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MFSRH Part 2 2024 > IUC Guideline > Flashcards

IUC Guideline Flashcards

1
Q

How many mcg/day initial release rate for each coil?

A

52mg is 20mcg day

19.5mg is 17.5mcg day

13.5mg is 14mcg day

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2
Q

Which one coil is licensed for 8 years contraception?

A

Mirena-not the other 52mg

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3
Q

When do nice recommend lng iud for hmb?

A

No underlying pathology
Adenomyosis
Fibroids if not distorting cavity and <3cm

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4
Q

What is main mode of action of Cu IUD?

A

Pre implantation toxic effect ovum and sperm

(Also cervical mucus and endometrium effects)

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5
Q

What is main mode action lng iud?

A

Cervical mucus

(Also endometrium and ovulation in some)

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6
Q

What effect do LNG iud have on HPO axis?

A

Little effect.
Serum estradiol normal.
Most still ovulate (>75% with 52mg-almost all with lower doses)

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7
Q

What is ukmec for any iud <20 yo

A

2- increased rate expulsion/painful insertion

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8
Q

What should you consider in Tran-men with insertion IUD

A

Effect on bleeding/cramps
Testosterone
1.teratogenic so LARC good
2. atrophy-consider vaginal e2 2/52 prior to insertion

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9
Q

What are contraindications to insertion iud at delivery?

A

PROM
PPH
sepsis

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10
Q

Who has highest risk perf?

A

BF
<36 weeks postnatal

Both individually increase the risk

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11
Q

What are rules re insertion post EMA?

A

If expulsion not confirmed (ie at home) must confirm no ongoing pregnancy first by
1. Low Sensitivity PT >2 weeks after miso
2.scan at any time

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12
Q

Iuc in GTD-when might you consider insertion before hcg normalised?

A

Cu IUD EC (ukmec 3 if falling hcg)

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13
Q

When is BMI relevant to IUD insertion?

A

Ukmec 2 if> 30 and additional CV RF

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14
Q

What ukmec is insertion IUD with cavity distortion?

A

3
If do use US or hyst guidance

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15
Q

IUD at time ablation what’s the issue?

A

Not an issue really at insertion
Removal may be tricky may need to be done at hyst if initial attempt fails

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16
Q

What’s the issue with IUD at interval after ablation?

A

Individualise.
USS by specialist immediately prior and insertion specialist
US-homogenous triple stripe endometrium normal cavity no harmatometra suggest patent cavity.

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17
Q

What to consider post lletz if IUD removed?

A

Any need for EC?
Bridge
If not immed replaced delay till cx healed approx 4-6 weeks

18
Q

In what circumstance would you consider prophylactic abx for gc/ct prior to coil fit?

A

If emergency EC IUD cannot be delayed and:
Asymptomatic contact of known GC/C4
Symptoms of gc/C4 but tests not back

19
Q

What ukmec are
Asymptomatic chlamydia and GC prior to fit?

A

GC is Ukmec 4-unacceptable risk
C4 is ukmec 3 if asymptomatic could treat on day of insertion…but UKMEC 4 if symptomatic.

20
Q

Apart from GC/C4 what is the only other incidental infection you should treat if detected prior to insertion?

A

Group A strep-TSS

Treat bv/tv/thrush but no need to delay insertion

Mgen not included in this ukmec but ideally treat first as can cause PID

21
Q

What do you advise re steroid and IUD insertion in adrenal insufficiency?

A

D/W their dr but….
General rule:
Double dose glucocorticoid 1hr prior
Procedure in am
Double dose next 24hrs

Mineralocorticoid no adjustment
If inhaled steroids >800mcg or oral >10mg may need to increase dose to cover stress also 24 hours pre and post

22
Q

What is risk of Vasovagal at iud insertion?

A

2%

23
Q

Which coils might contain silver?

A

Cu IUD (may also contain nickel, gold)
Jayden’s and kyleena have silver ring

24
Q

If someone is on warfarin can I do their coil?

A

If suitable then as long as target INR is <3.5 and stable no need to omit dose crack on

25
Q

What about DOAC/antiplatelets/LMWH can I insert coil?

A

Yes don’t omit doses
Try to time with lowest drug levels

26
Q

What do haemophilia guidelines say about coil for HMB?

A

Go for it

27
Q

What to tell people about breast cancer risk and lng iud

A

Small but statistically significant increased risk breast cancer for current or recent lng-iud pre menopausal women

Similar to other HC

Risk BC very small under 50 so absolute risk very low

28
Q

What are criteria to reasonably exclude pregnancy for coil insertion?

A

D1-5 or <d21 post partum or <5 days abortion/mc/gtd

No sex since LMP/pregnancy

Sex >21 days ago negative PT

Consistent contraception use

LAM

29
Q

When switching to CU and LNG IUD who needs cover 7 days?

A

Cu-no one

LNG-unless d1/5 (6,7 SPC) or method using in date and has cervical mucus effect that IUD can just maintain….7 days cover needed

Note: If removing either coil no sex 7 days before
1. May not be able to replace
2. For lng if switch to cu need 7 days to become effective post insertion (could be viable sperm from week with cu iud, could ovulate)

30
Q

CHC to LNG what are rules re cover after insertion in
1. Week 2-3+
2. Week 1 or after d1 HFI

A
  1. No cover needed (ovulation will be inhibited until lng kicks in)
  2. If no sex insert and use condoms/abstain, run cocp 7 days
    If sex then run cocp 7 days

Similar rules DRSP POP (d8-24 are the no cover days)

31
Q

What drugs must you have available?

A

Adrenaline 1:10,000 pre-filled 10ml (1mg) this is the IV/IO arrest dose

Atropine 500/600mcg iv/im 2 doses

O2

32
Q

Are all coils MRI safe?

A

Current Uk ones yes

But if inserted abroad careful as eg stainless steel not safe and must be removed prior

33
Q

What should you consider new pelvic pain post coil?

A

?perf (check threads)
? Ectopic (do PT)

34
Q

What to do if IUC and pregnant?

A

Scan to confirm ectopic or not

<12 Remove if easy to remove regardless plans, advise if left in greater risk of eg septic abortion/ptl/mc

If not easy to remove/>12 judgement

??risk virillisation lng…little known

35
Q

What is risk of infection post insertion?

A

<1% highest in first 3/52

36
Q

Is actinomyces an important pelvic infection?

A

Very rare. Commensal associated with long term IUC. If becomes pathogenic….
Pain
D/C
IMB
Fever
Need high dose long term abx
Send coil for culture (ensure other STI eliminated)

37
Q

What should you confirm in removing malpositioned IUC?

A

Any sex last 7 days? If possible defer….

If not consider EC/Pt at 21 days

38
Q

If ? Expulsion what imaging?

A

USS
Abdo/pelvis x ray or CT

39
Q

If inserting coil for gynae reasons and prev expulsion what could you consider?

A

Insert after d1-8
+-Suppress menses
(Eg inserted for HmB)

40
Q

How long should you wait after perforation before reinsertion?

A

6 weeks-suggest in service with USS

41
Q

What is prevalence of non visible threads?

A

18% standard (1.4-18)
30% post nvd
50% post cs

42
Q

Who should you report broken arm/lost sheath to?

A

MHRA

MFSRH Part 2 2024 (43 decks)

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