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Key Features

General Considerations

  • Contraception should be available to all women and men of reproductive ages

  • Education about and access to contraception are especially important for sexually active teenagers and for women following childbirth or abortion

  • Intrauterine devices (IUDs) are not abortifacients

Intrauterine devices

  • Available IUDs include Skyla, Liletta, and Mirena (which release levonorgestrel) and TCu380A (which is copper-bearing)

  • Duration of effectiveness

    • Skyla and Liletta: 3 years

    • Mirena: 5 years

    • TCu380A: 10 years

  • The hormone-containing IUDs have the advantage of reducing cramping and menstrual flow

  • Nulliparity is not a contraindication to IUD use

  • Adolescents are candidates for IUD use

  • The hormone-containing IUDs may have a protective effect against upper tract infection similar to that of oral contraceptives

  • Contraindications to use of IUDs are outlined in Table 18–5

  • A copper-containing IUD can be inserted within 5 days following a single episode of unprotected mid-cycle coitus as a postcoital contraceptive

  • Evidence is mounting that suggests IUDs can be safely inserted in the immediate postabortal and postpartum periods

  • An IUD should not be inserted into a pregnant uterus

  • If pregnancy occurs as an IUD failure, there is a greater chance of spontaneous abortion if the IUD is left in situ (50%) than if it is removed (25%)

  • Spontaneous abortion with an IUD in place is associated with a high risk of severe sepsis, and death can occur rapidly

  • Women using an IUD who become pregnant should have the IUD removed if the string is visible

  • An IUD can be removed at the time of abortion if this is desired

  • If the string is not visible and the patient wants to continue the pregnancy, she should be informed of the serious risk of sepsis and, occasionally, death with such pregnancies

  • Such women should be informed that any symptoms of fever, myalgia, headache, or nausea warrant immediate medical attention for possible septic abortion

  • Since the ratio of ectopic to intrauterine pregnancies is increased among IUD users, clinicians should search for adnexal masses in early pregnancy and should always check the products of conception for placental tissue following abortion

Table 18–5.Contraindications to IUD use.
Diaphragm

  • The diaphragm (with contraceptive jelly) is safe and effective; the diaphragm stretches from behind the cervix to behind the pubic symphysis

  • Its features make it acceptable to some women and not others

  • Advantages

    • Has no systemic side effects

    • Gives significant protection against pelvic infection and cervical dysplasia as well as pregnancy

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