iud insertion by ramesh simngh

1. DEMONSTRATION ON IUD
INSERTION
PRESENTED BY :RAMESH
SINGH CHAUHAN
MSC.NURSING 1ST YEAR

2. INTRODUCTION
• An Intrauterine Device (IUD) is a small object that
is inserted through the cervix and placed in the
uterus to prevent pregnancy. A small string hangs
down from the IUD into the upper part of the
vagina. The IUD is not noticeable during
intercourse. IUD’s can show pharmacological
efficacy for about 1-10 years.
• M O A :They work by changing the lining of the
uterus and fallopian tubes affecting the
movements of eggs and sperm and so that
fertilization does not occur

3. DEFINITION OF IUD
• Introduction of specially designed device into
the uterine cavity of a fertile woman who desires
to prevent conception/pregnancy for a specific
period of time.
• IUD’s are medicated devices intended to release a
small quantity of drug into uterus in a sustained
manner over prolonged period of time

4. PURPOSE OF IUD INSERTION
• TO AVOID UNWANTED PREGNANCY
• TO SPACE PREGNANCY

5. CONTRAINDICATION OF IUD
INSERTION
Absolute
• Suspected pregnancy.
• Pelvic inflammatory disease.
• Vaginal bleeding and undiagnosed etiology
• Previous ectopic pregnancy.
Relative
• Anemia
• Menorrhagia
• History of pelvic inflammatory disease .
• Distortion of the uterine cavity due to congenital
malformation, fibroids.

6. TYPES
• Types of IUD
• a. Non- medicated IUD’s: These IUD’s exert their contraceptive action by
producing a sterile inflammatory response in the endometrium by its
mechanical interaction. These do not contain any therapeutic agent. e.g.
ring shaped IUD’s plastic IUD’s, lippes loop, Dalkon shield, SafT-Coil.
• B. Medicated IUD’s: These IUD’s are capable of delivering
pharmacologically active antifertility agents. e.g. copper bearing IUD’s,
progesterone releasing IUD’s.
•
• Non – medicated IUD’s These IUD’s do not contain any therapeutically
active agent. These prominently make use of metal or plastic rings and
coils
• e.g. Dalkon shield,
• Lippes loop,
• SELF - T- coil. Rings of stainless steel have mechanical effects on the
uterus leading to contraception

7. NON MEDICATE

8. Non medicated IUD’s have vanished from
market. because of one or more following
reasons :
• Newer devices that are safer and effective.
• Irregularities in menstrual bleeding.
• Discomfort and lower patient compliance
Cases of pelvic inflammatory diseases
(PID).
• they show higher rates of pregnancies

9. MEDICATED IUD
1COPPER BEARING IUD’s E.g. cu 7
• This device uses copper wire wound to the stem.
• The device is made of T shaped polyethylene plastic
• There are various grades as per the surface area of the Cu-
wire such as Cu-T-30, Cu-T-200, Cu-T-380 Cytotoxic
• Cytotoxic
• Low conc.- Spermatocidal & Spermatodepressive
Contraceptive Effectiveness is more.
• Pregnancy rate –reduced to 5% e.g. cu –T-200, cu-T-30, cu-T-
380, Cu-T-220 Copper wire thickness –0.2-0.4 mm

10. MECHANISM OF ACTION
• Antifertility :
• Action of Copper In high concentration copper is cytotoxic.
It enhance the spermatocidal and spermato- depressive
action of an IUD.
• Cupric ion (Cu++) is a competitive inhibitor of progesterone
and to lesser effect estrogen.
• Evoke sterile inflammatory response in the endometrium.
• Release of Copper from the device The release is linear by
chelation, ionization, and corrosion over the period of 12
years.
• Release rate is directly proportional to the surface area of
exposed Cu. e.g. Cu-T-380A
• It has a surface area of 380 sq.mm

11. HORMONE RELEASING IUD’s (e.g.,
Progestasert }
• Doyle and Clewe first initiated the use of
hormone releasing IUD’s.
• Scommegna et al in 1970 carried human testing
using conventional IUD having contraceptive
steroids.
• A T-shaped progesterone releasing IUD having
vertical limb embedded with drug-containing
silicone capsule was evolved.
• Coated with polymer for achieving slower
release.

