Title/Topic: Inta-Uterine Device
I.Introduction
People have used birth control methods for thousands of years.Today we have many safe and effective birth control methods available to us.One of the best methods women used was IUD.IUD is a type of birth control.It is a small,plastic devise that is inserted and left inside the uterus t prevent pregnancy.It is contraciptive devise made from plastic and copper made from plastic and copper that fits inside the womb (uterus).It used to be called acoil or a loop. This study is very important for it provide the people proper information on birth control.
It is along-lasting and reversible method of contraception but it is not a barrier method, an IUD can not prevent you from contracting sexually transmitted infections (STIs).
There are different types and sizes of IUD to suit different women. IUDs need to be fitted by a trained doctor or nurse at your your GP surgery, local family planning clinic or sexual health clinic.
Most women who want an IUD fitted can do so, including women who have never been pregnant or are HIV positive.An IUD is usually fitted during your menstrual period.From the moment the IUD is fitted until the time it is taken out, you are protected against pregnancy.
II. Definition of IUD
An IUD is a small, t-shaped device that is inserted into your uterus by your doctor. It is made out of flexible plastic and contains either copper or hormones. At the end of the IUD are two transparent strings that hang down into the vagina, which women can feel for to check their IUD is still in place. Depending on the type you use, your IUD can provide you with continuous protection from pregnancy anywhere form five to 12 years.
III. History of IUD
According to popular legend, Arab traders inserted small stones onto the uterus of their camels to prevent pregnancy during long desert treks.The story was originally a tall tale to entertain delegates at a scientific conference on family planning; although it was later repeated as truth.
Precursors to IUDs were first marketed in 1902. Developed from stem pessaries,the stem on these devices actually extended into the uterus itself. Because they occupied both the vagina and the uterus, this type of stem pessary was also known as an IUD.
IV. Invention of IUD
The first published paper on actual IUD insertions was made by Dr. Richard Richter in 1909in Germany. The device he inserted was a ring made of silkworm gut, with 2 ends which protude from the cervical os enabling him both to check the device and remove it. In the mid 1920s, Ernest Graefenberg the silkworm gut with acoiled metal ring was widely used, it was considered arisky method in continental Europe and in the U.S. As late as 1959, Dr. Alan Guttmancher co-authored a paper in which the IUD was condemned for its ineffectiveneess, potential source of infection, and its carcinogenic potential.Since 1960, various kinds of IUDs have been developed, and various organization such as the population council showed a renewed interest in IUDs as a contraciptive method. In 1 study of IUD side effects data from 6,450 individuals, there were 10 deathes and 15 intances ofintestinal obstruction due to the preforation of ht eintestine by the device.
V. Types of IUD
There are two types of IUDs available: the Mirena which continuously releases hormones for up to five years, and the ParaGard Copper T 380A IUD which contains copper and can be worn for up to 12 years. IUD's are effective as soon as they are inserted.There are two types of IUDs available: ParaGard and Mirena. The ParaGard has a tiny copper wire wrapped around the plastic body and should not be used by anyone who is allergic to copper. The Mirena releases small amounts of a synthetic progesterone hormone. The hormone was added to attempt to decrease the bleeding and cramping that some women have with the IUD.
VI. Advantages of IUD
Because of the long lasting protection against pregnancy an IUD provides, the IUD is one of the most popular types of birth control throughout the world. Many women like the fact that they do not need to worry about their contraceptive on a regular basis. Additionally, the IUD gives a woman birth control options if she prefers non-hormonal forms of contraceptives, she can use the copper IUD which in no way interferes with her hormonal levels.
Women who use the Mirena IUD may find that their menstrual periods are lighter and that their cramps are not as severe. About 30% of women using this type of IUD will stop menstruating although their periods should return fairly soon after the IUD is removed.
The copper IUD can also be used as a form of emergency contraceptive. It has been shown to be as much as 99% effective in preventing pregnancy from occurring when it is inserted within five days of having unprotected vaginal intercourse.
- Allows sexual spontaneity.
- Requires no daily attention.
- Immediately effective.
- Long-lasting.
- Not messy.
• IUD does not give you protection against sexually transmitted disease. So it is recommended that you must use condoms along with IUD while go for sex.
• You cannot insert or remove IUD by yourself. Only a trained doctor or nurse can do it.
• You may have a longer, heavier and more painful period. However it may improve in few months. But there may be an average increased blood loss.
• It may injure the uterus during fitting.
• IUD may lead to infection in three weeks after insertion.
• IUD may lead to higher risk of pelvic inflammatory disease that can cause infertility.
