Lecture of intrauterine device (IUD)

2021-03-19 12:00 AM

The mechanism of action of the intrauterine device, especially the intrauterine device without active ingredients, is not completely clear. The intrauterine device causes a local inflammatory reaction

Since the 1960s, the intrauterine device has been widely used around the world as a contraceptive method whose mechanism of action has been known for a long time.

The intrauterine device also known as the IUD is the most widely used in our country. The intrauterine device is made of plastic, containing barium salt, so contrast with X-rays. Currently, to increase the ability to prevent pregnancy, people injected intrauterine device (1969), silver, hormones ( progestatií 1977) ...

Classification of intrauterine devices

Sort by shape

Closed uterine devices: Ota ring, Dana ring ...

Open uterine devices: TCu, Multiload ...

Classification by structure

Intrauterine device without active substance: first generation of intrauterine device, made of polyethylene (Dana, Lippes ...).

Copper uterine devices (TCu rings) appeared in the mid-70s, and come in many different forms. Copper has biological activity, which helps the uterine device to remain active while the size is smaller. The intrauterine device is less painful, less uncomfortable, but has a higher rate of drop compared to intrauterine devices without active ingredients. intrauterine device type TCu 380A (put into use in 1988, copper with cross section 380mm2) has a duration of effect lasting 10 years. Nova T ring with metal wire is a mixture of copper and silver with duration of effect for 5 years.

Intrauterine devices containing progestatií. Progestasert ring is T-shaped, T-body is the place to contain progesterone, this hormone is released slowly to promote contraceptive effect.

This ring is good for 5 years. These intrauterine devices make less menstrual blood flow, sometimes causing mid-menstrual bleeding. Recently appeared Mirena ring containing levonorgestrel with effect for 5 years.

Currently, we use popular intrauterine devices: TCu 380A (using time is 10 years), Multiload 375 (5 years) and Multiload 250 (3 years).

The mechanism of action of the intrauterine device

The mechanism of action of the intrauterine device, especially the intrauterine device without active ingredients, is not completely clear. The intrauterine device causes a local inflammatory response, altering the function of the endometrium, leading to a reaction of lysosomes to the blastocyst, possibly phagocytosis on sperm. In clinical fact, it has been observed that the pregnancy rate increases when using an intrauterine device combined with anti-inflammatory drugs. This is the first mechanism of contraceptive action of the intrauterine device. It is also mentioned the role of the uterine device to change the peristaltic activity of the ovary, the ovaries return to the uterus earlier than normal, not consistent with the stage of the uterine lining to welcome the eggs to fill. But there are also many authors who contradict this mechanism. With active uterine devices, copper has a toxic effect on the gametes (specifically, is toxic to the sperm), causing a strong change in the uterine lining, preventing the egg from implanting in the uterus, changing the composition of cervical mucus, preventing sperm from entering the uterus. Urinary instruments containing progestati affect the peristalsis of the oviduct, cervical mucus, change the properties of the endometrium. As a result, these factors become detrimental to the fertilization and foaming of the eggs.

Inserting, removing, and replacing intrauterine devices

Placing and removing the intrauterine device at the time of menstruation is the best time because the cervix is ​​ajar, easy to manipulate, and most importantly, there has not been a conception phenomenon. The intrauterine device should not be placed immediately after delivery because the rate of intrauterine drop is very high. It is recommended that the intrauterine device be placed at least 8 weeks after delivery (reducing the incidence of intrauterine contraction and reduction in perforation). After an abortion, aspiration should also wait for menstruation to return once and then fatigue by placing the uterus.

Intrauterine device replacement: for inactive uterine devices that can remain in the uterus for a long time. TCu 380A intrauterine device is effective for 10 years. Progestati uterine devices should be changed every year

Indications for use of intrauterine devices

Ideally used for women who have children, normal genitalia, and wish to avoid pregnancy. The uterus has scarring of striated fetal tissue that can place an intrauterine device.