12. Antifertility action of progesterone
releasing IUDs
• . They diminish sperm transport through the cervix to the
oviduct by increasing the thickness of the cervical mucous.
• 2. Steroid releasing devices induce progesteronal changes
that result in endometrial gland atrophy and inhibit further
development of the ova
• 3. Endometrial hypermaturation is unfavorable for
implantation of a blastocyst. This is associated with
decidual formation induced by progesterone.
• 4. Effect of estrogen-progesterone system is related to the
presence of a membrane electrical potential that inhibits
the ovum-endometrium contact before the occurrence of
implantations.
•

13. Progestesert :

14. PROGESTESERT
• A novel progesterone (pg) releasing IUD.
• The device has a solid poly EVA (ethyl vinyl acetate) side
arms and a hollow core.
• The microcrystalline Pg is suspended in the core in the
silicone oil with BaSo4. Dimensions-0.25mm thick, pg is
released by diffusion through rate limiting membrane.
• Loaded with 38mg of Pg, release rate is 65 mcg/day
• Approved by USFDA in 1975 for 12 month contraceptive
use
• Pregnancy . rate 1.8/100 for parous and 2.5/100 for
nulliparous.
• Does not inhibit ovulation but interfere with implantation
in endometrium, thickening of cervical mucus.

16. Levonorgesterol releasing IUD
• These carry levonorgesterol releasing device.
• It is an intrauterine system that has sleeves of
levonorgesterol 52 mg around its stem.
• It is composed of a polyethylene stem covered by
matrix Silastin :LNg (2:1).
• Releasing 20 mcg/day and lasting for at least 5
years. Initial fast release then at 60 % drug
release rate reduces to 16mcg/day.
• Suppresses endometrial and ovulation. Also,
unlike other IUDs, it may reduce the risk of (PID).

17. Disadvantages of LNg IUD
• It may cause noncancerous (benign) growths
called ovarian cysts, which usually go away
on their own.
• It can cause hormonal side effects, such as
breast tenderness, mood swings, headaches,
and acne. When side effects do happen, they
usually go away after the first few months.

18. CONTRAINDICATION OF IUD
• pregnancy
• puerperal sepsis or immediate post septic
abortion
• distorted uterine cavity (congenital or acquired)
• unexplained vaginal bleeding
• suspected genital malignancy
• genital tuberculosis
• active Pelvic Inflammatory Disease (PID)

19. TIME OF IUD INSERTION
• After child birth:
• Immediate after delivery of placenta(post-
placental insertion)
• Four to six week after child birth
• After spontaneous or induced abortion:
• Immediate after1st trimester abortion(aseptic)
• After 2nd trimester abortion it is advisable to wait
till involution of uterus is complete

20. MENSTRUAL CYCLE
• Can be inserted any time, duering menstrual
cycle,if reasonably sure that woman is not
pregnant and has not been having sexual activity
without contraception.
• Insertion during menstruationoffers following
advantages:
• Pregnancy is ruled out
• Insertion is easy due to open cervical canal.
• Any minor bleeding caused by insertion is less
likely to upset the client

21. Articles used for IUD insertion:
• IUCD presentalized insertion package
• Sterile tray containing.
• Vaginal speculum(cuscos)
• Vulsellum-1
• Uterine sound-1
• Sponge holder-1
• Bowl containing cotton swab.
• Sterile gloves.
• Scissors
• Disinfectant solution.
• Kidney tray.

23. STEPS OF IUD INSERTION
• Inspect vagina and cervix.
• Perform bimanual exam.
• Disinfect vagina and opening to cervix.
• Sound uterus.
• Insert IUD.

24. HEALTH EDUCATION
• she can expect some cramping for a day or two after
insertion, vaginal discharge for a few weeks after insertion
and slightly heavier menstrual period with possible bleeding
between the menstrual periods during first few months after
insertion
• follow-up visit after 3-6 weeks or after next menstrual period
to ensure that IUD is in place and no infection has developed.
• information about kind of IUD and when to have her IUD
removed or replaced.
• when she should see a nurse or doctor after IUD insertion?
• missed menstrual period
• lower abdomen pain / vaginal discharge / fever
• missing IUD string
• very heavy and prolonged bleeding that bothers her

25. SUMMARY
• An Intrauterine Device (IUD) is a small object that
is inserted through the cervix and placed in the
uterus to prevent pregnancy. A small string hangs
down from the IUD into the upper part of the
vagina. The IUD is not noticeable during
intercourse. IUD’s can show pharmacological
efficacy for about 1-10 years. M O A :They work
by changing the lining of the uterus and fallopian
tubes affecting the movements of eggs and
sperm and so that fertilization does not occur