1.

DEFINITION

IUD are one of the modern contraceptives designed so that the shape, size,
ingredients and active period are then placed in the uterine cavity as a contraceptive
attempt that inhibits fertilization and makes it difficult for the egg to implant in the
uterus (Hidayati, 2009).
AKDR or IUD or Spiral is a small object made of pliable plastic, has copper
or coil as well contains hormones and is inserted into the uterus through the vagina
and have yarn (Handayani, 2010).
An IUD is an intrauterine device inserted into uterine wombs of various
forms, consisting of plastics (polythyline), some are wrapped in copper (Cu) some are
not, but some are wrapped with copper mixed with silver (Ag). other than that there is
also a trunk containing the hormone progesterone. (Kusmarjati, 2011).

2. DESCRIPTION
The types of IUD used in Indonesia are:
a. Copper-T

According to Imbarwati, (2009). T-shaped IUD, made of material

polyethelene where in the vertical section given wire winding fine copper. This fine
copper coil has anti effect fertility (anti-fertilization) is good enough. According to
ILUNI FKUI (2010). Copper T type spiral (removing copper) prevents pregnancy by
disturbing the movement of sperm to reach the uterine cavity and can be used for 10
years.
This IUD releases a low concentration of lenovorgegestrel for at least five
years. From the results of the study showed a high effectiveness in preventing
unplanned pregnancy and menstrual bleeding. The disadvantage of this method is the
addition of hormonal and amenorrhea side effects.

b. Copper-7

The IUD is in the form of a number 7 with a view to facilitating installation.

This type has a diameter of 32 mm vertical rods and added copper wire coil (Cu)
having a surface area of 200 mm, its function is the same as the fine copper
circumference of the Copper-T type.
c. Multi Load

The IUD is made of plastic (polyethelene) with two left and right wing-shaped
hands that are flexible. Its length is from top to bottom 3.6 cm. The trunk is wound
with copper wire with a surface area of 250 mm or 375 mm for added effectiveness.
There are 3 sizes of multi-load, namely standard, small (small), and mini.

d. Lippes Loop

This IUD is made of polyethelene material, it looks like a spiral or S series.

To ease the control, threads are mounted on the tail. Lippes Loop consists of 4
different types according to the size of the upper part. Type A is 25 mm (blue thread),
type B 27,5 mm 9 (black thread), type C is 30 mm (yellow thread), and 30 mm (thick,
white thread) for type D. Lippes Loop has failure number The low one.
 The principle of installation is to place the IUD as high as possible in the
uterine cavity (cavum uteri). When the best installation is at the time the mouth of the
peranakan is still open and the uterus is soft. For example, 40 days after delivery and
at the end of your period.

According to Prawirohardjo (2008), IUDs can be installed in the following

circumstances:

a. When the menstruation is in progress

Because the advantages of mounting easier because the cervix at the time rather
open and soft. Pain is not how hard, bleeding that arises as a result of the
installation is not felt how much, the possibility of IUD installation on the
pregnant uterus does not exist.
b. During post partum
Installation of IUD after delivery can be done:
1) It is prematurely installed in women who dilute before being discharged
from the hospital.
2) Directly IUD is installed within 3 months after the childbirth or abortion.
3) Indirectly the IUD is installed after three months after the childbirth or
abortion.
c. During abortion
several days after the last menstruation.

Indications of Intrauterine Device (IUD)

a. Age of reproductive
b. The state of nullipara
c. Want long-term contraception
d. Women breastfeeding
e. After delivery and not breastfeeding
f. Post abortion and not infection
g. Low risk of STIs
 h. Does not require a hormonal method
i. Do not like to remember to take a pill every day
j. Does not require after 1 - 5 days of intercourse (emergency contraception)
k. Smoker
l. Fat or thin
m. Benign tumor / breast cancer, high TD, headache / dizziness, varicose veins in
the legs / vulva, heart disease, stroke, DM, hepatitis, epilepsy, malaria, tBC non
pelvik, thyroid disease, post-pregnancy ectopic, post pellex surgery.

Contra Indications of Intrauterine Device (IUD)

a. Pregnant / Get pregnant

b. Vaginal bleeding is not known why
c. Moderate genitalia (vaginitis, cervicitis)
d. Three months ago being / often suffering from PRP or septic abortion
e. Abnormal uterine congenital abnormalities or benign uterine tumors that can
affect the uterine cavity
f. Malignant trophoblast disease
g. Have pelvic tuberculosis
h. Genital cancer
i. The size of the uterine cavity is less than 5 cm.

