IUCD

IUCD
Intra-uterine contraceptive device
By Dr Purva Shoor
Asst. Prof. Community
Medicine
Introduction
Devices, when placed inside the
body of the uterus, prevent
pregnancy and therefore regulate
fertility
It is one of the most effective method
of contraception other than OCPs
LARC
IUCDs are Long acting Reversible
contraception
First generation-old, inert or non-
medicated(1960s) concept derived from
primitive practice in Egypt
Second generation- Copper containing
Third generation- Hormonal devices

First generation
Made of polyethylene polymers
Come in several shapes-spiral, loops,
coils, rings and bows
Lippes loop most commonly used
double S-shaped device, contains
barium sulphate for X-ray
observation
Tail made up of nylon
Lippes loop
Available in sizes A, B, C, D
D being the largest
C and D for multiparous uterus

Larger the size, lesser the chance of
expulsion and higher anti-fertility
effect but greater removal due to
pain and bleeding.
First Generation
Second Generation
Earlier generation- Copper-7, Copper
T 200
Newer Devices
T shaped: copper T 220 C, Copper T
380A
Nova T
Multiload: ML-Cu-250, ML-Cu-375
Advantages
Copper toxic to sperm, prevents motility
and capacitation, greater efficacy with the
silver core-larger life-preventing Copper
from corroding or
fragmenting(electrochemical protection)
Multiload devices can be inserted for 5
years and more, maximum 10 years with
Cu T 380 A
Copper T advantages
Smaller sizes, well suited even for
nulliparous women
Lower expulsion rates, bleeding and
pain
Effective post coital contraceptive if
inserted within 3-5 days
Copper T
Third Generation;
Hormonal
Progestasert filled with 38mg of
progesterone, releasing 65 mcg daily
to make cervical mucous thick,
preventing implantation and
restricting sperm viability.
Disadvantage: Not long term, needs
frequent replacement
Levenorgestrel-20; Mirena
It releases 20mcg of levenorgestrel daily
Long term contraceptive up to 7 years
Less chance of ectopic pregnancy
Can be inserted for endometrial hyperplasia,

endometriosis and endometrial cancer(anti-
estrogen, lesser proliferative uterus)
Causes lesser chance of menorrhagia
Minimum pregnancy rate with pearl index 0.2/hwy

Third generation: Mirena
How to insert
Measure uterine size using obstetric fingers
Adjust the size of the device using plunger
With speculum and tentaculum, retract the upper

lip of cervix
Insert the device with bended arms limiting
adjusted size
Pull through the adjustment, while arms take form
of T, allowing thread felt through cervix into the
vagina
Advantages
Simplicity of procedure and maintenance
No metabolic side-effects associated with

OCPs
Long term
Reversible
No need for many follow-ups or motivation
Inexpensive- one time expenditure

Contraindications
Absolute: Pregnancy suspected (not post
coital), Pelvic inflammatory disease, vaginal
bleeding of unknown etiology, cancer of
cervix, adnexa, uterus or pelvic tumours,
previous ectopic pregnancy
Relative: anemia, unmotivated person,
purulent vaginal discharge, menorrhagia, PID
history since previous pregnancy, anomaly of
uterus(congenital) example bicornuate uterus
Ideal IUCD Candidate
Has borne one child at least
No history of PID
Willing to check the thread and keep

track
Has normal menstrual periods
Has access to health facility
Is in a monogamous relationship
Why not nulliparous?
Uterus is small
Greater chances of complications like

heavy bleeding, infection and lower
abdominal pain
Timing of insertion
Within 10 days before starting menstruation or
during menstruation
Caution if within first week post partum as uterine
perforation or expulsion rate is greater
Ideal time post puerperal insertion
After abortion not recommended because of

infection
But is recommended method of emergency(post
coital) contraception
Ideally..
Uterus should be of normal size and
less contraction of uterine musculature
so that expulsion does not occurs
Larger diameter of the uterus in
secretory phase of menstrual cycle so
that the device is easily placed.
Indications for removal
Pain
Fever
Bleeding
Pregnancy
Not willing to check tail/thread
Complications
Pain
Bleeding during menses- heavily or
longer duration, or intermittent
Pelvic infection-more during first few
months of exposure, needs antibiotic
coverage, follow-up and removal if
infection is not controlled
Causative organisms- actinomyces,
gardenella, coliform bacilli, anaerobic
streptococcus, bacteroides (ascending
infection)
Complications
Uterine perforation, immediately
postpartum or within 6 weeks
Pregnancy, average 3-5/HWY
Ectopic pregnancy
Expulsion-less with copper T
Mortality due to bleeding or sepsis or
ectopic pregnancy
Thank you !!
Assessment..

IUCD

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IUCD

Intra-uterine contraceptive device

Third generation- Hormonal devices

D being the largest

C and D for multiparous uterus

Long term contraceptive up to 7 years

Less chance of ectopic pregnancy

Can be inserted for endometrial hyperplasia,

Minimum pregnancy rate with pearl index 0.2/hwy

Adjust the size of the device using plunger

With speculum and tentaculum, retract the upper

No metabolic side-effects associated with

No need for many follow-ups or motivation

Inexpensive- one time expenditure

Has borne one child at least

Willing to check the thread and keep

Has access to health facility

Greater chances of complications like

After abortion not recommended because of

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