IUD PASCA PLASENTA

Baksono Winardi P2KT surabaya

PENDAHULUAN AKDR sudah lama dipergunakan secara luas dan cukup populer di seluruh dunia. dunia. Keunggulan AKDR adalah efektifitasnya yang tinggi dengan jangka waktu relatip lama. Kelemahannya adalah memerlukan tenaga terlatih untuk memasangnya. memasangnya. Masalah besar saat ini : unmet need

IUDs Around the World100 million users worldwide

Source: Treiman et al 1995.

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Macam IUD Copper-releasing: $ Copper T 380A $ Nova T7 $ Mul iload 375 Proges in-releasing: $ Proges aser 7 $ LevoNova7 (LNG-20) $ Mirena7

Copper IUDs: mekanisme kerja

Mengganggu kemampuan sperma un uk melewa i kavum u eri Mengen alkan lendir serviks

Mempengaruhi proses reproduksi sebelum sel elur mencapai kavum u eri Merubah lapisan endome rium

IUDs: Keun ungan kon rasepsi! ! ! ! ! ! Sanga efek if (0.6B0.81 kehamilan per 100 wani a selama ahun per ama pemakaian un uk Copper T 380A) Segera Efek if Penggunaan jangka panjang (perlindungan hingga 10 ahun dengan Copper T 380A) Tidak mengganggu hubungan sexual Segera kembalinya kesuburan se elah dilepas Tidak mempengaruhi proses menyusui

IUDs: Keun ungan Kon rasepsi lanjutan! ! ! ! Efek samping minimal Klien kembali kon rol hanya jika ada keluhan Dapa dikerjakan oleh enaga erla ih Tidak mahal (Copper T 380A)

IUDs: Keun ungan Nonkon rasep if! ! ! Mengurangi nyeri haid (proges in-releasing only) Mengurangi perdarahan haid (proges in-releasing only) Mnegurangi resiko kehamilan ek opik (excep Proges aser

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IUDs: Ba asan! ! ! ! Pemeriksaan pelvik diperlukan dan skrining Penyaki Menular Seksual direkomendasikan sebelum pemasangan Memerlukan enaga erla ih un uk insRequire rained provider for pemasangan dan Pelepasan Perlu un uk memeriksa benang IUD jika erdapa nyeri, kram saa periode haid. Tidak dapa berhen i menggunakan IUD sendiri ( ergan ung enaga erla ih yang memasang)

IUDs: Ba asan lanjutan! ! ! ! ! Meningka kan perdarahan haid dan nyeri selama beberapa bulan per ama (hanya copper-releasing) Dapa keluar spon an Jarang erjadi perforasi u erus (< 1/1000 kasus) saa pemasangan Tidak mencegah kehamilan ek opik ( eru ama Proges aser ) Dapa meningka kan resiko penyaki radang panggul dan subinfer ili as pada wani a dengan resiko penyaki menular seksual (e.g., HBV, HIV/AIDS)

Siapa yang dapa menggunakanIUDs ani a dengan usia reproduksi a au pari as berapapun, yang:$ Menginginkan kon rasepsi yang sanga efek if dan $ $ $ $ $ $ $

jangka panjang menyusui Pasca melahirkan dan idak menyusui Pasca keguguran Resiko rendah PMS Tidak dapa menginga minum pil se iap hari Memilih un uk idak menggunakan a au idak bisa menggunakan me ode hormonal Memerlukan kon rasepsi darura

IUDs: yang idak boleh menggunakan ( HO Class 4) IUDs idak digunakan pada wani a yang: $ hamil (dike ahui pas i a au dicurigai) $ Mengalami perdarahan yang idak dapa dijelaskan hingga di emukan dan $ $ $ $ $ $ $dioba i sebabnya. Menderi a penyaki radang panggul Mengalami kepu ihan purulen aku Memiliki kavum u erus yang idak normal Menderi a penyaki rofoblas ganas Menderi a TB pelvik Menderi a kanker rak us geni alis Menderi a infeksi rak us geni al (e.g., vagini is, cervici is)

IUDs: kondisi yang memerlukan perha ian ( HO Class 3) IUDs are no recommended unless o her me hods are no available or accep able if a woman has: $ Benign rophoblas disease $ More han one sexual par ner $ A par ner who has more han one sexual par ner

Source:

HO 1996.

IUDs:

ho May Require Addi ional Counseling

omen who experience he following problems: $ Cervical s enosis $ Anemia (hemoglobin < 9 g/dl or hema ocri < 27) $ Painful mens rual periods $ Simple vaginal infec ion (candidiasis or bac erial vaginosis)wi hou cervici is $ Symp oma ic valvular hear disease

When o Inser an IUD! ! ! Any ime during he mens rual cycle when you can be reasonably sure he clien is no pregnan Days 1 o 7 of he mens rual cycle Pos par um (immedia ely following delivery, during he firs 48 hours pos par um or af er 4 o 6 weeks; af er 6 mon hs if using LAM) Pos abor ion (immedia ely or wi hin he firs 7 days) provided no evidence of pelvic infec ion

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Pemasangan iud Dapat dilakukan interval Post partum Post abortus. Pasca plasenta

IUDs: Infec ion Preven ion Recommenda ions Pre-inser ion: $ Wash hands before examining clien . $ Wash geni al area if hygiene poor. Inser ion: $ Pu new or high-level disinfec ed gloves on bo h hands. $ Load IUD in s erile package. $ Clean cervical os (and vagina) horoughly wo imes wi h an isep ic. $ Use no ouch inser ion echnique.