• While using IUD if you got pregnant it may lead to a severe infection. However it is very rare that a woman get pregnant while using IUD. In this case a woman become pregnant only when the IUD is out of place. In this case you must got you IUD removed as soon as possible.
• IUD may expel itself from the uterine cavity without coming to your knowledge. It may occur during the menstrual period.
Irrespective of the disadvantages, if placed and maintained properly, IUD can be a very effective method for birth control.
VIII. Insertion of IUD
copper-releasing iud
The proper equipment (Table 2) should be assembled before the procedure. Then, a bimanual examination with nonsterile gloves should be performed to determine the position of the uterus.
|  Figure 3. The arms of the copper-releasing intrauterine device are folded into the insertion tube. Reprinted with permission from FEI Women's Health. |
The arms of the IUD are to be folded into the insertion tube far enough to retain them. This can be done before the start of the procedure, working through the sterile package (Figure 3).
Sterile technique, including sterile gloves, is necessary during the procedure to minimize the risk of contamination or infection. The cervix and adjacent vaginal fornices should be cleansed liberally with an antiseptic solution. Chlorhexidine gluconate (Hibiclens) may be used if the patient is allergic to iodine.
The physician should stabilize the cervix during the insertion of the IUD with a tenaculum. Local anesthesia, such as 5 percent lidocaine gel (Xylocaine) placed in the cervical canal, or a paracervical block may be used to minimize discomfort.
A sterile uterine sound should be used to determine the depth of the uterine cavity. Contact with the vagina or speculum blades should be avoided. The uterine sound has a bulbous tip to help prevent perforation. An alternative to the uterine sound is an endometrial aspirator such as those used for endometrial biopsy sampling. An adequate uterine depth is between 6 and 9 cm and should be documented in the patient's record. An IUD should not be inserted if the depth of the uterus is less than 6 cm.
The physician should use sterile gloves to remove the IUD from the sterile package. The blue flange should be aligned with the IUD arms and set at the distance the uterus was sounded. The white inserter rod should then be placed into the insertion tube at the end opposite the arms of the IUD and approximated against the ball at the base of the IUD.
 Figure 4. The arms of the copper-releasing intrauterine device are released. Reprinted with permission from FEI Women's Health. |  Figure 5. The insertion tube is advanced for placement of the copper-releasing intrauterine device. Reprinted with permission from FEI Women's Health. |
The physician should then insert the IUD into the uterus until the flange is against the cervical os. The clear inserter tube should be pulled back on the insertion rod approximately 2 cm so that the arms can spread to the "T” position (Figure 4). The tube should be advanced slowly to ensure a correct positioning of the IUD (Figure 5). The physician should remove the insertion rod by holding the insertion tube in place (Figure 6) and then remove the insertion tube and the tenaculum. Finally, the threads emerging from the cervical os should be cut to a length of 3 cm. The length of the threads in the vagina should be noted in the patient's record for further reference.
 Figure 6. The insertion rod of the copper-releasing intrauterine device is withdrawn. Reprinted with permission from FEI Women's Health. |  Figure 7. The arms of the hormone-releasing intrauterine device are aligned to a horizontal position when removing the device from the package. Reprinted with permission from Berlex, Inc. |
hormone-releasing iud
As with the copper-releasing IUD, the proper equipment (Table 2) for insertion of the hormone-releasing IUD should be assembled before the procedure. Then, a bimanual examination with nonsterile gloves should be done to determine the position of the uterus. Sterile technique with sterile gloves is necessary during the procedure itself to minimize the risk of contamination or infection. The cervix and adjacent vaginal mucosa should be cleansed liberally with an antiseptic solution. Chlorhexidine gluconate may be used if the patient is allergic to iodine.
The physician should stabilize the cervix during the insertion of the IUD with a tenaculum. Local anesthesia, such as 5 percent lidocaine gel placed in the cervical canal, or a paracervical block may be used to minimize discomfort.
A sterile uterine sound or an endometrial aspirator should be used to determine the depth of the uterine cavity. Contact with the vagina or speculum blades should be avoided. An adequate uterine depth is between 6 and 9 cm and should be documented in the patient's record. An IUD should not be inserted if the depth of the uterus is less than 6 cm.
