A.

Definition Implant
Contraception threaded under the skin of the upper arm side in the form of capsules silastik (flexible)
length is slightly shorter than the matchstick and in each bar contains the hormone levonorgestrel that can
prevent pregnancy (BKKBN, 2006).
Contraceptive implants are shaped rod containing progestin. After the midwife numbing the skin by using
an anesthetic, then a tool such as a needle (trocar) used to place the implant under the skin on the upper
arm. Implant does not require sutures on the skin. Slowly, the implant releases progestin into the
bloodstream. The implant is effective for 3 years.
B. Implant type
The types of implants according to Saifuddin (2006) is as follows:
a. Norplant consists of six rods silastik soft hollow with 3.4 cm long with a diameter of 2.4 mm, which is
filled with 36 mg of levonorgestrel and his 5-year old.
b. Implanon consists of one white flexible rod with a length of approximately 40 mm, and a diameter of 2
mm, which is filled with 68 mg ketodesogestrel and his 3 year old.
c. Jadena and Indoplant consists of two rods containing 75 mg of levonorgestrel at work 3 years old.
C. Working Mechanism
How it works implants every implant capsule containing 36 mg of levonorgestrel released every day as
much as 80 mg. The concept is its mechanism of action according Manuaba
1) Can blocking LH spending so that ovulation does not occur.
2) thicken cervical mucus and hinder the migration of spermatozoa.
3) Diluting the endometrium so not ready to be a nidasi.
D. Effectiveness Implant
According Hartanto, (2002) the effectiveness of the implant are:
a. Norplant a failure rate of approximately 1 per 100 women per year in the first five years. This is lower
than oral contraceptives, IUDs and barrier methods.
b. Effectiveness Norplant is reduced slightly after 5 years and in the year to 6 approximately 2.5-3%
acceptors become pregnant.
c. -2 Norplant as effective as Norplant also be effective for five years, but it turns out after 3 years use
pregnancy occurs in a large number of unforeseen, ie 5-6%. The cause is unclear, unexpected decline in
the release of hormones.
E. Indications

Implant according to Saifuddin (2006) can be done at:

a. Women who have had children or who have not.
b. Women of reproductive age (20-30 years).
c. Women who want contraception that have a high effectiveness and require long-term pregnancy
prevention.
d. Nursing women and in need of contraception.
e. Postpartum women.
f. Women after a miscarriage.
g. Women who do not want more children, refuse sterilization.
h. Women who should not use hormonal contraceptives containing estrogen.
i. Women who often forget pills.
F. Contraindications
According to Saifuddin (2006) explains that the implant is contraindicated as follows:
a. Women who are pregnant or suspected pregnancy.
b. Women with bleeding pervaginaan penyababnya unclear.
c. Women who can not accept change in menstrual patterns that occur.
d. Women with breast cancer and uterine myoma.
e. Women with lumps / breast cancer or a history of breast cancer.
F. Contraindications
According to Saifuddin (2006) explains that the implant is contraindicated as follows:
a. Women who are pregnant or suspected pregnancy.
b. Women with bleeding pervaginaan penyababnya unclear.
c. Women who can not accept change in menstrual patterns that occur.
d. Women with breast cancer and uterine myoma.
e. Women with lumps / breast cancer or a history of breast cancer.
G. Advantages
Advantages of the implant according to Saifuddin (2006) are:

a. Advantages of contraception, namely:

a) The performance high.
b) Long-term protection (up to 5 years).
c) Return of fertility levels quickly after revocation.
d) Does not require examination.
e) Free from the influence of estrogen.
f) Do not interfere with intercourse activities.
g) Do not interfere with breastfeeding.
h) The client only needs to go back to the clinic if there are complaints.
i) It can be revoked at any time according to need.
b. Non-contraceptive advantages, namely:
a) Reduce menstrual pain.
b) Reduce the amount of menstrual blood
c) Reduce / improve anemia.
d) Protect the occurrence of endometrial cancer.
e) Reduce the incidence of breast abnormalities child.
f) Protect yourself from some of the causes of inflammatory diseases pangul.
g) Reduce the incidence of endometriosis.
H. Losses implant
Hartanto, (2002) suggested that the loss of implants are:
a. Insertion and expenditure must be carried out by trained personnel.
b. Medical officers require training and practice for the insertion and removal of the implant.
c. More expensive costs.
d. Often resulting changes in menstrual patterns.
e. Acceptor can not stop at will implant itself.
f. Some women may be reluctant to use it because it is less known him.

g. Implant can sometimes be visible to others.

I. How to install
According Manuaba implant placement technique is as follows:
a. Engineering installation place with proper (if composed of 6 capsules of fruit like an open fan).
b. The installation site on the upper left arm, dipatirasa with likokain 2%.
c. A small incision is made, so that the trocar can enter.
d. Trocar is inserted subcutaneously to the limit.
e. The capsule is inserted into the trocar, and is driven by a driving tool until there is any resistance.
f. To put the capsule, trocar is pulled out.
g. To ensure that the capsule had been in place, the driving tool is inserted until it feels no prisoners.
h. After 6 capsules fitted, the former incision is closed with tensoplas (band aid). This technique applies to
all types of implant.
i. Side effects / complications and how Abatement
Saifuddin J. (2006) explains that the side effects / complications and ways to overcome them are as
follows:
a. Amenorrhoea
i. Make sure pregnant or not pregnant, if not pregnant do not require special handling, special counseling
alone.
ii. If the client still does not accept, lift the implant and angjurkan using other contraceptives.
iii. In the event of pregnancy and the client wants to continue her pregnancy, remove the implant and
explain, that the progestin is not harmful to the fetus. When suspected ectopic pregnancy, referred clients.
There is no point giving hormone drugs to provoke the onset of bleeding.
b. Bleeding, spotting (spotting) light
i. Explain that light bleeding is common, especially in the first year.
ii. If there is no problem and the client is not pregnant, no action was necessary.
iii. If the client still complain of bleeding problems and want to continue the use of implants can be given
the combination pill cycle, or ibuprofen 3 x 800 mg for 5 days. Explain to the client that will be bleeding
after the combination pill exhausted.

iv. If there is bleeding more than usual, give 2 tablets pill combination for 3-7 days and then followed by
one cycle of the combination pill, or it can also be given 50 mg or 1.25 mg estrogen estinilestradiol equin
conjugate for 14-21 days.
c. Ekspulasi
i. Pull the capsule expulsion, check whether another capsule is still in place, and whether there are signs
of local infection insertion.
ii. If there is no infection and other capsules were still in place, install a new capsule 1 piece at a different
insertion site.
iii. If there is infection around the capsule existing unplug and plug the new capsule on the other arm, or
encourage clients to use another contraceptive method.
d. Infection in the insertion area
i. If there is no pus infection, wash with soap and water or antiseptic. Give appropriate antibiotic for 7
days.
ii. Implants should not be removed and clients were asked to return one week.
iii. If not improved, unplug and plug the new implant. On the other side of the arm or find another method
of contraception.
iv. If found abscess, clean with antiseptic, and stream incision pus out, remove the implants do wound
care and oral antibiotics given 7 days.
e. Weight up / down
i. Inform the client that changes in body weight 1-2 kg is normal. Review the client if there is a change
diet weight 2 kg or more.
ii. If the weight change is unacceptable, help clients look for other methods.