knobs at the end of the arms Figure 2b

8. Why changes????

9. Packaging Size of secondary package smaller Evo Inserter ™ is positioned horizontally in the primary package Primary package contains a sticker

10. EVO Inserter Threads are released when the slider is pulled downwards and past the mark The IUS system is already in the horizontal position in the package. No need to check the horizontality. New shape of the slider Scale on both sides of the insertion tube Loading of the IUS system is achieved by only pushing the slider upwards. The removal threads are thinner and softer, and are inside the inserter handle: no handling of threads required for the loading of the IUS system.

11. Insertion procedure Less preparatory steps: simplified loading by pushing the slider forward to its furthest position Insertion technique remains the same as before!

12. Mirena ® Evo Inserter Open the sterile package completely (Figure 1). Push the slider forward in the direction of the arrow to the furthest position to load Mirena ® into the insertion tube (Figure 2). Figure 1 Figure 2

13. (Click the picture to see video) Preparatory steps Loading of Mirena ® : note the arrow in the slider which indicates the direction of movement

14. What has changed? Dimensions Mirena ® old inserter Mirena ® Evo Inserter™ Insertion tube cross-section (mm) 4.8 4.4 Removal thread lenght (cm) 40 27 Removal thread thickness (mm) 0.30 0.27

15. Modified knobs to form a smooth sphere when loaded New Old T-body of Mirena ®

16. What is different about this inserter?  threads are now inside the inserter handle, eliminating the handling of threads  p reloaded in the horizontal position  The arms of the LNG-IUS can be loaded into the inserter using a one-step technique (slider pushed forward)  The diameter of the insertion tube, reduced from 4.8mm to 4.4mm  There is now a centimetre scale on both sides of the insertion tube  The LNG-IUS cannot be reloaded into the inserter if it is released prematurely (important to avoid pulling the slider down before the inserter is correctly positioned in the uterus)

17. To make it easy to insert in the correct position

18. GOLDEN RULE IF YOU USE EXCESSIVE FORCE TO DO ANYTHING, YOU ARE DOING SOMETHING WRONG

19. CONCLUSION Mirena I.U.C.D., if properly inserted with aseptic precautions, by an experienced gynecologist, chances of its expulsion, failure and misplacement are rare and few. Some patients experience pain during insertion as the device is relatively bulky Doctors must follow the instructions of application

20. THANK YOU From: AHMED ZAKI To: ALL OF YOU