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1. OSCE……..ON IUD DR. ARUNAKUMARI .MD ASISSTANT PROFESSOR PF DEP .OF OBG UNIT 1

2. Classification of IUD’S with examples Mechanisim of action of IUCD Indications and contraindications of IUD insertion IUCD with pregnancy Missed IUCD threads timing of insertion of IUD’S Complications of IUCD 8) FAILURE RATE OF IUCD Non contraceptive benefits of IUCD Merina

3. QUESTION NO : 1 Classification of IUD’S with examples First generation ( inert, non medicated ) IUD : examples : lippe’s loop , saf T coil , margulis spiral etc … Second generation IUD : Copper releasing IUD’S EXAMPLE : Cu T 200, Multiload 250 , Cu T 375 , Cu T 380 A Third generation IUD: hormone releasing IUD’S : example : progestasert , LNG –IUS Fourth generation IUD: frameless IUD’S : example : Gynefix and Fibroplant

4. WHO CATEGIRISATION OF IUD’S GROUP I : when pregnancy risk is more than 2 per 100 women years example; lippe’s loop , Cu T 200 , Cu T 200 B GROUP II : when pregnancy risk is between 1 to 2 per 100 women years example; nova T , multiload GROUP III : when pregnancy risk is less than 1 per 100 women years example; Cu T 380 A , multiload Cu 375 and LNG IUS

5. Mechanism of action of IUCD Chemical and cellular changes in the endometrium Inflammatory or foreign body reaction Increase in prostaglandins 3)Defective fibrinolytic system Increase tubal motility Impairs sperm ascent Copper devices prevents implantation LNG IUS : hinders implantation by local action of progesterone on endometrium

6. Indications of IUD insertion As long acting contraceptive method Emergency contraception Non contraceptive indications : AUB , ENDOMETRIOSIS , ADENOMYSOSIS , PROGESTOGENIC COMPONENT OF COMBINED HRT

7. CONTRAINDICATIONS OF IUD INSERTION Pregnancy or suspected pregnancy Undiagnosed genital bleeding Acute pelvic infection current or within 3 months Distorted shape of uterine cavity Known or suspected uterine or cervical malignancy GTD Postpartum or postabortal endometritis within last 3 months Significant immunosuppression

8. IUCD with pregnancy If threads are visible better to remove IUD to prevent complications like miscarriages , preterm labor , sepsis etc …. If threads are not visible better to counsel the women regarding the risks involved Pregnancy undesired …….manual vacuum aspiration to remove pregnancy and device In rare cases the device is expected to expel spontaneously after delivery of placenta .

9. Missed IUCD threads threads coliled inside Thread torn through Device expelled outside Device perforated uterine wall and is lying in the peritoneal cavity Device pulled up by the growing uterus due to pregnancy METHODS OF IDENTIFICATION USG HYSTEROSCOPY SOUNDING THE UTERIBE CAVITY BY A PROBE Plain X ray after introducing radiopaque probe

10. Timing of insertion IMMEDIATE POST PARTUN < 48 hrs Post abortal Interval insertion : 6 weeks postpartun or MTP or abortion Any time during lactation after ruling out pregnancy Any time of period after excluding pregnancy

11. QUESTION NO : 7 Complications of IUCD IMMEDIATE Cramp like pain Syncopal attack Perforation REMOTE PAIN AUB PID Spontaneous expuldion Rarely perforation

12. FAILURE RATE OF IUCD Method Failure rate per 100 women years Typical use Failure rate per 100 women years Perfect use Cu T 380 A 0.8 0.6 LNG - IUS 0.1 0.1

13. Non contraceptive benefits of IUCD LNG IUS in menorrhagia LNG IUS in endometrial hyperplasia in peri and postmenopausal women LNG IUS in fibroid …. Reduces blood loss LNG IUS in endometriosis and adenomyosis ……. Reduces pain LNG IUS ….for endometrial protection during HRT and as adjuvant therapy while using tamoxifen Cu IUD used in post operative management of Asherman’s syndrome.

14. Merina 1) LNG IUS ….. 20 mcg of levonorgestrol into uterine cavity directly i.e higher endometrial concentrations when compared oral drug 2) Effective for 5-7 years .. 3)Non contraceptive benefits