9. 1. A 32 year old woman, P2L2 has come to the
hospital for advice on contraception. She is a
model and couldn’t tolerate excessive weight
gain. When asked about her menstrual history,
she says that she soaks through a pad every 2 to
3 hours and she has to get up in the middle of
the night to change her pad. She also has severe
cramps. She said she doesn’t prefer taking pills
because she has never been able to remember
to take a pill daily.
10. What is the best method of contraception?
a)Depot- medroxyprogesterone acetate
b)Progestin- only pill (minipill)
c)Combined oral contraceptive pills
d)Levonorgestrel - IUS
11.
12. 2. A 26 year old woman, G3P3 comes to the
hospital to get a copper T inserted. On
examination, she is found to have ascites and
splenomegaly. Signs of chronic liver disease
were also found. On slit lamp examination :
Would you proceed with the copper T insertion?
13. 3. Lalitha is a married 30-year-old mother of one
infant child. She and her husband both wish to
delay having a second child. Lalitha is
currently breastfeeding. She had an
occurrence of pelvic inflammatory disease
(PID) in her early-20’s. She heard about IUCDs
from a community health worker and has
come to the clinic to learn more about them.
During your meeting, Lalitha wants to learn
more about IUCDs and asks the following
question:
14. a)Is it safe to use
copper IUDs while
breastfeeding?
Why?
Answer : Yes. No hormones.
16. Ideal candidate for IUCD
• Normal uterus
• Parous
• Low risk for STD
• Monogamous
• Don’t wish to have baby for few years
• Want to avoid surgical sterilisation
• Willing to check IUCD thread
• Assess – follow up, treatment
31. 4. It is now 6 months since Yamuna had her IUD
inserted. During a visit 3 months ago, Yamuna had
complained of a heavy bleeding and cramping during
menses. She was also concerned about the IUD
expulsion. You had examined her and confirmed that
the IUD is still in place and reassured her about the
side effects. Today, she has returned to the clinics and
complains of fever, purulent vaginal discharge, lower
abdominal pain, and pain during sexual intercourse.
She has checked the threads after each menses since
her last visit and had felt them each time.
38. Answer :
• Complication if untreated
• Partner also treated
• Abstinence from sexual intercourse until
treatment completed
• Use other contraceptive method
39. 5. Sudha, a P1L1 has had her IUCD for three
months. She is returning to the clinic and
complains that she still has cramping,
especially during menses, and heavy bleeding
during her periods.
46. 2. PELVIC INFECTION(PID)
Risk :
• Low overall
• Higher (first 20 days)
• Extremely rare (> 20 days)
• Gonorrhea/chlamydia
• Similar to risk of PID
in women with
gonorrhea and chlamydia
who are not using IUCD
47. How to reduce the risk of PID?
• Don’t insert IUCD if :
- High risk of STIs
- Clinical symptoms and signs of STI
• Aseptic technique
• Follow-up visit at 3 to 6 weeks
49. Perforations
• Incidence 1 in 1000
• IUCD, the inserter tube, the sound, or other
gynecological instrument
• Withdrawal technique (less common)
• Postpartum between 72 hours and 6 weeks
50. 4. Expulsions
• During menstruation
• Factors contributing to expulsion :
1.Provider’s skill
2.Age, parity
3.Time since insertion
4.Timing of insertion
54. Ectopic Pregnancy
• Risk much lower than noncontraceptive users
• IUCD user pregnant, mostly ectopic
• Lowest rate : copper T 380A, levonorgestrel
IUCD
• Higher rate : progestasert (action limited to
local effect on the endometrium)