The smart way to learn. The smart way to teach.


Course PAID
Do you realy want to delete this discussion?
Forum >>

cu -t

cu -t Posted by Sunitha P.
A 20-year-old woman with two previous vaginal deliveries. Wants Cut-How to counsel.

The intra uterine device a coil is used as a long-standing reversible method of contraception by 4% of the people. There are three generations in it. The hormones containing fourth generation are also available. It acts mainly by preventing fertilization and implantation. The women are given detailed verbal information and within documentation. An empathetic approach is needed to counsel her. She is asked about her cycle regularity whether associated with dots and diminishes. Any history suggestive of pelvic infection is also rated. Any new partner in the previous six months on more than one in the previous six months or more than one in the previous year along with the fidelity of the partner is known If any positive history she is screened for genital infections. Any other contraindications like prosthetic heart values, bacterial endocarditis, undiag nosed vaginal bleeding, cervical cancer, choriocarcinoma or gestational trophoblastic disease is noted. She is explained that fibroids not distorting cavity, previous pelvic infections, expulsion, on cervical intra epithelial neoplasia is not a risk.

The coil is inserted between second to seventh day of the cycle, No anesthesia required for her. The best type of coil will be CuT380. This has a failure rate of 1.5-2/100 women years. It is licensed for use for five years. The expulsion is 8/100 women years. If she has other problems like hemorrhagic, dysmenorrheal, premenstrual symptoms the levonorgestial IUCD is a better option due to its non-contraceptive benefits. The risk of failure is similar to female sterilization. She is advised regarding the follow up the initial visit being 1 week later and next being 6 weeks later. The importance of annual Pap smear?s is emphasized. She is also informed about the complications like perforation during insertion, expulsion most common in the first cycle, pelvic infection which is six fold higher soon after insertion and they?re after consultant of 1.4/1000 women years. For mild infection can be treated without removal of the coil, if no improvement after 72 hours requires, removal. There is a rare possibility of pregnancy the risk of being ectopic more common. Removal of the thread if seen is vagnial will decease 50% of the spontaneous miscarriage.

There may be increased bleeding with dysmenorrheal in her next few cycles which can be medically managed. If the coil is unacceptable to her for more than six months it can he removed and alternative methods used. The return to fertility after removing is within 1 or 2 months in 90% of women. Oral she wishes to have permanent method sterilization can be done at a later date.