Intra-uterine contraceptive devices (IUD) types complications and contra indications of IUD use
Those IUDs that carry biologically active agents into the uterine cavity like levonorgestrel-releasing device [MIRENA]. It is an intrauterine system (LNG_IUS) that has sleeves of levenorgestril 52mg around its stem releasing 20 microgram/day and lasting for at least five years. The advantage of medicated IUDs is that the carrier part of the devices is smaller and less traumatic.
2. Non-medicated IUD:
No drugs are added to the matrix or plate form of the IUD. It consists of plastic polyethylene and copper. There are so many types of this group. The most commonly used are copper T, TCU 380A, Multiload 375 and Nova T.
Newer developments aim to reduce side effects and decrease expulsion rate by producing smaller and lighter IUDs.
MECHANISM OF ACTION OF IUDs
1. Prevent implantation of the fertilized oocyte
2. Produce a local sterile inflammatory reaction in the endometrium as a result of the presence of a foreign body causing spermicidal effect, and the presence of copper increases this reaction and also increases the local release of prostaglandins thus decreasing the rate of pregnancy.
3. They diminish sperm transport through the cervix to the oviduct by increasing the thickness of the cervical mucus (this happens with the hormonal IUD).
4. Steroid-releasing devices induce progestational changes that result in endometrial gland atrophy& Inhibit further development of the ova.
TIME OF INSERTION OF Intra-uterine contraceptive device
The best time to insert IUD is during the menstrual cycle at any
day of the week following menstruation, which indicates that the woman is not
IUD Penetrating the
This can occur at the time of insertion.The incidence is 1.3 of every 1000 cases. It may be best prevented by straightening the uterine axis through pulling the tenaculum which holds the cervix and by performing a bimanual examination to check if the uterus is anteverted or retroverted before attempting to insert the IUD.
3. EXPULSION OF Intra-uterine contraceptive device
Rate of expulsion varies from 1_7/100 women in first year of use. Expulsion is commoner in the first three months of use so that every woman should be examined frequently and should be taught to feel the thread of the IUD vaginally frequently.
4. PELVIC INFECTION
This is caused by bacteria carried into the uterus at the time of insertion. But having the pelvic inflammatory disease after insertion usually results from sexually transmitted bacteria . The consequences of these bacterial infections in the ovaries it may cause salpingitis, tubo- ovarian abscess, or pelvic peritonitis and tubal blockage. Symptomatic pelvic inflammatory disease is frequently treated with antibiotics without removing the IUD until the symptoms resolve, then a new IUD should be inserted under aseptic technique.
5. PREGNANCY ON TOP OF IUD
Pregnancy with IUD
This doesn't happen unless the IUD is not in its proper place in the endometrial cavity (slightly low or tilted) so an intra uterine pregnancy may ensue.
A spontaneous abortion rate of up to 55% has been reported in women becoming pregnant on top of IUD, which is not removed after being pregnant. However, if the IUD appendage is visible it, should be removed or it might be expelled without any intervention, abortion rate diminished after that. If the thread is not seen, it is not advisable to perform uterine probing because of increased risk of perforation, abortion, and/or sepsis.
Reported cases of preterm deliveries have been found in patients with an IUD in situ.
EFFICACY OF Intra-uterine contraceptive devices
Throughout the years, pregnancy rate among IUD users has decreased steadily. Non medicated IUDs and copper IUDs (up to 200) had up to 3% pregnancy rates.
CONTRA-INDICATIONS FOR THE USE OF IUD
RELATIVE CONTRAINDICATIONS of
Intra uterine contraceptive devices
ABSOLUTE CONTRAINDICATIONS of Intra uterine contraceptive devices
last modified 02/07/13