2. • IUCD is an effective, reversible and long term method of
contraception
• Why is IUCD being preferred in the recent times?
• No replacement needed for long time
• Independent of patient compliance
• No interference with sexual activity
3. STRUCTURE :
• Made of Polyethylene
• Flexible body
• Impregnated with Barium sulphate ( makes it Radio – opaque)
• Nylon thread is attached to its lower end
GENERATIONS OF IUD:
FIRST
GENERATION
• Inert
SECOND
GENERATION
• Copper
containing
THIRD
GENERATION
• Hormone
containing
4. FIRST GENERATION:
• Comprise of inert and non medicated devices
• Best and most common in this generation is : Lippe’s Loop
• LIPPE’S LOOP:
• Made of Polyethylene
• Contains BaSO4 , to make it Radio opaque
• Contains Nylon thread
• Comes in 4 sizes = A, B, C, D
• Larger the size more is the anti – fertility effect
less is the expulsion rate
• Larger the size more side effects (Pain and Bleeding)
• S/E: increased Bleeding and pain
• Other devices in this generation:
• Saf – T – coil
• Mahua Ring
• Ota Ring
6. SECOND GENERATION
• Copper containing devices
• STRUCTURE: Copper wire is wrapped around the polypropylene stem
• EXAMPLES : Copper-T-200, Copper – 7,Multi – Load Copper 250, Nova – T
• ADVANTAGES:
• Low expulsion rates
• Lower side effects
• Easy to fit and better tolerated in nulliparous
• Increased efficacy
• Used as an emergency contraception
• Long acting
• Amount of copper released = 50 mcg
7. NAME DURATION IMAGES
Earlier Devices • Copper – 7
• Copper T 200
Newer Devices
• Cu-T-220
• Cu-T-380
A(ParaGard)
3 yrs
10 Yrs
• Nova T
(contains Silver
lining)
5 Yrs
• ML – Cu – 250
• ML – Cu - 375 3-5 Yrs
8. THIRD GENERATION
• Releases hormones
• EXAMPLES: Mirena, Progestasert, Fibroplant (under trial)
• PROGESTASERT:
• T –shaped device
• 38 mg of Progesterone
MIRENA PROGESTASERT
DURATION (Yrs) 5-7 yrs 1 yr
9. • MIRENA :
• LNG-20 progesterone is released
• 52 mg of LNG progesterone
• 20 mcg is released daily
• ADVANTAGES:
• does not release the drug into systemic circulation, less side effects
• Main action on Endometrium and cervical mucus
• One time insertion and effective for 5 yrs
• Reduces menorrhagia and dysmenorrhea
• Other uses of AUB:
• Abnormal uterine bleeding
• Endometrial hyperplasia
• Women on Tamoxifen
• DISADVANTAGES:
• Teratogenic,if pregnancy occurs
10. MECHANISM OF ACTION OF IUCD
Non Medicated IUD
• Leads to foreign body reaction
• Sterile inflammatory response, which is spermicidal
Cu Releasing IUD
• Foreign body reaction
• Enzymatic and metabolic changes in Endometrium
• Initiates cytokine release
Hormone Releasing IUD
• Alteration in cervical mucosa making sperm penetration difficult
• Long term progesterone exposure causes endometrial atrophy
11. IDEAL CANDIDATE FOR IUD
• Borne atleast one child
• No history of pelvic disease
• Normal menstrual cycles
• Willing to check the thread
• Access to follow up and treatment
• Monogamous relationship
• Unhappy or unreliable users of OCP/ Barrier methods
12. CONTRA INDICATIONS OF IUD
• Suspected pregnancy
• Pelvic inflammatory disease
• Fibroid uterus
• IUD causing menorrhagia and dysmenorrhoea
• Severe anaemia
• Uncontrolled diabetes
• Scarred uterus
• Uterine anomlies
• LNG IUCD in breast Ca
• AVOID in unmarried and nulliparous patients
13. IUD INSERTION
• Pelvic examination to confirm position of uterus and size
• Vaginal and cervical examination to rule out any active infections
• Grasp cervix with Allis or vulsellum
• Device mounted onto the introducer
• PUSH IN TECHNIQUE
• Introducer length adjusted in accordance to the uterine length
• Introducer passed through the cervical canal and plunger is
pressed
• WITHDRAWAL TECHNIQUE
• Rod inserted upto tip of fundus
• Withdrawal of outer rod followed by inner rod
• Device uncoils in the uterine cavity
• Cut the thread to the required length
14. Timing of Insertion
Recently Delivered
POST PLACENTAL INSERTION
Within first 10 mins of delivery
POST PARTUM DELIVERY
From 10 mins to 48 hours of
delivery
INTERVAL IUD
After 6 weeks of delivery
Not recently delivered
Insert in the first 10 days of
cycle
15. •Uterine cramps
•Diffculty in insertion
•Vasovagal attack
IMMEDIATE
•Expulsion
•Perforation
•Spotting
•Dysmenorrhoea
•Menorrhagia
•Vaginal infections
•Actinomycosis
EARLY
•PID (does not prevent HIV transmission)
•Failure of IUD
•Ectopic Pregnancy
•Perforation
•Menorrhagia
•Dysmenorrhoea
LATE
COMPLICATIONS OF IUD
16. When patient complains of MISSING THREAD
Missing Thread
Coiled Thread
If she wants to
continue
let her continue
If she wants to
remove
remove under
Hysteroscopic
guidance using
Schroadkar hook/
Artery forceps
Perforation
If IUCD in the
peritoneum
Immediate
Laprotomy/
Laproscopy
Partly in
peritoneum and
partly in uterus
Hysteroscopy +
Laproscopy
CAUSES:
Coiling of thread
Expulsion of IUD
Pregnancy
Perforation
Do a TVS scan
17. When patient becomes pregnanant-
Women is
Pregnant
If women does not want
the pregnancy
TERMINATE
If women wants to
continue PREGNANCY
If thread is VISIBLE
Remove the thread
If NOT – VISIBLE
Continue the pregnancy
with IUD
Term as a HIGH RISK
PREGNANCY
Confirm pregnancy by:
UPT
USG ( to rule out
Ectopic)
18. RISKS OF PREGNANCY WITH IUCD
• Increased risk of infection
• Increased risk of abortion
• Increased risk of Pre – term labour
• Increased risk of Pre Mature Rupture of Membranes
• Increased risk of Intra Uterine Growth Restriction
• IUCD are not teratogenic
• IUCD don’t cause Congenital Malformations in fetus
19. LATEST DEVELOPMENTS
FRAMELESS IUCD ( GyneFlex)
• 3-4 cm long, 1.2 mm in width
• Adapts to the shape of the uterine cavity
• STRUCTURE: 6 Copper beads on a monofilament polypropylene thread
• ADVANTAGES:
• small in size, hence less bleeding, pain, expulsions and ectopic pregnancies
20. ESSURE Device
• Spring like device that is inserted to the Intra-mural part of fallopian
tube
• STRUCTURE: outer part made of Nickel and Titanium
inner part made of Stainless Steel
Once inserted into the
fallopian tube
inflammation
Fibrosis occurs
Blockage of tubes
MECHANISM
OF ACTION
21. • Since tissue reaction takes time females are advised for backup
methods for 3 months
• After 3 months HSG done to confirm the block