3. FUNCTION
Prevent the occurrence of pregnancy as a result of meeting a mature egg with
sperm cells. In using contraception, couples in general have the planning and goals to
be achieved. These goals include to delay or prevent pregnancy, exclude pregnancy,
and stop or terminate pregnancy or fertility.
4. STRENGTH
a. The American College of Obstetricians and Gynecologists, New Orleans.
David said, IUD can reduce the risk of endometrial cancer by 40 percent.
Protection against cancer is equivalent to using oral contraceptives.
b. Very effective. 0.6 - 0.8 pregnancies / 100 women in the first 1 year (1 failure
in 125 - 170 pregnancies). A long-term preventive of pregnancy, at least 10
years
c. IUDs can be effective immediately after installation
d. Long-term method (10 years of protection from CuT-380A and does not need
to be replaced)
e. Does not affect sexual intercourse. Intimate relationships become more
comfortable because of the security of the risks of pregnancy
f. No hormonal side effects with CuT-380A
g. Does not affect the quality and volume of breast milk. Safe for nursing
mothers - does not interfere with the quality and quantity of breast milk
h. Can be installed immediately after delivery or abortion (if no infection occurs)
i. Can be used until menopause
j. No interactions with medications
k. Helps prevent ectopic pregnancy
l. After the IUD is removed, it can be fertile

5. WEAKNESS
IUDs:
1. Have menstrual delays accompanied by signs of pregnancy: nausea, dizziness,
vomiting.
2. There is more bleeding (more severe) than regular menstruation.
3. There are signs of infection, such as leucorrhoea, increased body temperature,
chills, and so forth. In short if the mother feels unwell.
4. Pain, for example, in the time of intercourse. Immediately go medicine if you
find the symptoms above.
Side Effects and Complications

1. Common side effects `menstrual cycle changes, menstruation longer and

more, bleeding between mensturasi, when menstruation is more sick
2. Other complications: pain and seizures for 3 to 5 days after insertion, heavy
bleeding during menstruation or among others that may cause anemia,
perforation of the uterine wall (very rarely if the installation is correct)
3. Does not prevent STIs including HIV / AIDS
4. Not good for women with STIs or who frequently switch partners
5. Pelvic inflammatory disease occurs after women with STIs use an IUD, PRP
can trigger infertility
6. Medical procedures, including pelvic examinations, are required in IUD
insertion
7. Less pain and bleeding (spotting) occur soon after IUD insertion. It usually
disappears within 1-2 days
8. Client can not remove IUD by himself. Trained attendants who can take off
9. IUD may be out of the uterus unnoticed (often occurs when IUD is installed
immediately after delivery)
10. Does not prevent the occurrence of ectopic pregnancy because IUD function
prevents normal pregnancy
11. Women should check the IUD yarn position from time to time.
12. Installation Time
6. PROCEDURE

IUD insertion step :

1. Open part of the plastic cover and fold it back.

2. Insert the IUD arm into the inserter tube.

3. Insert the IUD arm into the inserter tube – 2.

 4. Wear new gloves.
5. Attach the vaginal speculum to see the cervix.
6. Wipe the vagina and cervix with an antiseptic solution 2 to 3 times.
7. Cut the cervix with tenakulum at 11 a.m and 1 p.m.
8. Enter the uterine sonde with a "touching" technique (ie no touch technique)
that carefully inserts the sonde into the uterine cavity with a single entry
without touching the vaginal wall or the lips of the speculum.
9. Determine the position and depth of the uterine cavity and remove the sonde.
10. Adjust the blue neck position with the size of the uterine depth on the sonde.

11. Adjust the IUD size to the depth of the uterine cavity by holding the blue neck
on the inserter tube, then pushing the inserter tube according to the depth size
of the uterine cavity.
12. Lift the IUD tube out of its package without touching the non-sterile surface,
be careful not to push the thrusters.
13. Hold the IUD tube with the blue neck in a horizontal position (parallel to the
IUD arm). While pulling carefully on the tenaculum, insert the inserter tube
into the uterus until the blue neck touches the cervix or until it feels prisoner.
14. Hold and hold the tenaculum and thrusters with one hand.
Step of removing the IUD tube :

1. Withdrawal Technique: pull the tube to the base of the plunger while still
holding the plunger
2. Remove the plunger, then the inserter tube is pushed back into the cervix until
the blue neck touches the cervix or feels prisoner.
3. Remove part of the inserter tube.
4. IUD thread scissors are approximately 3-4cm.