2. Types
i. Non-medicated IUCD (first generation)
a. Lippes loop
b. Saf T coil
• The non-medicated can be inserted and stay
in the uterus for 5 years.
• It is made up of polythene .
• Saf T coil is usually used for nulliparous client
3. Introduction
• IUCD is an object inserted in the womb to
prevent unwanted pregnancy.
• They are small flexible devices made of metal
or plastic.
4. Lippes Loop
• There are four types A,B,C&D
• The sizes are used to identify the different types.
• SIZE A
• Has a blue string
• It is 26.2mm in length
• The width is 22.2cm
• It is spiral
• Bow type & coil type
5. Lippes Loop cont’d
• SIZE B
• The string is black in colour
• Length is 25.2mm
• Width is 27.4mm
• SIZE C
• The string is yellow in colour
• Length is 27.5mm
• Width is 30.0mm
6. Lippes Loop cont’d
• SIZE D
• Colour is white
• Length is 27.5mm
• Width is 30.0mm
• It was first marketed in 1962
10. Medicated IUCD
• Copper is usually added to IUCD
• There are many types of IUCD
• Copper T
Cu T 380A
Cu T 220c
Cu T 380Ag
Cu T 380 slim line
Cu T 200 B
• Medicated 200Ag
• Multiload 375 0r 250Cu
• Progestasert 38mg- contains only progesterone. It contains
38mg & releases 65Ag every day for one year.
11. Medicated IUCD cont’d
• The multiload was invented in 1974 in
Netherland.
• CuT 380- It was developed in Canada in 1982
• CuT 200 series was developed in USA in 1972
13. Mechanism of Action of IUCD
1. It prevents fertilization by stimulating a pronounced
inflammatory or foreign body response in the uterus
(white blood cell will have to play). The concentration
of WBC, prostaglandins and enzymes increases rapidly
in the uterus and fallopian tubes thereby interfering
in the transportation of sperm in the genital tract.
This may also change the sperm or the ovum thereby
making fertilization impossible.
2. There will be immobilization of sperm resulting in no
fertilization
3. There will be increased motility of the ovum in the
fallopian tube
14. Mechanism of Action of IUCD cont’d
4. Various types of WBC will consume the
sperm in the uterus because the uterus see it
as a foreign body. (Numbers 2,3 &4 are new
mechanisms newly invented).
5. Increase local production of prostaglandins
which inhibit implantation
6. Impairment of implantation by disrupting the
proliferative secretion
15. Effectiveness of IUCD
• The most effective of the IUCD is the
medicated and is about 97-99%
• The non-medicated is less effective & is about
97-98%
• The effectiveness can be attributed to the size,
shape and presence of CuT or progesterone,
the age and the parity.
16. Contraindication
1. Absolute Contraindication
• These set of people must not be given IUCD
Intrauterine pregnancy, suspected or not
Acute vaginitis
Suspected cases of acute PID
Abnormal vaginal bleeding of undetermined
origin
Malignancy of the genital organs
17. Contraindication cont’d
2. Strong relative Contraindications
Cervical or uterine malignancy- need to be
diagnosed and treated before inserting IUCD
History of ectopic pregnancy- this is because
incidence of ectopic pregnancy is higher in
patient with IUCD
Congenital abnormalities or fibroids- This will
interfere with proper placement.
• IUCD should be placed in the fundus, if there is
abnormality, it will lead to malposition.
18. Contraindication cont’d
3. Relative Contraindication
• IUCD may be used when there is no alternative but
with caution and regular monitoring.
Anaemia- IUCD worsens anaemic condition
Nulliparity- IUCD will usually increase the incidence of
infection and if not properly treated will result in
infertility.
Blood coagulation disorder- uncontrolled bleeding
aggravated
Severe primary dysmenorrhoea- There is increased
intrauterine cramping with IUCD.
