IUCDS

Question 1

Define conttaception

Answer 1

The intentional prevention of contraception through use of various devices

Question 2

What are the modes of action of copper IUDS

Answer 2

The copper IUD is a foreign body that creates a sterile inflamm reaction that is toxic to the sperm and ova and impairs implantation

Question 3

Other modes of action

Answer 3

Causes changes in cervical mucus that inhibit sperm transport
Is thought to be spermicidal
Inhibits implantation by causing chronic inflammatory changes and thinning of the endometrium
Is thought to be ovicidal

Question 4

Women who cannot use IUCD(MEC3/4)

Answer 4

Women who are pregnant
Between 48hrs and 4 weeks after delivery
Puerperal sepsis/post septic abortion
Unexplained vaginal bleeding
GTD
Pelvic cancer
Fibroids distorting the endometrial cavity
Congenital uterine/cervical anomalies
Current PID/cervicitis
High individual likelihood of exposure to gonorrhea/Chlamydia

Question 5

Timing of IUCD insertion

Answer 5

Interval insertion- during menstrual cycle and woman is not pregnant
Postpartum insertions- Immediately after SVD or CS, past 48 hours wait to 6 wks
Post abortion- immediately, no infection

Question 6

Complications of IUCD insertion

Answer 6

Uterine perforation (rare 1:1000 insertions)
Increases risk of pelvic inflammatory disease in high risk patients
Missing strings
Expulsion
Pregnancy with IUCD
Cramp like pain

Question 7

Methods of removal of IUCDs

Answer 7

(i) Specially designed blunt hook
(ii) Artery forceps (Fig. 42.8)
(iii) Uterine curette (Fig. 42.17)
(iv) Hysteroscopically under direct vision

Question 8

The indications of its removal are

Answer 8

missing threads, persistent pelvic pain, menorrhagia, pregnancy, displacement of the device and flaring up of pelvic infection.

Question 9

Mode of action of hormone releasing IUS

Answer 9

They are also called intra-uterine systems (IUS)
They release levornogestrel, a progesterone hormone,

Question 10

Types of hormone releasing IUS

Answer 10

Mirena®: contains 52mg of levornogestrel - 8years
Kyleena 19.5 mg - 5years
Skyla: contains 13.5 mg of levornogestrel - 3 years

Question 11

Moa of hormonal IUS

Answer 11

Release a progestin, levonorgestrel.
Levonorgestrel:
suppresses ovulation
thickens cervical mucus, prevents sperm penetration
makes the endometrium thin, hence unsuitable for implantation

Question 12

Who cannot use medicated iucd

Answer 12

Acute DVT/Pulmonary Embolus
Severe liver cirrhosis/Hepatocellular carcinoma
Breast cancer
SLE
Migraine headaches with aura
Breastfeeding women before 4 weeks postpartum

Question 14

How are intrauterine devices broadly classified based on their design?

Answer 14

They are classified as “open” devices (e.g., Lippes loop, Cu T, Multiload) and “closed” devices (e.g., Grafenberg ring). Closed devices are now obsolete because they pose a risk of strangulating the gut if they accidentally perforate into the peritoneal cavity.

Question 15

What are the main types of medicated IUCDs currently in use?

Answer 15

The currently used medicated IUCDs include Multiload 250, Multiload 375, Cu T 380A, Levonorgestrel intrauterine system (LNG-IUS), and GyneFix.

Question 16

What is the effective lifespan before replacement is required for the Cu T 380A device?

Answer 16

The Cu T 380A device is replaced every 10 years.

Question 17

How much hormone does the LNG-IUS contain, and at what rate is it released?

Answer 17

The LNG-IUS acts as a steroid reservoir containing 52 mg of levonorgestrel, which is released at a rate of 20 µg/day.

Question 18

What is the primary mode of action of IUCDs in preventing pregnancy?

Answer 18

They produce a nonspecific inflammatory reaction and biochemical changes within the endometrium that possess gametotoxic and spermicidal properties.

Question 19

How does the addition of copper enhance the contraceptive effect of an IUCD?

Answer 19

Ionized copper has a local antifertility effect that prevents blastocyst implantation through enzymatic interference. Copper also initiates the release of cytotoxic cytokines.

Question 20

What is the specific mechanism of action for the Levonorgestrel Intrauterine System (LNG-IUS)?

Answer 20

It induces strong and uniform suppression of the endometrium and causes the cervical mucus to become very scanty.

Question 21

What are the absolute contraindications for inserting an IUCD?

Answer 21

Contraindications include the presence of pelvic infection (current or within 3 months), undiagnosed genital tract bleeding, suspected pregnancy, distortion of the uterine cavity’s shape, and a past history of ectopic pregnancy.

Question 22

What are the specific additional contraindications for inserting a copper-bearing IUCD?

Answer 22

Wilson’s disease and copper allergy are specific contraindications for copper IUCDs.

Question 23

When are the generally accepted times to introduce an IUCD?

Answer 23

The device can be introduced in the interval period, following an abortion, or following childbirth.

Question 24

Which specific insertion techniques are preferred for a Copper T device to prevent contamination and uterine injury?

Answer 24

The “withdrawal” technique and the “no-touch” insertion method are preferred.

Question 25

What are the common immediate complications following IUCD insertion?

Answer 25

Immediate complications include cramp-like pain, syncopal attacks (more frequent in nulliparous women), and partial or complete perforation of the uterus.

Question 26

What are the principal factors that lead women to discontinue IUCD use?

Answer 26

Pain, abnormal uterine bleeding, and pelvic inflammatory disease (PID) are the main reasons for discontinuation.

Question 27

When does spontaneous expulsion of an IUCD most commonly occur?

Answer 27

It usually occurs within the first few months following insertion, and is more common during the menstrual period.

Question 28

What are the failure rates for third-generation IUCDs?

Answer 28

The lowest pregnancy rates are observed with the Cu T 380A at 0.8 per 100 women years and the LNG-IUS at 0.2 per 100 women years.

Question 29

If a woman becomes pregnant with an IUCD in situ, what major obstetric complication is she at a higher risk for?

Answer 29

She is at an increased risk of having an ectopic pregnancy.

Question 30

What steps should be taken to investigate a "missing thread" in an IUCD user?

Answer 30

After excluding pregnancy, identification methods include ultrasonography, hysteroscopy, sounding the uterine cavity by a probe, or taking a straight X-ray after introducing a radiopaque probe into the uterine cavity.

Question 31

What should be done if a copper IUCD is diagnosed to have perforated the uterus and is lying in the peritoneal cavity?

Answer 31

It must be removed by laparoscopy or laparotomy because a copper-bearing device induces an intense local inflammatory reaction and causes adhesions with surrounding structures.

Question 32

What are the non-contraceptive benefits of using a Levonorgestrel Intrauterine System (LNG-IUS)?

Answer 32

It provides a significant reduction in menstrual blood loss, menorrhagia, dysmenorrhea, and premenstrual tension syndrome (PMS).

Question 33

What are the general indications for the removal of an IUCD?

Answer 33

Indications for removal include persistent excessive uterine bleeding, flaring up of salpingitis, perforation of the uterus, partial expulsion, pregnancy occurring with the device in situ, missing thread, or the woman desiring a baby.