Contraindicated

Absolutely contraindicated

Pregnant.

Genital tract infections.

Blood clotting disorder.

Cardiovascular disease.

Genital cancer.

Relatively contraindicated

Abnormal uterine cavity (fibroids, malformations ...).

Are being treated with anticoagulants.

History of upper genital tract infections.

History of ectopic pregnancy.

No children.

Complications of an intrauterine device

Common pelvic pain due to uterine contractions, nonspecific analgesics give good results. Sometimes because the uterine device is too large, the contractile uterus tends to expel the uterine device.

Epilepsy can be seen with inactivated uterine devices or with high prostag- landin isotopes. In this case, the uterine device can be changed many times when the results are available.

Menstrual disorders are the most common weakness, accounting for 10-15% of cases requiring removal of the intrauterine device in the first year after insertion. Treatment with antifibrinolytic drugs, vascular protection drugs and anti-prostaglandin drugs. It is most common to remove an intrauterine device to replace it with another type of intrauterine device or to use another method of contraception.

A decrease in the intrauterine device by 5-20% in the first year of use. Factors that affect the rate of intrauterine contraction are: age, number of births, type of intrauterine device, experience of the insertion person, at which time the intrauterine device is placed ... intrauterine device within the first 3 months after insertion. There are up to 20% of cases of intrauterine indentation without knowing.

Perforation of the uterus is very rare (about 1.2 / 1000 injections). Detecting at the time of insertion, the uterine device and uterine conservation treatment are taken.

An intrauterine device can be inserted into the abdomen at the moment of insertion (perforation of the uterus of the uterus without being detected) or a population in the future. The leg is predictable because the uterine device is not visible in the uterus (no ultrasound, no intrauterine transmission), the uterus with a contrast pump shows the uterine device outside the uterus. Treatment is an intrauterine device, especially an intrauterine device or copper-containing device.

You can open the abdomen or use an endoscope to remove an intrauterine device.

Genital infections are a serious complication that can cause infertility. The incidence varies depending on the statistic from 3-9%. The risk of infection in intrauterine carriers is higher than in oral contraceptive users or those who are not using birth control. Pathogenesis of infection is due to the role of micro-trauma, the change in endometritis, the cord of the uterine device has broken the barrier in the cervix, sometimes as a transmission factor. bacteria. The start is usually discreet (pelvic pain, low fever, hemorrhage, cloudy, dirty cervical mucus ...), combined antibiotic treatment gives good results, no need to remove the uterine device. If not treated well, it can lead to ovarian inflammation, ovarian abscess, and framed peritonitis.

Pregnancy with intrauterine device is experienced at the rate of 0.5-5 women per 100 users per year. The rate of miscarriage with the risk of infection is very high. In case of trying to keep pregnancy, it is not required to remove an intrauterine device. Labor is nothing special.

Intrauterine devices and ectopic pregnancy: intrauterine device carriers are at risk of having an ectopic pregnancy 4-5 times higher than intrauterine carriers. This shows that the intrauterine device works to prevent the fetus from implanting in the uterus, but does not prevent the fetus from implanting outside the uterus. However, there is no definitive study to confirm that intrauterine device causes ectopic pregnancy.

Pregnant again after removing the uterine device

Once you want to become pregnant, remove the intrauterine device. In general, the procedure of removing an intrauterine device is very simple. Rate of pregnancy again after IUD removal:

30% after 1 month.

50% after 3 months.

70% after 1 year.

90% after 2 years.

10% of secondary infertility can be caused by a tubal infection.

Effective contraception

For intrauterine devices without active ingredients, contraceptive effectiveness reaches 95-96% of women / year (Pearl index). The contraceptive efficiency is even higher when using an intrauterine device with active ingredients (metal or endocrine) reaching 99% of women/year. In our country today, the intrauterine device is the most widely used contraceptive method, has high contraceptive efficiency, and has great economic significance.