19. Contraindication cont’d
• Copper allergy or Wilson’s Disease
• Intrauterine depth that is less than 5cm, the
uterus will not accommodate IUCD
• Valvular Heart Disease- This is because she
can be susceptible to sub-acute bacteria
endocarditis
• Cervical stenosis
• If she has more than one sexual partner
20. Factors to Consider in Choosing an
IUCD
1. Competence on the part of the nurse, doctor
or the inserter
2. Familiarity with the selected IUCD (use the
one you are familiar with)
21. Guideline for Timing the IUCD
• There are some basic principles:
1. Confirm that your client is not pregnant
2. Confirm that there is no pelvic infection
3. During normal menstrual cycle
4. Immediately after evacuation of an incomplete
abortion if there is no infection
5. Six weeks post partum
6. Three months after a successfully treated pelvic
inflammatory disease
7. Three months after caesarean section
22. Guideline for Timing the IUCD cont’d
• IUCD should not be used if there is:
1. Offensive vaginal discharge
2. Offensive lochia
3. Dyspareunia
4. Pain on pelvic examination (means there is
cervical erosion)
23. Equipments for IUCD Insertion
A pair of sterile gloves
Sponge holding forceps
Speculum- Cuscos or Sims
Artery forceps for holding the IUCD (optional)
Vulsellum or tenacullum
Uterine sound
Tegar’s cervical dilator
IUCD with inserter and the introducer
24. Equipments for IUCD Insertion cont’d
A pair of scissors
Hibitane or Savlon
Sterile gauze
Cotton swabs (sterile)
Sanitary pad Hibitane cream
Angle poise lamp or touch light
25. Procedure for IUCD Insertion
Read the IUCD pack instruction before insertion
Collect necessary equipment
Prepare the client mentally and physically so that she will
relax
Tell her to empty her bladder
Perform careful bimanual examination
• To rule out pregnancy
• To rule out infections
• To locate the position of the uterus
Switch on the angle poise lamp
Put on your gloves
Clean the vulva with antiseptic lotion
26. Procedure for IUCD Insertion
Lubricate the speculum with hibitane cream
Insert the speculum
Inspect the cervix
Clean the cervix
Grab the anterior tip of the cervix
Sound the uterus with uterine sound
Load your IUCD under sterile techniques with the nylon
tape hanging out of the edge
The IUCD insertion must be under sterile technique
• The interval between the loading and insertion should not
be more than a minute, otherwise, the IUCD will lose its
shape. When this happens, the effectiveness is reduced.
27. Procedure for IUCD Insertion cont’d
• Insert the IUCD by pushing the inner plunger into the outer
barrel and this is referred to as PUSH TECHNIQUE.
• Insert the IUCD by retracting the outer barrel over the
plunger referred to as WITHDRAWAL TECHNIQUE, used for
CuT
• Remove the plunger and the barrel clip, the string, if too
long, trim it to 5cm
• Remove the speculum
• Tidy up the client
• Then try and clean the examining finger of the client
• Ask the client to feel the string before leaving the
examination room
28. How to Check IUCD Insertion
• Tell the woman to wash her hand
• She should try to reach the vagina with the
index and middle fingers to locate the string
• Warn her not to pull on the string so as not to
dislodge the IUCD
29. Post Insertion Instruction
• Tell the client that post insertion menses may
be heavy
• Give her information card
• Tell her that IUCD does not offer protection
against STD and AIDS, thus, she should avoid
multiple partners.
• She should check the string after insertion.
30. Instruction after Insertion
1. How often the client should check string:
• Middle way between periods
• Check it before intercourse
• Check it after each menstrual period
• She should check it after the following symptoms
Cramping in the lower abdomen
Spotting between periods or spotting after intercourse
2. If client gets pregnant, she should report to the hospital
as soon as possible so as to get IUCD removed
3. If she wants it removed anytime for any reason
whatsoever, she should report or come to the clinic
4. Instruct her that if strings is not felt before intercourse,
she should check for string in squatting position.
31. When Client Should Report to Clinic
for Follow-up
1. She should see the healthcare provider when she sees any of
these signs:
P- When period is late, if there is abnormal spotting or
bleeding
A-Abdominal pain or pain during intercourse
I- Increased temperature, fever, chills and all these denote
infections, likely signs of gonorrhoea, abnormal vaginal
discharge
N- Not feeling well or noticeable foul smelling vaginal
discharge
S- Strings missing, shorter or longer
2. She should return 6 weeks after insertion and 3 monthly for
check up even when there is no problem. After 3 months,
client should report for annual checkup.
32. Advantages
1. Highly effective 99% (for medicated)
2. No systemic side effect
3. It is nearly always reversible
4. Does not interfere with sexual intercourse
5. It does not require day to day actions
6. It is relatively cheap
7. It does not influence milk volume or
composition (breastfeeding)
33. Non-contraceptive Advantages
1. It can be used to prevent or treat Alzheimer’s
syndrome
2. It can be used to bring or induce
menstruation in women with amenorrheoea
due to long use of hormonals
3. The progestin or progesterone bearing or
release in IUCD can decrease menstrual
blood loss to those with heavy menses or
chronic dysmenorrhoea
34. Disadvantages
• There can be :
Intrauterine pregnancy
Tubal pregnancy
Expulsion
Malposition
Pelvic infection
Abnormal bleeding
Infertility
More cramps and pain during monthly period
Prolonged and heavy monthly bleeding
35. Side Effects
• Spotting, bleeding, anaemia- Once these
occur and is getting out of hand, remove IUCD
• Endometriosis
37. Removal of IUCD
• Equipment needed include:
Speculum
Angle poise lamp
Sponge holding forceps
• Put in your speculum
• Locate the IUCD
• Get hold of the string and remove gently
• Make patient comfortable and clear away
equipment
38. • Show to the client after removal
• Clean up the patient
• Allow her to rest
• Inform her pregnancy is an immediate possibility
• Tell her to come back for another method
anytime she is ready.
• Give prescribed medication such as PCM and
flagyl.
