Karnataka PGET Gynecology MCQ Answer 1

IUCD’S

Coils prevent implantation of the fertilised ovum in the uterine cavity.

Advantages:

• Immediately effective.
• No interference with spontaneity of sex.
• No opportunity for poor compliance.
• Gynae 380T can be left in situ for 10yrs; Multiload 375 for 8yrs.
  

Disadvantages:

• Pain at time of fit and at menstruation
• Inc. menses
• Inc. relative risk of ectopic pregnancy
• Inc. risk of infection on insertion (? first month only)
  

Complications:

• Expulsion 10% usually within 3months of fitting
• Risk of embedding/migration/perforation
• Risk of pregnancy
• (Cu allergy)
  

Fitting:

Should be fitted between day 1 and day 19 of cycle.

IUCD best fitted at either: -

• End of a period, or
• D14 when ovulating; (time when least cervical spasm, os most patent and cervix softest). (Patient will inevitably experience post-fitting spotting.)
  

Do not fit after day 19 (or > 5 days earliest predicted date of ovulation.)

Current IUCD’s

• Gyne 380T
• NovaT 380
• Multiload 375.

These coils with higher surface area of copper have <1% s =" 0.3-0.5%).">

b) IUS. Mirena

Levonogestrel released by Mirena makes it quite unlike a coil.

1. There is much less risk of PID because of the profound cervical mucous effect.
2. This effect means there is virtually no fertilisation, therefore , a very low ectopic rate.
   

Advantages:

• Suitable for patients with h/o previous ectopic pregnancy.
• Reduces loss - the continuous output of low levels of progesterone mean that many women cease to menstruate after several months.
• Perimenopausal women/reduce need for hysterectomy (see above)
• HRT- when IUS in situ, women need only use oestrogen alone as they have a source of progesterone.
  

Disadvantages:

• Increased diameter and rigid structure makes fitting more difficult.
• Costly (~£100/5yrs).

c) IUI. GyneFix

This is a frameless intrauterine implant .The GyneFix is implanted into the myometrium it consists of 6 small Cu tubes on a propylene thread held in the fundus by a knot. It is inserted with a stilette. It has a licence to be left in place for 5yrs currently.

Advantages:

• Less painful periods
• Lighter periods
• Can be more easily fitted in nullips because of size.
• Lower expulsion rate (0.5%)
• Low removal rate for S/E (5.7%)
• High efficacy (failure rate 0.5%)
  

Disadvantages:

• Potentially painful fitting
• Licensed for only (5yrs at present).
  

IUDs has gone through tremendous changes on the course of evolution from the small round stones for camels to the modern Progestasert

• First Generation - INERT

• Lippes loop

• Second Generation - METAL

• Earlier devices

• Copper T
• Copper T 200
• Newer devices
• Variants of the T Devices
• T Cu - 220 C
• T Cu - 380 A or Ag
• Nova T
• Multiload Device
• ML - Cu - 250
• ML - Cu - 375

• Third Generation - HORMONE

• Progestasert

Category: Karnataka PGET 2007 MCQs