Intrauterine Contraception Flashcards
an LNG-IUD fitted after 45 can be used for contraception until ?
Age 55
Under 45 an LNG-IUD can be used for ?
8 years
Cu-IUD with more than 300mm squared of copper inserted after age (1) can be kept until menopause or 1 year after the last period if under (2)
- 40
- 50
Copper coils effectiveness with perfect use (1) with typical use (2) in first year of use.
- 99.4%
- 99.2%
Failure rate for a 52mg LNG-IUD ?
99.8% effective in first year of use
Effectiveness of 19.5 and 13.5mg devices
99.7%
What UKMEC is IUC insertions between 48 hours and 28 days post delivery ?
UKMEC 3 - shouldn’t really be doing it risk outweighs benefit
UKMEC for know distortions of uterine cavity ?
UKMEC3
Is the copper coil still effective in immunocompromised or suppressed people ?
Yes it is
For individual at risk of adrenal crisis what measure need to be taken ?
Their appointment should be first thing in the morning and thy need to take a double dose of glucocorticoids 1 hours before the procedure and 24 hours after. Mineralocorticoids do not need to be adjusted.
Ehlers-Danlos patients are at increased risk of perforation what should we do when fitting their coils ?
Discuss appropriate setting with EDS specialist, and assure positioning appropriate for the patient
What considerations need to be taken into place for individuals with PoTS ?
Should be a straight forward procedure, assure hydrated and awareness into transition of positions
What is PoTS ?
People with PoTS experience an abnormal increase in heart rate when they transition from lying down to standing up.
What is Eisenmenger Physiology
Happens to people that have a congenital defect and have a left to right shunt (oxygenated to deoxygenated blood), then due pulmonary hypertension this reversed to a right to left shunt, which is an issue
Why should some cardiac patient be done in hospital ?
those with arrhythmia, long QT and impaired ventricular function, should be done in hospital as a vasovagal poses significant risk of an cardiac event
What precautions should be taken for someone that is anti coagulated and requires a coil ?
an experienced clinician should do the procedure and time the procedure away from when medications is taken and endure haemostat agents are available
Precautions with inherited bleeding disorders ?
check with their haematologist
In which rare genetic disorder is a copper coil contraindicated ?
Wilson’s disease
Is presence of or history of ovarian cysts a contraindication to a LNG-IUC ?
No
Is the increased incidence of ovarian cysts with LNG-IUD of clinical significance ?
No
In which time frame after coil fit is the risk of infection the highest ?
In the first three weeks, however overall risk is less than 1%
Actinomycoes like organism on cervical cytology, what are you going to do ?
Nothing, its likely a colonisation rather then infection. If an infection is suspected raise with radiology, microbiology and gynae, might require some high dose penicillin for 2-6 weeks, initially IV. IF penicillin allergic, then we are looking at cef, doxy or erythromycin.
When does expulsion tend to be most common ?
Within the first year of use, especially the first 3 months.
In who are expulsion rates higher ?
Those that have had a device fitted after late first or second trimester abortion, adolescents, HMB, distorted cavity , menstrual cup used and previous expulsion
After how many expulsions should an USS be requested ?
2
How longs should you wait after confirmed or suspected perforation before re fitting ?
6 weeks
Percentage of non visible threads post standard fit ?
18 %
Percentage of non visible threads post 48 hour vaginal delivery fit ?
30%
Percentage of non visible threads post at section fit ?
50%
Is there evidence that the IUC causes a loss of libido or weight gain ?
No
How many mcg of LEVONORGESTREL does 52mg device realise daily at the beginning and end of licence ?
20 - 8.6-9 at 6 years
What UKMEC is known uterine cavity distortion ?
3
Which analgesia, has an evidence base for reducing insertion related pain ?
para/intracervical block
10% lidocaine spray
2.5% lidocaine prilocaine cream
If woman is found to be pregnant with a coil, up to what gestation with visible threads should attempts be made to remove the device ?
less than 12 weeks, IUC removal is associated with more favourable pregnancy outcomes.
What is the overall risk of infection after IUC insertion ?
less than 1%, highest in the first 3 weeks post insertion
What are the indication for removal of a malpositioned device ?
more than 2cm from fundus
within cervical canal
pain or bleeding
How many micrograms of Levonogetrel is released by a 52mg device in the first year and at the 5th year ?
20mcg to 8.6-9mcg
How many micrograms of Levonogetrel is released by a 19.5mg device in the first year and at the 5th year
17.5mcg to 7.4mcg
How many micrograms of Levonogetrel is released by a 13.5mg device in the first year and at the 3rd year
14mcg to 5mcg
Copper coil mode of action ?
mainly pre fertilisation:
-Toxic to ovum and sperm
-inhibits passed of sperm into the upper reproductive tract, due to copper in the cervical mucus
-inflammatory response within the endometrium which impairs implantation
Hormonal coil mode of action
Again pre fertilisation:
-progestogenic effects on the cervical mucus prevent passage of sperm
-in around 1 in 4 inhibitions of ovulation
-effects of the endometrium may inhibit implantation
-foreign body effect may also contribute
Why should an IUC not be fitted after GTD? and when can it be fitted post GTD?
Theoretical increased risk of perforation and dissemination of the tumour. A device be fitted when HCG levels are normal
UKMEC for decreasing HCG in GTD ?
UKMEC 3
UKMEC for current and past breast cancer with an LNG-IUC
UKMEC 4 & 3
What should you do if Group A Strep is detected ahead of a planned coil fit ?
delay the coil fit and assure urgent treatment for GAS, penicillin (erythromycin or clindaymicyin if allergic)
IUC fit in the immunosuppressed, what do we need to do ?
Discuss with patient lead clinician the decision will be individualised depending on their degree of immune suppression, underlying health condition and concurrent antibiotic use
What is the risk of vasovagal with coil insertion
2%
What is the mechanism of vasovagal with manipulation of the cervix ?
Stimulation of the vagus nerve which results in hypotension and bradycardia, in some tachycardia and arrhythmia.
Belsey WHO bleeding patterns ?
Amenorrhea - no bleeding in a 90 reference period
Infrequent bleeding - one or 2 episode of spotting or bleeding in the same 90 day reference period
Frequent bleeding - more than 5 bleeding/spotting episodes within the reference periods
Irregular bleeding - three - five bleeding/spotting episodes fewer than 3 bleed free intervals of 14 days
Prolonged bleeding - bleeding/spotting lasting more than 14 days
By the end of licensed duration of use, studies report amenorrhoea Jaydess, Kyleena and Mirena at that percentages ?
11-12%
23%
42%
Anovulation rates for Mirena in years 1,2 and 3
23.5%, 15% and 2%
Anovulation rates for Kyleena in years 1,2 and 3
11.5%, 5% and 0%
Anovulation rates for Jaydees in years 1,2 and 3
2.9%, 3.8% and 0%
