The document discusses intrauterine contraceptive devices (IUCDs), including their history, types, mechanisms of action, commercially available devices, advantages, disadvantages, and the role of nurses. It provides details on copper IUCDs and hormonal IUCDs. Some key points are: 1. IUCDs are small devices inserted in the uterus to prevent pregnancy, either releasing copper ions or hormones. 2. The first IUCDs were developed in the early 1900s but were improved upon with the Lippes Loop in the 1960s and additions of copper in later generations. 3. Common devices now include Copper T, Multiload Cu 250, and Mirena, which releases

1. INTRA-UTERINE
CONTRACEPTIVE DEVICES
GUIDE: MAJ KIRTI MAAN
BY : NCDT SHIWANI THAKUR

2. INTRA UTERINE
CONTRACEPTIVE DEVICES
 An Intrauterine Device is a small
object is inserted through the cervix
an placed in the uterus to prevent
pregnancy.
 A small string hangs down from the
IUD into the upper part of the vagina.

3. HISTORY
 The first IUCD was developed in 1909
by German physician Richard Richter,
of Waldenburg. His device was made
of silkworm gut and was not widely
used.
 Jack Lippes developed Lippes Loop in
1960s,which became the best known
and most widely used IUCD.

6. TYPES
INTRAUTERINE
DEVICES
MEDICATED NON- MEDICATED

7. IUCDs
 Made of polyethylene
 Release either metal ions (copper)
or hormones (progestogens)

8. MECHANISM OF ACTION
 IUD causes a foreign- body reaction
in uterus causing cellular and
biochemical changes in endometrium.
 Medicated IUDs produce other local
effects. Copper seems to enhance
cellular response in the endometrium.

9. CONTD…
 Hormone releasing devices increase
the viscosity of the cervical mucus
and thereby prevent sperm from
entering cervix.
 They also maintain high levels of
oestrogen, thereby sustaining an
endometrium unfavourable to
implantation.

10. FIRST GENERATION IUCDs
 The first generation IUDs comprise
the inert or non- medicated devices.
 Different shapes and sizes- loops,
spirals, coils, rings, and bows.
 Made of polyethylene and polymers

11. LIPPLES LOOP
 It is double-S shaped device, a plastic
material that is non-toxic, non tissue
reactive.
 It contains barium sulphate to allow
X- ray observation.
 Sizes A,B,C and D

12. LIPPLES LOOP

13. SECOND GENERATIONS IUCDs
 Release metal ions (copper)
 Strong anti fertility effect
 Addition of copper has made it
possible to develop smaller devices
which are easier to fit.

14. DIFFERENT DEVICES

15. COMMERCIALLY AVAILABLE
DEVICES
 EARLIER DEVICES
1. Copper - 7
2. Copper T- 200
 NEWER DEVICES
1. Cu-T-220 C
2. Cu-T-380 A
3. Nova T
4. ML-Cu-250
5. ML-Cu-375

16. DESCRIPTION OF DEVICES
 Cu-T 380A:Its vertical stem is
wrapped with 314 mm2 of fine copper
and each arm has 33 mm2.
The device is replaced every 10 years.
 Multiload Cu 250:This device emits
60-100ug of copper per day during
one year. The device is to be replaced
every 3 years.

17. ADVANTAGES
 Low expulsion rate
 Increased contraceptive
 Better tolerated by nullipara
 Easier to fit in nullipara
 Lower incidence of side effects, e.g.,
pain and bleeding

18. THIRD GENERATION IUCDs
 Release of a hormone
 Most widely used hormonal device is-
progestasert , which is a T-shaped
device filled with 38 mg progesterone
 The hormone is released slowly in
uterus at rate of 65mcg daily.

19. DESCRIPTION OF DEVICES
 Levonorgestrel: Total amount is 52
mg and is released at rate 20ug/day.
This device is to be replaced every 7
years though approved for 5 years.
 Progestasert:It is a progesterone 38
mg containig IUD.

20. LEVONORGESTREL

21. CONTRAINDICATIONS
 ABSOLUTE
1. Suspected pregnancy
2. Pelvic inflammatory
disease
3. Vaginal bleeding
4. Cancer of cervix,
uterus
5. Ectopic pregnancy
 RELATIVE
1. Anaemia
2. Menorrhagia
3. Distortions of uterine
cavity due to fibroids
congenital
malformations
4. Unmotivated person

22. IDEAL IUCD CANDIDATE
 Planned Parenthood Federation of
America:
1. Who has borne at least one child
2. Has no history of pelvic disease
3. Has normal menstrual periods
4. Is willing to check the IUD tail
5. Has access to follow up and
treatment

23. TIME OF INSERTION
 Interval
 Postabortal
 Post placental
 Intracesarean
 Within 48 hours after delivery

24. IUCD INSERTION STEPS
 Inspect vagina and cervix
 Perform bimanual exam
 Disinfect vagina and opening to cervix
 Sound uterus
 Insert IUD

25. METHODS OF INSERTION

26. INSTRUCTIONS
 She should regularly check threads or
tail to be sure that IUD is in uterus
if she fails to locate threads, she must
consult the doctor.
 She should visit the clinic whenever
she experiences any side effects.
 If she misses a period, she must
consult the doctor.

27. INDICATIONS FOR REMOVAL
OF IUCDs
 Persistent excessive bleeding
 Flaring up of salpingitis
 Perforation of uterus
 Missing thread
 Partial expulsion
 Pregnancy
 One year after menopause
 When effective lifespan of device is over

28. SIDE EFFECTS
CANCER
EXPULSION
PREGNANCY
UTERINE
PERFORATION
PELVIC
INFECTION
PAIN
BLEEDING
SIDE
EFFECTS

29. PAIN

30. BLEEDING

31. PELVIC INFECTION

32. UTERINE PERFORATION

33. CANCER

34. PREGNANCY

35. COMPLICATIONS
 IMMEDIATE
1. Cramp like pain
2. Syncopal attack
3. Partial perforation
 REMOTE
1. Pain
2. Abnormal
menstrual bleeding
3. PID
4. Spontaneous
expulsion
5. Perforation

36. The Nursing Personnel at PHC level
can impart Family Planning during
 Village health days through ASHA and
AWWs
 Antenatal and postnatal sessions in
health facilities
 Post partum visits
 During home visits to families

37. ROLE OF NURSE
 The nursing staff is a key element in
the implementation, execution and
continuity of family planning
practices.
 Give accurate information and
respond to questions
 Inform about side effects and
encourage for follow up visits.

38. CONCLUSION