IUDs: Infec ion Preven ion Recommenda ions continued Pos inser ion: $ Decon amina e all dir y i ems. $ Safely dispose of con amina ed was e i ems. $ Wash hands af er removing gloves.

IUD Inser ion: Wi hdrawal Me hod

(2) Wi hdraw inser er ube

(1) Hold plunger

Source: PATH and Popula ion Council 1989.

IUDs: Common Side Effec s Copper-releasing: $ Heavier mens rual bleeding $ Irregular or heavy vaginal bleeding $ In ermens rual cramps $ Increased mens rual cramping or pain $ Vaginal discharge Proges in-releasing: $ Amenorrhea or very ligh mens rual bleeding/spo ing

IUDs: Possible O her Problems! ! ! ! ! ! ! Missing s rings Sligh increased risk of pelvic infec ion (up o 20 days af er inser ion) Perfora ion of he u erus (rare) Spon aneous expulsion Ec opic pregnancy Spon aneous abor ion Par ner complains abou feeling s rings

IUDs: Immedia e Pos placen al Inser ionSpecial raining for providers Prena al counseling for clien s No addi ional risk of infec ion, bleeding or perfora ion Convenien for clien Cos effec ive

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Immedia e Pos placen al IUD: Spon aneous Expulsion Ra es1 1 1 Ra e per 1 omen 8 Inexperienced Prac i ioners Experienced Prac i ioners

1

1 Mon hs

18 er Inser ion

Source: Theiry, Van Ke s and Van der Pas 1985.

IUDs: Clien Ins ruc ions! ! ! ! ! The IUD is effec ive immedia ely. The IUD can come ou of he u erus spon aneously, especially during he firs few mon hs. Bleeding or spo ing may occur during firs few days. Mens rual bleeding may change depending on ype of IUD. The IUD may be removed any ime you wish. However, i is safe and effec ive for (x number of years) when using he ( ype of IUD). IUDs do no provide pro ec ion agains STDs, (e.g., HBV, HIV/AIDS.)

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The IUD: A Contraceptive Option The IUD is a safe and effective contraceptive option for postpartum women who wish to either space or limit subsequent births; Immediate postpartum IUD insertion has a higher retention rate if the IUD is inserted within 10 minutes after expulsion of the placenta, but the IUD can be inserted safely at any time during the first 48 hours after delivery; IUDs can be inserted after the fourth week postpartum; IUDs can be inserted after most abortions; and IUDs provide effective, reversible contraception for up to 12 years.

KEUNTUNGAN Motivasi tinggi. tinggi. Pasti tidak hamil Tidak ada hambatan kecemasan pasien Popularitas yang tinggi di China, Mesir, Mesir, Mexico mendukung cara ini. ini.

Warning Signs for IUD Users $ $ Con ac heal hcare provider or clinic if you develop any of he following problems: Delayed mens rual period wi h pregnancy symp oms (nausea, breas enderness, e c.) Persis en or crampy lower abdominal pain, especially if accompanied by no feeling well, fever or chills (symp oms sugges possible pelvic infec ion) S rings missing or he plas ic ip of IUD can be fel when checking for s rings Ei her you or your par ner begin having sexual rela ions wi h more han one par ner; IUDs do no pro ec women from STDs (e.g., HBV, HIV/AIDS)

$ $

IUDs: Managemen of Vaginal Bleeding Problems! Reassure clien ha menses generally are heavier wi h an IUD and bleeding/spo ing may occur be ween periods, especially in firs few mon hs. Evalua e for o her cause(s) and rea if necessary. If no o her cause(s) found, rea wi h nons eroidal an iinflamma ory agen (NSAID, such as ibuprofen) for 5B7 days. Counsel on op ions and consider IUD removal if clien reques s.

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IUDs: Managemen of Cramping and Pain! Reassure clien ha cramping and mens rual pain (dysmenorrhea) may occur wi h an IUD, especially in firs few mon hs. Evalua e for o her cause(s) and rea if necessary. If no o her cause(s) found, consider rea ing wi h ace aminophen or ibuprofen daily wi h onse of menses. Counsel on op ions and consider IUD removal if clien reques s.

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Managemen of Par ner Complain s Abou Feeling IUD S ring! ! ! Discuss clien /couple's concerns, reassure i is no a serious problem and requires rea men only if really bo hersome. Check o be sure IUD is no par ially expelled. If IUD is in place, rea men op ions are: $ cu s ring, or $ remove IUD if clien desires.

Managemen of Par ner Complain s Abou Feeling IUD S ring continued When cu ing he s ring: $ Cu s ring so i does no pro rude from cervical os. $ Explain ha IUD s ring now is loca ed a opening of cervical os,and she will no be able o feel i . $ No e in record ha s ring has been cu flush wi h he cervix (impor an for followup and fu ure removal).

AKDR (IUD) Post-plasenta

Insersi AKDR(IUD) dilakukan dalam 10 menit setelah plasenta lahir. AKDR dimasukkan dengan tangan KEUNTUNGAN : Pasien langsung ber KB Risiko kecil

Metode Teknik pemasangan AKDR dengan tangan kanan yang menjepit AKDR pada telunjuk dan jari tengah; masukkan kedalam uterus mencapai fundus Sementara itu fundus uteri ditahan dengan tangan kiri. Lepaskan AKDR di fundus.

Cara insersi postplasenta : tangan kiri menekan fundus dan tangan kanan yang menjepit AKDR menelusuri serviks mencapai fundus. Kemudian tangan melepaskan AKDR tersebut.