عرض تقديمي (10) IUD.pdf

Intra- Uterine device) IUD( Under Supervision: Ass prof dr violet Nicola. Dr rehab Maged Dr Magda Ahmed. Dr samar ali Dr neama Mohamed Prepared by: Group 4B...

Intra- Uterine device) IUD( Under Supervision: Ass prof dr violet Nicola. Dr rehab Maged Dr Magda Ahmed. Dr samar ali Dr neama Mohamed Prepared by: Group 4B Hager Hamdy Hatem Hager Emad Abdelhamed Hager Samy Hassan Hager Hamed Mahmoud Yousef Talal Saeed  Intra- uterine device (IUD) Outline: Definition of Intra uterine device. Types of IUD. Effectiveness. Mechanism of action. Advantages and disadvantages. Indications and contraindications. Side effects and complications. Management of complications. Time of IUD insertion. Nursing role. Definition of Intra Uterine device: An intrauterine device (IUD) is a form of birth control that a healthcare provider inserts into your uterus. Once it’s inserted, an IUD can prevent pregnancy for up to 10 years or more, depending on the specific type. Your provider can remove your IUD at any time if you decide to become pregnant. An IUD is a type of long-acting, reversible contraception depending on the type. A small, flexible, T-shaped device, an IUD is inserted into the uterus through the vagina. Generally speaking, IUDs prevent pregnancy by reducing the ability of sperm to reach the egg for fertilization. Type of IUD: There are two types of IUD; 1) Non-medicated IUD: a) Ring-shaped IUD made up of stainless steel. b) Plastic IUD fabricated from polyethylene or polypropylene. 1) Medicated IUD: a) Copper-bearing IUD. b) Hormone-releasing Non medicated IUD The non- medicated IUD is made up of inert material or from stainless steel or plastic that is used as a method of birth control designed for insertion into a woman's uterus. Medicated IUD 1. Hormonal IUDs - Description: These release a small amount of progestin (a synthetic hormone) into the uterus. Type include : Mirena: Effective for up to 7 years. Kyleena: Effective for up to 5 years. Liletta: Effective for up to 6 years. Skyla: Effective for up to 3 years. Indication Hormonal IUD often is prescribed for people with: 1-Heavy bleeding during periods. 2-Cramping or pain with periods. 3-Endometriosis. 4-Unusual growth of the lining of the uterus, called endometrial hyperplasia. 5-Unusual growth of uterine-lining tissue into the muscles of the wall of the uterus, called adenomyosis. 5-A lack of enough healthy red blood cells to carry oxygen through the body, called anemia. Growths in the uterus that aren't cancer, called fibroids. - Benefits: Can reduce menstrual bleeding and cramping, and may even stop periods altogether for some users. 2. Copper IUDs - Description: These are hormone-free and use copper to prevent sperm from fertilizing an egg. ,often known as ParaGard, effective for up to 10-12 years. Indication The copper IUD is an option for people who: 1-want a reliable, long-term contraceptive. 2-haven't had a pregnancy, have completed their families. 3-spacing their pregnancies. 4-breastfeeding. 5- do not want to, use hormonal contraception because of medical conditions or personal preference. - Benefits: Can be used as emergency contraception if inserted within five days after unprotected intercourse; does not involve hormones. Effectiveness of IUD The effectiveness of intrauterine devices (IUDs) is very high. Here are the key points regarding their effectiveness: 1. General Effectiveness - Failure Rate: IUDs have a failure rate of less than 1%, making them over 99% effective at preventing pregnancy. 2.Emergency Contraception - The copper IUD can be used as emergency contraception if inserted within five days after unprotected intercourse, with a success rate of about 99%. 3. User Error - IUDs eliminate the risk of user error since they do not require daily attention, unlike pills or condoms. 4. Long-term Use - Once inserted, they require minimal maintenance, making them a convenient option for long-term birth control. Mechanism of action: Illustration of intrauterine device IUDs primarily work by preventing fertilization.The progestogen released from hormonal IUDs mainly works by thickening the cervical mucus, preventing sperm from reaching the fallopian tubes. IUDs may also function by preventing ovulation from occurring but this only occurs partially. Copper IUDs do not contain any hormones, but release copper ions, which are toxic to sperm. They also cause the uterus and fallopian tubes to produce a fluid that contains white blood cells, copper ions, enzymes, and prostaglandins, which is also toxic to sperm.The very high effectiveness of copper-containing IUDs as emergency contraceptives implies, they may also act by preventing implantation of the blastocyst. Advantages and disadvantages: Advantages The IUD is one of the most popular contraceptive methods, especially for long-term reversible contraception, as it can be easily fitted and removed. It is highly effective, with a 98-99 percent success rate over five years of IUD use. It can be used by almost any woman including nulliparous. Its action lasts for ten years if it is not removed in between. The onset of action is immediate. It is independent of sexual activity. It doesn’t interfere with intercourse. It is suitable for lactating women. Disadvantages Despite the obvious benefits of an IUD, it has minor and major drawbacks, such as: Menorrhagia is a frequent complaint, as are dysmenorrhea and polymenorrhea. These are the major reasons for IUD discontinuation as well. It doesn’t offer any protection against sexually transmitted infections (STIs). There is a slight risk (1 percent) of acquiring uterine infection during IUD insertion within 20 days of the procedure. If a woman becomes infected with an STI with an IUD in situ, pelvic inflammatory disease may result without adequate treatment. Expulsion of the IUD may occur especially following or during the periods in the first three months. IUD Contraindications Contraindications for the use of IUD ▪ Pregnancy or suspected pregnancy. ▪ Sexually transmitted infection. ▪ A congenital uterine abnormality that distorts the shape of the uterine cavity making insertion difficult. ▪ Acute pelvic inflammatory disease. ▪ Confirmed or suspicion of uterine or cervical malignancy/neoplasia. ▪ Abnormal uterine bleeding of unknown origin. ▪ Hypersensitivity to any component of the device. For the levonorgestrel IUD, additional contraindications include: 1. Confirmed or suspicion of breast malignancy or other progestin-sensitive cancer. 