Mitos dan Fakta

MKJP: AKDR
Riyan Hari Kurniawan

Divisi Kesehatan Reproduksi

DepartemenObstetri dan GinekologiFKUI – RSCM
1 Juli2024
Content

01 Mengapa MKJP?
02 AKDR

03 Mitos vs Fakta
Demografi Indonesia
 Demografi Indonesia

Visi Indonesia 2045. Kementerian PPN/Bappenas. 2017

Demografi Indonesia
Demografi Indonesia

Biro Pusat Statistik

Demografi Indonesia
Demografi Indonesia
 Demografi Indonesia

70
59,9
60

50

40

30

20 15,8
10
10 8
4,2
1,8 0,2 0,1
0
Suntik Pil Implan IUD/AKDR MOW Kondom MOP MAL
Profil Kesehatan Indonesia 2021. Ditjen Kesehatan Masyarakat, Kemenkes RI, 2022
 Kontrasepsi:
Usaha-usaha untuk mencegah
terjadinya kehamilan,
dapat bersifat sementara atau
permanen.

• Berdasarkan kategori dalam program pemerintah dan masa perlindungan yang

diberikan, dibagi menjadi:
• Metode Kontrasepsi Jangka Panjang (MKJP) dan
• non Metode Kontrasepsi Jangka Panjang (non-MKJP).
Mengapa MKJP?

Williams Gynecology 3rd ed.

 AKDR (IUD)

- Banyak dipakai
- Sangat efektif
- Reversibel

13.9% of the world’s 1.16 billion women aged 15–49 are using this
method.
United Nations Department of Economic and Social Affairs World contraceptive patterns 2013, New York.

Baseline fecundity returns rapidly after IUD removal.

Contraception 2007;75:88–92. Notes: (A) Ota Ring, (B)
Birnberg Bow, (C)
Majzlin Spring, (D)
Lippes Loop, (E)
GyneFix®, (F) copper-
bearing device:
CuTT380 slimline, and
(G) Levonorgestrel
intrauterine system:
Mirena®.
IUD Copper-T dan LNG-IUS
 AKDR (IUD)

• Failure rates <1 %.

• Contraceptive action: have not • Adverse-effect:

been precisely defined, but • Uterine perforation
prevention of fertilization is now • Device expulsion
favored: • Menstrual changes
• Intense local endometrial • Infection
inflammatory: decreased • Miscarriage (if pregnancy
sperm and egg viability, is occurs)
endometrium is transformed
into a hostile site for
implantation.

Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open access Journal of
Contraception 2016:7 19-32.
 AKDR (IUD): PENCABUTAN

• Pasang spekulum vagina untuk melihat porsio

• Usap vagina & porsio dengan larutan antiseptik 2-3 kali
• Jepit benang yang dekat porsio dengan klem
 AKDR (IUD) POSTPARTUM: Cara Pemasangan

Waktu pemasangan AKDR Pasca Persalinan :

1. AKDR Pasca Plasenta:

dipasang maksimal dalam waktu 10 menit plasenta lahir.
2. AKDR Pasca Persalinan Dini:
dipasang setelah 10 menit sampai 48 jam pasca persalinan.
3. AKDR Transesaria/saat operasi sesar:
dipasang saat dilakukan operasi sesar setelah plasenta lahir.
 AKDR (IUD) POSTPARTUM: Cara Pemasangan

1. Menggunakan Forsep Kelly panjang 2. Menggunakan Inserter panjang

3. Menggunakan tangan (insersi manual)

 AKDR (IUD): KOMPLIKASI

Angka perforasi AKDR: 1-2 per 1000, meningkat

pada kondisi:
1. Operator tidak berpengalaman
2. AKDR dipasang < 6 bulan postpartum
3. Perempuan dengan kehamilan sebelumnya
yang lebih sedikit
4. Perempuan dengan jumlah keguguran yang
meningkat

AKDR yang bermigrasi keluar uterus, dapat

menyebabkan komplikasi tambahan seperti perforasi
usus atau vesika.

Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open access Journal of Contraception 2016:7 19-32
Caliskan E, Ozturk N, Dilbaz BO, Dilbaz S. Analysis of risk factors associated with uterine perforation by intrauterine devices. Eur J Contracept Reprod Health Care 2003; 8:150–155.
Honarbakhsh A, Rastegar M, Hervai I, Khoury E. Unrecognised perforation of the uterus into bladder by an IUD. J Obstet Gynaecol 2003; 23:444–445.
 AKDR (IUD): KOMPLIKASI

Jika tidak
tampak benang
Kemungkinannya adalah:

(1) AKDR ekspulsi

(2) AKDR di intrauterin (lokasi
normal atau abnormal), namun
benang rusak atau misplaced
(3) Uterus perforasi dan AKDR
tidak di kavum endometrium

Muller LAL, Ramos LJG, Martins-Costa SH, et al.

Transvaginal ultrasonographic assessment of the expulsion
Situmorang, et al.: IUD translocation: Case series and management algorithm. Journal of Reproductive Healthcare and Medicine • 2022 • 3(1)
rate of intrauterine devices inserted in the immediate
postpartum period: a pilot study. Contraception 2005;
72:192–195.
 mITOS TERKAIT AKDR (IUD)

MYTH: Abortion
FACT: IUDs do not work by causing abortions

• IUDs work by preventing fertilization.

• The copper-bearing IUD acts as a spermicide, killing or impairing sperm so they cannot reach the egg.

MYTH: Effectiveness
FACT: IUDs are the more than 99% effective!

• Copper-bearing IUDs: < 1 pregnancy per 100 women using an IUD over the first year (6 to 8 per 1,000
women).
• (LNG-IUD): < 1 pregnancy per 100 women using the LNG-IUD over the first year (2 per 1,000
women).

https://www.ippf.org/blogs/myths-and-facts-about-intra-uterine-devices
 mITOS TERKAIT AKDR (IUD)

MYTH: Health risks and side effects

FACT: IUDs are safe!

• Infection related to IUD insertion probably occurs because the instruments or IUD carry with them
organisms from the lower genital tract.
• The IUD never travels to the heart, brain, or anyother part of the bodyoutside the abdomen.
• IUDs do not cause cancer in otherwise healthy women, but confirmed or suspected cancer of the genital tract is a
contraindication to IUD use

MYTH: Problems after removal:

FACT: No increased risk of infertility

Good studies find no increased risk of infertility among women who have used IUDs, including young
women and women with no children.

https://www.ippf.org/blogs/myths-and-facts-about-intra-uterine-devices
 mITOS TERKAIT AKDR (IUD)

MYTH: Change of menstrual pattern

FACT: Change in bleeding patterns are not harmful

• Women can experience changes in bleeding patterns depending on the type of IUD
• These bleeding changes are normal and usually are not signs of illness. They are most common in the first 3 to 6
months after insertion and usually lessen with time.

MYTH: Sexual desire and sexual pleasure

FACT: It might make you more relaxed about unintended pregnancies and enjoy sex even more!

• There is no reason why an IUD should negatively affect sexual pleasure.

• There is no reason why an IUD should cause discomfort or pain during sexual intercourse

https://www.ippf.org/blogs/myths-and-facts-about-intra-uterine-devices
 kesimpulan

• MKJP adalah alat kontrasepsi untuk menunda,

menjarangkan kehamilan serta menghentikan kesuburan
yang digunakan dalam jangka panjang.

• AKDR:
• Efektif mencegah kehamilan hingga 99%
• Jangka waktu pemakaian lebih lama
• Biaya terjangkau
• Tidak mempengaruhi produksi air susu ibu
• Tidak ada perubahan fungsi seksual
• Dapat bertujuan untuk merencanakan kehamilan dan
masa depan anak.
 TERIMA KASIH

www.rscmkintani.com
Ig: @rscmkintani

ig: @dr.riyan.spog
dr. Riyan Hari Kurniawan, SpOG (K)
08128195884
riyanharikurniawan@yahoo.com