Which of the following has life span of upto 10 years?
Correct Answer: CuT 380A
Description: Ans. B. CuT 380A. (Ref. Obstetrics D.C. Dutta 6th Ed. - 483).The TCu380A IUD (ParaGard) is a T-shaped polyethylene rod, wrapped with copper around the arms and stem. It is approved for 10 years of continuous use.Good Candidates for TCu380A# Postpartum women, breastfeeding or not, after 4 weeks.# Women with liver disease, hepatitis.# Women with breast cancer.# Women with hypertension, hyperlipidemia.# Women with current or history of ischemic heart disease, stroke.# Women with multiple risk factors for cardiovascular disease. Women with uncomplicated valvular heart disease.# Women with current deep vein thrombosis/pulmonary embolism.# Women who have had major surgery.# Women with migraines with or without focal neurological symptoms.# Women with gall bladder disease or history of pregnancy-related cholestasis.The LNG-IUS (Mirena). is a T-shaped polydimethylsiloxane rod con- taining 52 mg LNG. The LNG-IUS is approved for 5 years of use. The LNG-IUS adds an important non-contra- ceptive advantage for this age group: it decreases menstrual blood loss and dysmenorrhea and may avoid the need for hysterectomy or endometrial ablation. The copper IUD is generally associated with heavier menses.In addition to decreasing menstrual blood loss, the local administration of LNG to the endometrium protects it from development of estrogen-induced endometrial hyperplasia. This is of benefit for transitional women with irregular bleeding and for women on tamoxifen therapy following breast cancer. Use of the LNG-IUS is reported to reduce the risk of endometrial cancer by 40-60%.GOOD CANDIDATES FOR LNG-IUS# Women with menorrhagia, dysmenorrhea, or endometriosis.# Women with bleeding disorders or on anticoagulation therapy.Women with thalassemia, sickle cell disease, or iron- deficiency anemia.# Breastfeeding women after 4-6 weeks postpartum.Generation of IUCDCoilFailure rateLasts for (years)FirstCuT (200)>2/1003-5 CuT (200)>2/100 SecondMultiload Cu 2501-2 /1003-5 NovaT1-2 /1001-2/100ThirdMultiload Cu 3750.5-111005+ Copper Cu 380A0.3-1/100 Hormone releasingProgestasert (no more manufactured)1lyr LNG-IUCD(52mg Levenorgestrel impregnated; releases at arte of 20?g/day)0.5/100 at 1 yr5 yrs 0.7/100 at 3 yr 1/100 at 5 yr Marina (Latest)Least5 yrsMore Educational points:# Cu T 380A and Levenorgestrel have got lowest rate, whereas progestasert has got highest rate of ectopic pregnancy.# The Mirena IUD works by killing or irreparably damaging sperm and obstructing it's ability to fertilize an egg. It does this by releasing levonorgestrel, also known as progestin.# Progestin is a synthetic substance which imitates the biological activity of the natural hormone progesterone.# Progesterone can inhibit ovulation during pregnancy. Progestin was synthesized for, among reasons, suppresing ovulation for birth control.- Mirena reduces the frequency of ovulation. Ovulation occurs during the menstrual cycle where the ovarian follicle releases an egg. Reduction of the times in which an egg is available to fertilize handicaps the sperm's opportunity for reproduction.- Mirena changes the consistency of cervical mucus. This change thickens the cervical mucus making the passage of sperm through the cervix much more difficult.- Mirena thins the endometrium, the lining of the walls of the uterus. It is thought that this reduces the chances of embryo implantation to the endometrium.LNG-IUCD:# A new device, levonova (LNG IUD) contains 60mg of levonorgestrel and releases the hormone in very low doses i.e. 20 microgram/ day (versus Progestasert which carries 38mg of progesterone and releases 65microgram of the hormone per day).# It is thus longacting (5 years) and has low pregnancy rate of 0-3 per 100 woman years, n However, risk of ectopic pregnancy is higher.# Mechanism of action: - Strong and uniform endometrial suppression - Scanty cervical mucus - Anovulation and insufficient luteal phase and normal progesterone levels, n It can be used as hormone replacing therapy.# It is useful for the treatment of endometrial hyperplasia, n Irregular uterine bleeding can be a problem initially.# MIRENA contains 52mg levonorgestrel, eluting 20 microgram daily. It can be retained for 5 years, with failure rate of 0 to 3 per 100 woman years.EMERGENCY CONTRACEPTION (Postcoital contraception)Mechanism of action1. Delaying /inhibiting ovulation2. Inhibiting fertilization3. Preventing implantation of fertilized eggIndications1. Unprotected intercourse2. Condom rupture3. Missed pills4. Sexual assault or rape5. First time intercourse.Methods1. Morning after pills (Conjugated estrogen and ethnyl estradiol)--use in 72 hr.2. Combined hormonal regimen (YUZPE method)Q3. POP (very successful)4. IUCD (should be inserted within5 days)5. RU486 (Mifepristone)-single dose 600 mg irrespective of day and number of intercourse.
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Gynaecology & Obstetrics
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