Professional Documents
Culture Documents
Dr. Eddy Hartono, Spogk
Dr. Eddy Hartono, Spogk
Dr. Eddy Hartono, Spogk
IUD
(Intra Uterine Device)
AKDR
IUD
IUCD
IUD Classification
I.
Material
NON-MEDICATED
Marqulis Spiral
Lippes Loop
Ota ring
MEDICATED
Cu
:
Tatum T : * Tcu. 200
* Tcu.220
Cu 7
Multiload (Ml Cu 250, 375)
Copper T 380 A(Tcu 380 A)
Cu + Ag
:
Nova T
T Cu 380 Ag
Progestin
Progestasert (Progesteron)
Mirena (Levonorgestrel)
II.
CONFIGURATION
OPEN
Lippes Loop
Copper IUD
CLOSED
Ota ring
Birn Berg Bow
IUD INDICATIONS
CONTRACEPTIVE
NON-CONTRACEPTIVE :
Intrauterine Adhesiolysis Asherman Syndrome
Dysmenorrhea
Post-pill Amenorrhea
for
progestasert,
mirena
Contraindications
Most contraindications
Uterus carcinoma
Congenital Heart disease
History of
rheumatic/endocarditis
heart disease
AIDS
Cu IUD allergy towards
Cu
INSERTION
INTERVAL : inserted during menstrual period
or one day after menstruation starts EASIER.
preferable because:
Small chances of accidental pregnancy
Cervix is softer and easier to open
Masking effect of menstruation for bleeding
Post partum:
Immediate Post Partum Insertion
(after 1 week of delivery)
Puerperal / delayed insertion (1 6 weeks PP)
extra caution : expulsion / perforation
Post puerperal insertion ( 6 8 weeks PP)
Immediately after womb is delivered
Post Abortion
Curette/ spontaneous abortion
DURING CEASAREAN SECTION
Anamnesis :
Identity
Generally :
history of rheumatic disease
specifically :
Parity
:
GPA
menstrual
:
When is your last period...
How long..
Was it painful..
Physical examination
General :
Blood Pressure
Anemic/not anemic
Normal Heart sound
Specific :
Bimanual examination
Uterus : what to notice
consistency
size
Mobility
Sensitivity
Irregularity
Adneksa / Parametrium
Laboratory
Hb
Pap smear
Cervical discharge culture Go
Bimanual examination
Cervical stabilization : straightening uterus neck by
clamping the portio using tenaculum
Uterus sounding to know :
4.
5.
6.
7.
Depth
heading
Kav. uteri
If required dilatation
Use suitable technique (pushing / withdrawing)
Placing IUD as high as the fundus without perforating
Cutting the tail 2 cm from oue
INSERTION TECHNIQUE
Pushing technique (Push out method, Push
in method, Planging technique)
eg: Lippes Loop
2. Withdrawing technique (Withdrawal
Method)
eg : Cu T, Cu 7, ML Cu 250 (no introducer)
1.
PRINCIPLES :
Pushing method : fixed to the
tenaculum : tube then pushed
2. Withdrawal method : fixed to the
tenaculum : introducer tube
withdrawed.
1.
alarmed
Check tail position :
- before ovulation
- immediately after menstruation stops
- when there is lower abdominal pain
When the tail is not in position : do not have sex
/use other contraceptive & contact the clinic
medicated IUD
INSPECULO EXAMINATION
1.
2.
3.
4.
INSPECULO EXAMINATION
5.
2.
BLEEDING
Menstruation bleeding more than usual
could be because of :
- IUD is to large
- not high enough
- changes in bleeding mechanism
UTRINE PAIN
MANAGEMENT : - Select IUD size
- analgesics
- when non medicated IUD is used
medications
- do no take contraceptive pills
give
COMPLICATIONS
1.
2.
3.
4.
Expulsion : complete/incomplete
Perforation : is suspected when :
Tail ( - )
Severe pain
Abnormal bleeding
Infection
Pregnancy
Pregnancy : ectopic/intrauterin
Pelvic infection
pregnant
Wanted to
change method
MEDICAL :
Pregnancy
Severe pain
PID
Uterine Neoplasm /
suspected
Menopause
Partial expulsion
Bleeding
PREGNANCY POSSIBLITY
ADR Plastik
Cu T / TCu 200
Nova T, MLCu-250/375
TCu 220, TCu 380
ADR Lng (20 g/h)
Progestasert
: 2 / 100 STW
: 2 / 100 STW
: 1 2 / 100 STW
: < 1 / 100 STW
: < 2 / 100 STW
: 2.9 / 100 STW