Mitos dan Fakta AKDR Mitos dan Fakta AKDR

AKDR

1. Mitosdan Fakta
MKJP: AKDR
RiyanHari Kurniawan
Divisi Kesehatan Reproduksi
DepartemenObstetridan GinekologiFKUI –RSCM
1 Juli2024

2. Content
01MengapaMKJP?
0202AKDR
03Mitosvs Fakta

3. DemografiIndonesia

4. DemografiIndonesia
Visi Indonesia 2045. Kementerian PPN/Bappenas. 2017

5. DemografiIndonesia

6. DemografiIndonesia
Biro Pusat Statistik

7. DemografiIndonesia

8. DemografiIndonesia

9. DemografiIndonesia
59,9
15,8
10
8
4,2
1,8
0,2 0,1
0
10
20
30
40
50
60
70
Suntik Pil ImplanIUD/AKDR MOW Kondom MOP MAL
Profil Kesehatan Indonesia 2021. Ditjen Kesehatan Masyarakat, Kemenkes RI, 2022

10. Kontrasepsi:
Usaha-usahauntukmencegah
terjadinyakehamilan,
dapatbersifatsementaraatau
permanen.
•Berdasarkankategoridalamprogrampemerintahdanmasaperlindunganyang
diberikan,dibagimenjadi:
•MetodeKontrasepsiJangkaPanjang(MKJP)dan
•nonMetodeKontrasepsiJangkaPanjang(non-MKJP).

11. Williams Gynecology3
rd
ed.
MengapaMKJP?

12. AKDR (IUD)
-Banyak dipakai
-Sangat efektif
-Reversibel
Baseline fecundity returns rapidly after IUD removal.
Contraception 2007;75:88–92.
13.9% of the world’s 1.16 billion women aged 15–49 are using this
method.
United Nations Department of Economic and Social Affairs World contraceptive patterns 2013, New York.
Notes: (A) Ota Ring, (B)
BirnbergBow, (C)
MajzlinSpring, (D)
Lippes Loop, (E)
GyneFix®, (F) copper-
bearing device:
CuTT380 slimline, and
(G) Levonorgestrel
intrauterine system:
Mirena®.
IUD Copper-T dan LNG-IUS

13. AKDR (IUD)
•Failure rates <1 %.
•Contraceptive action: have not
been precisely defined, but
prevention of fertilization is now
favored:
•Intense local endometrial
inflammatory: decreased
sperm and egg viability,
endometrium is transformed
into a hostile site for
implantation.
•Adverse-effect:
•Uterine perforation
•Device expulsion
•Menstrual changes
•Infection
•Miscarriage (if pregnancy
is occurs)
Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open access Journalof
Contraception 2016:7 19-32.

14. AKDR (IUD): PENCABUTAN
•Pasang spekulum vagina untuk melihat porsio
•Usap vagina & porsiodenganlarutan antiseptik 2-3 kali
•Jepit benangyang dekatporsiodenganklem

15. AKDR (IUD) POSTPARTUM: Cara Pemasangan
1.AKDRPascaPlasenta:
dipasang maksimaldalamwaktu10menitplasentalahir.
Waktu pemasangan AKDR Pasca Persalinan :
2.AKDR Pasca PersalinanDini:
dipasang setelah 10 menit sampai 48 jampascapersalinan.
3. AKDR Transesaria/saat operasisesar:
dipasang saat dilakukan operasi sesarsetelahplasentalahir.

16. AKDR (IUD) POSTPARTUM: Cara Pemasangan
3. Menggunakantangan (insersi manual)
1.Menggunakan Forsep Kelly panjang 2.Menggunakan Inserter panjang

17. AKDR (IUD): KOMPLIKASI
Angka perforasi AKDR: 1-2 per 1000, meningkat
pada kondisi:
1.Operator tidak berpengalaman
2.AKDR dipasang < 6 bulan postpartum
3.Perempuan dengan kehamilan sebelumnya
yang lebih sedikit
4.Perempuan dengan jumlah keguguran yang
meningkat
AKDR yang bermigrasikeluaruterus, dapat
menyebabkankomplikasitambahansepertiperforasi
ususatauvesika.
Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open access Journalof Contraception 2016:7 19-32
CaliskanE, OzturkN, DilbazBO, DilbazS. Analysis of risk factors associated with uterine perforation by intrauterine devices. EurJ ContraceptReprodHealth Care 2003; 8:150–155.
HonarbakhshA, RastegarM, HervaiI, KhouryE. Unrecognisedperforation of the uterus into bladder by an IUD. J ObstetGynaecol2003; 23:444–445.

