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Intrauterine Devices


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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