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Dr.Niraj Mahajan
Dr.Niraj Mahajan
Dr.Niraj Mahajan


IUCD - Copper T

By AdminPosted On 05-Oct-2016

1. Contraindications of IUCD

IUCD are relatively contraindicated in the following patient EXCEPT:

a) With past history of chronic Salphingitis.
b) With Submucous fibroid
c) With history of ectopic pregnancy
d) With septate uterus
e) With history of C section

Correct Answer: c and e. The absolute risk of ectopic pregnancy is extremely low due to the high effectiveness of IUDs. However, when a woman becomes pregnant during IUD use, the relative likelihood of ectopic pregnancy is greatly increased (history of ectopic pregnancy and history of C section are Category 1: A condition for which there is no restriction for the use of the contraceptive method). Ref: WHO (2010). Option a, b and d are Absolute Contraindications to IUD Insertion (Category 4: A condition that represents an unacceptable health risk if the contraceptive method is used).

2. Mechanism of IUCD

Postulated mechanism of the IUCD include all of the following action EXCEPT:

a) Altered tubal motility
b) Altered endometrium
c) Altered cervical mucus
d) Copper has spermicidal effect
e) Inhibition of implantation

Correct Answer: a) Altered tubal motility. The "mythologic" mechanism of the IUD is the creation of an inflammatory reaction in the endometrial cavity that prevents or disrupts the implantation of a fertilized egg. Research has proven this to be untrue; the IUD acts primarily as a contraceptive device by preventing fertilization. Copper-containing IUDs release free copper and copper salts without any measurable increase in serum copper levels. The resulting changes in the intrauterine environment and cervical mucus act to immobilize sperm or prevent their migration to the fallopian tubes. Progesterone-containing IUDs, on the other hand, cause a decidualization of the endometrium, leading to atrophy of the glands and thickening of the cervical mucus, creating a barrier to sperm penetration.

3. Which of the following is a second generation copper IUCD

a) Copper T 200
b) Lippes Loop
c) Multiload Cu 375
d) Progestasert

Correct Answer: c) Multiload Cu 375Second generation copper intrauterine device carry more copper wire, copper and silver sleeves and copper in the silver core; these improve their effectiveness and life span. The major IUDs in this group are Cu T 380A, Nova T, Multiload Cu 375 and Cu T 220C.Reference – Practice of Fertility Control – Chaudhari S. K.

4. Do we need to do sounding of the uterus prior to IUCD insertion?

Traditional teaching says "yes"."IUD insertion traditionally dictates uterine sounding for assessing the depth and direction of the uterus. However, assessing the size of the uterus by sounding is generally not necessary. Sounding can be used when vaginal examination is inconclusive of size or position of the uterus, when an IUD with a long stem does not appear to fit or if a previously inserted IUD was expelled. A flexible plastic Karman catheter with a diameter of 4–5 mm can be used for sounding. Sounding exposes the uterus to instrumentation twice in the form of uterine sounding followed by IUD insertion, which increases the risk of perforation compared to IUD insertion without sounding. The resistance felt by uterine sound at the level of the uterine fundus to measure the uterine length is the same as that felt by IUD. Size and direction of the uterus can be assessed by bimanual examination."Ref: Mahajan NN, et al. Surgical management of intra-abdominal mislocated intrauterine devices(IUDs). Contraception. 2007 Sep;76(3):257. PubMed PMID: 17707727.

5. Missing Thread

During follow up after 1 year of insertion of IUCD, thread is missing. Pregnancy is ruled out. What next?a) Probe the cervical canal using long artery forceps to locate the strings, and gently draw them out. b) X-ray abdomen AP and Lateral c) Sound the uterus and perform X-ray AP and Lateral d) Plain X-ray abdomen and Transvaginal USG e) Transvaginal USG

Correct Answer a) Once pregnancy has been ruled out: Probe the cervical canal using long artery forceps to locate the strings, and gently draw them out so that they are protruding into the vaginal canal.
Manage as appropriate based on findings:
1) If the strings are located and drawn out, and the woman wants to keep the IUCD, leave it in place.
2) If the strings are located and drawn out, and the woman does not want to keep the IUCD, remove the IUCD.
3) If the strings are not located in the cervical canal, do an ultrasound (X ray, if ultrasound is unavailable) to help determine whether the IUCD is still in place, is malpositioned, or has been expelled.
Most often when strings are missing, it is coiled inside the cervical canal.

6. IUCD with Pregnancy

1-year after insertion of IUCD, woman becomes pregnant and wants to continue pregnancy. Strings are seen. Ectopic pregnancy is ruled out.a) Leave IUCD in place and continue pregnancy b) Remove IUCD as it can cause second-trimester miscarriage, infection, and preterm delivery.Correct Answer: b) When ectopic pregnancy has been ruled out, if she wishes to continue the pregnancy, remove IUCD. Leaving the IUCD in place can cause second-trimester miscarriage, infection, and preterm delivery. Removing the IUCD slightly increases the risk of miscarriage.
In case IUCD is not removed (as desired by woman), closely monitor the pregnancy and look for expelled IUCD at the time of abortion/ delivery.

7. PID and IUCD

If a patient is diagnosed with pelvic inflammatory disease (PID) and has an intrauterine device (IUD), it is recommended not to remove IUD?

a) Yes
b) No

Correct Answer: a) Yes. PID treatment does not need to be altered by the presence of an IUD. Evidence is insufficient to recommend that the removal of IUDs in women diagnosed with acute PID. However, caution should be exercised if the IUD remains in place, and close clinical follow-up is mandatory. The rate of treatment failure and recurrent PID in women continuing to use an IUD is unknown. (Ref: CDC Guideline: 2010). 

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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