18. AKDR (IUD): KOMPLIKASI
Jika tidak
tampak benang
Kemungkinannya adalah:
(1)AKDR ekspulsi
(2)AKDR di intrauterin (lokasi
normal atau abnormal), namun
benang rusak atau misplaced
(3)Uterus perforasi dan AKDR
tidak di kavum endometrium
Muller LAL, Ramos LJG, Martins-Costa SH, et al.
Transvaginal ultrasonographic assessment of the expulsion
rate of intrauterine devices inserted in the immediate
postpartum period: a pilot study. Contraception 2005;
72:192–195.
Situmorang, et al.: IUD translocation: Case series and management algorithm. Journal of Reproductive Healthcare and Medicine • 2022 • 3(1)

19. mITOSTERKAIT AKDR (IUD)
MYTH:Abortion
FACT:IUDsdonotworkbycausingabortions
•IUDsworkbypreventingfertilization.
•Thecopper-bearingIUDactsasaspermicide,killingorimpairingspermsotheycannotreachtheegg.
MYTH:Effectiveness
FACT:IUDsarethemorethan99%effective!
•Copper-bearing IUDs: < 1 pregnancy per 100 women using an IUD over the first year (6 to 8 per 1,000
women).
•(LNG-IUD): < 1 pregnancy per 100 women using the LNG-IUD over the first year (2 per 1,000
women).
https://www.ippf.org/blogs/myths-and-facts-about-intra-uterine-devices

20. mITOSTERKAIT AKDR (IUD)
MYTH:Healthrisksandsideeffects
FACT:IUDsaresafe!
•InfectionrelatedtoIUDinsertionprobablyoccursbecausetheinstrumentsorIUDcarrywiththem
organismsfromthelowergenitaltract.
•TheIUDnevertravelstotheheart,brain,oranyotherpartofthebodyoutsidetheabdomen.
•IUDsdonotcausecancerinotherwisehealthywomen,butconfirmedorsuspectedcancerofthegenitaltractisa
contraindicationtoIUDuse
https://www.ippf.org/blogs/myths-and-facts-about-intra-uterine-devices
MYTH:Problemsafterremoval:
FACT:Noincreasedriskofinfertility
GoodstudiesfindnoincreasedriskofinfertilityamongwomenwhohaveusedIUDs,includingyoung
womenandwomenwithnochildren.

21. mITOSTERKAIT AKDR (IUD)
MYTH:Changeofmenstrualpattern
FACT:Changeinbleedingpatternsarenotharmful
•WomencanexperiencechangesinbleedingpatternsdependingonthetypeofIUD
•Thesebleedingchangesarenormalandusuallyarenotsignsofillness.Theyaremostcommoninthefirst3to6
monthsafterinsertionandusuallylessenwithtime.
https://www.ippf.org/blogs/myths-and-facts-about-intra-uterine-devices
MYTH:Sexualdesireandsexualpleasure
FACT:Itmightmakeyoumorerelaxedaboutunintendedpregnanciesandenjoysexevenmore!
•ThereisnoreasonwhyanIUDshouldnegativelyaffectsexualpleasure.
•ThereisnoreasonwhyanIUDshouldcausediscomfortorpainduringsexualintercourse

22. kesimpulan
•MKJPadalahalatkontrasepsiuntukmenunda,
menjarangkankehamilansertamenghentikankesuburan
yangdigunakandalamjangkapanjang.
•AKDR:
•Efektifmencegahkehamilanhingga99%
•Jangkawaktupemakaianlebihlama
•Biayaterjangkau
•Tidakmempengaruhiproduksiairsusuibu
•Tidakadaperubahanfungsiseksual
•Dapatbertujuanuntukmerencanakankehamilandan
masadepananak.

23. TERIMA KASIH
www.rscmkintani.com
Ig: @rscmkintani
dr. Riyan Hari Kurniawan, SpOG (K)
08128195884
[email protected]
ig: @dr.riyan.spog