2. Liver tumors, benign or malignant. 3. Acute liver disease. For the copper IUD, additional contraindications include: 1. Wilson disease. 2. Sensitivity to copper. Side effects and Complications: Before inserting an IUD, a doctor should make sure that the individual is aware of the potential side effects and risks, including the known side effects of particular brands. Common IUD side effects include: o Irregular bleeding for several months. o Lighter or shorter periods or no periods at all. o Symptoms of premenstrual syndrome (PMS), which include headaches, nausea, breast tenderness, and skin blemishes. Rarer side effects of IUDs include: o Lost strings The IUD strings, which hang from the bottom of the IUD, protrude from the cervix into the vagina. These strings are left in place when the IUD is inserted, but they can sometimes work their way up into the uterus. “Missing” or “lost” IUD strings are known as nonvisualized strings. o Infection One of the most serious complications that can arise because of an IUD is infection. o Perforation Uterine perforation is a serious but rare complication of IUD use. o Failed Insertion Failed IUD insertion is thought to be uncommon; however, IUD providers should be aware of risk factors that can make insertion difficult without additional procedures, adjunctive imaging, and pain control. o Expulsion Expulsion occurs when the IUD has moved from its intended position at the top of the uterus. Management of IUD complications: Regular check-ups: Schedule regular check-ups with a healthcare provider to ensure the IUD is properly positioned and to address any emerging issues promptly. Pain management: Over-the-counter pain relievers can help manage cramping and discomfort associated with IUD use. If pain persists, consult a healthcare professional. Monitoring side effects: Be vigilant about monitoring side effects and changes in menstrual patterns.Report any unusual symptoms promptly to a healthcare provider. Follow-up procedures: In cases of complicated removals or migration, follow healthcare provider Recommendations for additional procedures or interventions. Time of IUD Insertion: Insertion of the IUD Insertion of an IUD takes only about 5 to 10 minutes. Just like having a gynecological exam, you will lie on your back with your feet on foot rests. A sheet will drape over your body. The health care provider will first do a pelvic exam to measure the size, shape, and position of the uterus and ovaries. Your provider will then use a device called a speculum that holds the vagina open. Next, an antiseptic solution will be used to gently clean the vagina and cervix. The IUD will be inserted through the opening of the cervix into the uterus. You will likely feel some cramping when the IUD is inserted. It is OK to schedule the insertion of the IUD at the time of your period. If you are sexually active, the IUD should be inserted during your period, or when you have not had intercourse for 2 weeks before the IUD insertion. Nursing role: 1. Patient Education: Nurses provide detailed education about the types of IUDs (copper and hormonal), how they work, and their effectiveness. They also explain potential side effects, risks, and benefits to help the patient make an informed decision. 2. Assessment: Before insertion, nurses assess the patient's health history, menstrual history, and any contraindications (e.g., pelvic inflammatory disease or certain sexually transmitted infections). They ensure the patient is a good candidate for an IUD and address any concerns. 3. Informed Consent: Nurses ensure the patient fully understands the procedure, potential risks, and alternatives. They are responsible for obtaining informed consent prior to IUD insertion. 4. Assisting with IUD Insertion: During the procedure, nurses may assist the healthcare provider by preparing the necessary instruments, ensuring sterile technique, and providing comfort and support to the patient. 6. Post-Insertion Care: After insertion, nurses educate the patient on what to expect, including potential c cramping or spotting, how to check for the IUD strings , and signs of complications such as infection or expulsion. They may also schedule follow-up visits for the patient. 7. Complication Management: Nurses play a key role in monitoring for and managing complications like IUD displacement, infection, or pelvic pain. They ensure patients know when to seek medical help if they experience severe symptoms. 8. Follow-Up and Removal: Nurses provide instructions on routine follow-up care, assist with IUD removal when necessary, and educate patients on alternative contraceptive options if needed. References: "Clinical Guidelines for Contraceptive Management" by the American College of Obstetricians and Gynecologists (ACOG). World Health Organization (WHO), "Family Planning: A Global Handbook for Providers". "Essentials of Contraceptive Technology" by John Hopkins University, Center for Communication Programs. https://www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354 https://en.m.wikipedia.org/wiki/Copper_IUD https://my.clevelandclinic.org/health/treatments/24441-intrauterine-device-iud