 Figure 8. The hormone-releasing intrauterine device is drawn into the insertion tube. Reprinted with permission from Berlex, Inc. |  Figure 9. Threads are fixed tightly in the cleft. Reprinted with permission from Berlex, Inc. |
The physician should open the sterile IUD package, put on sterile gloves, pick up the inserter containing the IUD, and carefully release the threads from behind the slider, allowing them to hang freely. The slider should be positioned at the top of the handle nearest the IUD. While looking at the insertion tube, the physician should check that the arms of the device are horizontal. If not, they must be aligned using sterile technique (Figure 7). The physician should pull on both threads to draw the IUD into the insertion tube so that the knobs at the end of the arms cover the open end of the inserter (Figure 8). The threads should be fixed tightly in the cleft at the end of the handle (Figure 9), and the flange should be set to the depth measured by the sound (Figure 10).
 Figure 10. The flange is adjusted to sound depth. Reprinted with permission from Berlex, Inc. |  Figure 11. The slider is pulled back to reach the mark. Reprinted with permission from Berlex, Inc. |
The physician should insert the IUD by holding the slider firmly at the top of the handle and gently placing the inserter into the cervical canal. The insertion tube should be advanced into the uterus until the flange is situated at a distance of about 1.5 to 2 cm from the external cervical os, allowing ample space for the IUD arms to open. While holding the inserter steady, the physician should release the arms of the IUD by pulling the slider back until the top of the slider reaches the raised horizontal line on the handle (Figure 11). The inserter should be pushed gently into the uterine cavity until the flange touches the cervix.
The IUD should now be positioned at the top of the fundus. The physician then releases the IUD by pulling the slider all the way down while holding the inserter firmly in position. The threads will be released automatically (Figure 12). The inserter should be removed from the uterus. Finally, the threads emerging from the cervical os should be cut to a length of 2 to 3 cm. The length of the threads in the vagina should be noted in the patient's record for further reference.
The manufacturers of both IUDs have created practice kits that can help physicians learn to insert an IUD.
 Figure 12. The inserter is withdrawn while the intrauterine device is released. Reprinted with permission from Berlex, Inc. |
|
IX.Removal of IUD
An IUD should be removed at the expiration date, when the patient develops a contraindication, when adverse effects do not resolve, or on patient request. Treatment for cervical dysplasia may be different with the IUD present. Colposcopy may be performed, but the IUD should be removed if an excisional procedure is performed.
The IUD is removed by securely grasping the threads at the external os with ring forceps. Traction should be applied away from the cervix. If resistance is met, the removal should be abandoned until it is determined why the IUD is not moving. A deeply embedded IUD may have to be removed hysteroscopically.
X.Effectiveness Rate of IUD
Virginia Commonwealth University researchers have found that intrauterine devices are safe and effective in a population of women previously not considered as good candidates for this method of birth control.The findings may help physicians develop improved guidelines for providing intrauterine devices (IUDs) to patients.
The IUD is the most common form of reversible birth control used by women worldwide. While IUDs offer a high level of long-term contraceptive efficacy, they have been associated with health risks, including pelvic inflammatory disease and upper genital tract infections. Women who are at high risk for both sexually transmitted infections and pregnancy have been classified as poor candidates for this method of contraception.
In a study published in the August issue of the American Journal of Obstetrics and Gynecology, researchers concluded that IUDs were acceptable and not associated with a significant increase in occurrence of gynecologic infections in women who are at high risk for both sexually transmitted infections and pregnancy.
"We once thought that IUDs could only be used in married, monogamous women because of a perceived increase in the risk of pelvic infections," said lead investigator, Catherine A. Matthews, M.D., assistant professor in the Department of Obstetrics and Gynecology at VCU.
"From our study, we now know that IUDs are safe to use in all women who don't have an acute infection of the cervix. Therefore, young, unmarried, sexually active women can now be considered good candidates for this contraceptive option, which doesn't require taking a pill, patch, or injection," she said.
The team conducted a medical chart review of approximately 200 women who had IUDs inserted between 2000 and 2005. Researchers compared the efficacy and complication rates of the Paragard IUD and Mirena intrauterine system (IUS). Both are T-shaped devices placed in the uterus to prevent pregnancy, however, the Mirena IUS releases a hormone.
According to Matthews, a third of women who received an IUD had a history of STD prior to insertion. Additionally, 32 percent of women had a history of other gynecological infections such as bacterial vaginosis, and almost half were unmarried. Matthews said that the Mirena IUS had lower rates of complications and greater acceptability than the Paragard IUD.
Matthews collaborated with VCU colleagues Samuel J. Campbell, M.D., with the Department of Obstetrics and Gynecology; and Karen L. Cropsey, PsyD., with the L. Douglas Wilder School of Government and Public Affairs.
XI.Conclusion
0 comments:
Post a Comment