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Intrauterine Devices
Contraception
| Question | Answer |
|---|---|
| What are side fx of IUDs (in general) | Breakthru bleed, expulsion, perforation, increased risk of PID in 1st 10 days, increased risk of ectopic if pregnancy occurs |
| What are specific side fx of CuIUD? | increased blood loss during menses, dysmenorrhea |
| What are specific side fx of progesterone IUD? | bloating, headache |
| Known/suspected preg? | Abs C/I to all IUD |
| undiagnosed genital bleeding? | Abs C/I to all IUD |
| lifestyle risk for STI? | Abs C/I to all IUD |
| known allergy to Cu? | Absol. C/I to Cop IUD |
| Wilson's? | Abs C/I to Cop IUD |
| Valvular heart disease? | Rel C/I to all IUD |
| Past hx of PID? | Rel C/I to all IUD |
| Past hx of ectopic? | Rel C/I to all IUD |
| Cervical stenosis? | Rel C/I to all IUD |
| Immunosuppression | Rel C/I to all IUD |
| Severe dysmenorrhea/menorrhagia? | Rel C/I to all IUD |
| What Ix should be done prior to IUD insertion? | Cervical swab for gonorrhea & chlamydia |
| advantages of IUD? | 1, Long term 2. no hormonal risks, 3. sexual spontaneity 4. no preparation or personal responsibility 5. reversible 6. nil drug interactions 7. no effect on milk production |
| disadvantages of iud | 1. dysmenorrhea 2. menorrhagia 3. risk of perforation 4. risk of PID 5. risk of expulsion 6. trained personnel required for use 7. risk of migration 8. risk of ectopic preg if become preg |
| how would you prevent perforation on insertion? | 1. Bimanual exam to ascertain size and orientation of uterus' 2. Use of uterine sound with corresponding measurement matched to iud 3. On deployment leave space between fundus & introducer |
| How would you reduce the risk of infection? | 1. clean cervix thoroughly 2. cut string very short 3. antibiotic ex augmentin for 3-5 dys |
| how would you insert an iud? p1 | No touch aseptic technique. Insert during/after menses. Perform pelvic exam. insert speculum & clean cervix & vag twice. use tenaculum to steady anterior lip. use uterine sound to measure. insert delivery device to appropriate measurement. |
| how would you insert an iud p2 | trim threads so that 2-3cm visible past external os. show woman how to feel for string. feel for string after each period to ensure iucs is in situ. follow up visit in 6 weeks to ensure no perforation |
| what is the moa of copper T | Reduce ability of sperm to move through genital tract. incite inflammatory response in uterine and tubal fluid which is toxic to sperm and oocyte. |
| how can the efficacy of the IUD be improved | Addition of Cu, hormones, silver |
| what are the types of iud | lippes loop, cu iucd, mirena |
| how long can an copper T be left in-situ | 10 years |
| how long can a mirena be left in situ | 5-7 years |
| how would you treat a pt complaining of dysmenorrhea due to cu T. | prostaglandin synthetase inhibitor (ex mefanamic acid) |
| what would you do if a pt complains she cannot feel thread | 1.sweep cervix with cytobrush 2. preg test & pelvic u/s with backup contracep. 3. pelvic xray with dye/a sound 4. use an iucd thread locator or iucd hook. 5. hysteroscopy and currettage |
| what are the risk factors for iud expulsion | 1. first 3 months after insertion 2. nulliparous women 3. those less than 30 yrs 4. larger devices |
| what risk fctor would u ensure to counsel the pt about, and what would u say? | risk of ectopic preg and signs and symptoms of same (abd pain, nausea, vomiting, missed period, faint, clammy) |
Created by:
IonaDel
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