And whether you know...
Intrauterine contraceptives (Naval Forces)
Intrauterine means are for the first time mentioned in 1909 when Richter managed to describe in detail the device executed in the form of a ring which those years was made from a gut of a usual silkworm. Though the first in the history of Naval Forces were known in antique times, you should not consider such devices at present. Now various forms intrauterine contraceptives, including "umbrella", "loop", a letter "T", devices in the form of a spiral or Naval Forces in the form of a ring are used.
For production of Naval Forces use now various innovation materials which plastic, silver and copper is among. Most often presently in domestic and world gynecology are used Sorreg-T adaptation 380A which contains copper. Intrauterine contraceptives the most actual in China where such devices are the main way of contraception now. Among the most often used forms of Naval Forces it should be noted a ring without threads, with one curl which is produced from corrosion-proof copper. Such form of a ring gradually forces out earlier popular ring of Makhua which is carried out with two symmetric curls.
Statistically, now 85 million women around the world use Naval Forces, from them more than 60 million are the share of China. Such method of protection from approach of undesirable pregnancy is on the second place now, and on the first place voluntary surgical sterilization still remains. In the XXI century the most actual are intrauterine means made of copper which received the collective name Sorreg-T 380A. It is necessary to refer such modern modifications as Multiload, Si-380-of Slimilin to such Naval Forces, Soar of r - T 200, Nova T, Lipps's loop and T of SI-380Ag, and also means with the content of progestin.
Contraceptive opportunities of Naval Forces, are generally based on special impact on a female ovum, they have effect on migration of spermatozoa, on implantations and processes of fertilization, and also directly on a uterus. But, unfortunately, the exact mechanism of action of intrauterine contraceptives is up to the end not studied and is not installed by scientists still. It is considered that such contraceptives affect a uterus and cause ability of its reduction, and also activity change. Perhaps, their use leads to development of inflammatory process of aseptic character, at the same time the enzymatic system of an endometria changes activity, and the peristaltics of uterine tubes accelerates. Therefore migration of spermatozoa from which there is a fertilization of a female ovum significantly changes, they quickly get to a cavity of the uterus, and then perish, without having achieved the goal.
Studying presumable properties and various mechanisms of influence of modern uterine contraceptives, it is possible to note their following possible influence:
- on spermatozoa, and also delay of their migration in pipe fallopiyeva from the woman's vagina;
- on an oospore, at the same time its subsequent transition to a uterus through pipe fallopiyeva accelerates;
- on a fertilization – considerable braking of process on fertilization of an ovum;
- on implantation – the subsequent death of blastocysts owing to reaction to presence at a uterus of a foreign body and to essential development of inflammatory processes;
- perhaps abortal influence of intrauterine contraceptives because of rejection already an oospore from an endometria;
- on an endometria owing to reduction of activity of a karboangidraza, and also an alkaline phosphatase. It is reached by the introduction in a chemical change of copper of which intrauterine means are made.
Important conditions at the choice of Naval Forces are not only their form and the size, level of progestins in spirals and contents of copper, and also age of the woman, the number of her previous pregnancies or childbirth. If it is correct to apply medicamentous Naval Forces, then the frequency of approach of undesirable pregnancy fluctuates at the level of 0,1-1,5%, and for typical use of non-drug intrauterine contraceptives this indicator rises to the level of 2-3%. Among women at advanced age, as a rule, Naval Forces are already less effective as indicators of efficiency are directly interconnected the woman with age. Statistical data show that the least effective are the intrauterine means executed in the form of a ring with the content of copper, and means of Naval Forces Soar of r - T 380A is characterized by the minimum frequency of approach of undesirable pregnancy.
Frequency of approach of pregnancy can be minimized when using the following means:
- The Naval Forces including in the structure copper, progestin or pregesteron;
- Naval Forces, for which the characteristic big superficial area;
- Naval Forces with an insignificant frequency of an ekspulsiya;
- the intrauterine means entered completely and which are located on an uterine fundus;
- means in which the full or partial ekspulsiya is found in time.
Not contraceptive properties of intrauterine means:
- Naval Forces with progestins are capable to reduce intensity of a dysmenorrhea and menstrual bleeding;
- Naval Forces quite often use for prevention and treatment of a syndrome of Asherman – the commissural process arising in a cavity of the uterus.
Types of intrauterine means
Lipps's Loop which is subdivided into four versions depending on the size belongs to neutral type of Naval Forces. They are on sale in drugstores or in sterile packagings, or in the inexpensive packages demanding the subsequent sterilization in special antiseptic solution with the maintenance of a benzalkonium. As a rule, Lipps's Loop is implemented into a uterine cavity by means of the entering core – the special medical tool.
Modern Naval Forces in the form of a ring from stainless steel with one curl are characterized by lack of threads. This intrauterine means is most often applied in the territory of the People's Republic of China, at the same time diameter of curls makes 18-24 millimeters. At first by means of a uterine probe it is necessary to determine length of an internal cavity of the uterus, and already then to decide on the necessary size of a ring.
The type of Naval Forces which is the most extended now is Coopper-T 380A which is let out in sterile packagings. It represents the copper wire wound on a vertical plastic core. Coopper-T 380A is entered into an internal cavity of the uterus by means of the special conductor, and such type of Naval Forces in case of the correct establishment and lack of negative effects can be not pulled out during the five-year period.
Means of Sorreg-T 200 is counted on contraception during the four-year period, it is issued in sterile packaging and is most often used in Mexico and China. This type of Naval Forces is entered into a uterus in the curtailed view with use of the special conductor.
Such kind of Naval Forces as Copper-7, is on sale in modern sterile packaging, and the conductor is already included in the package at sale. In this case the intrauterine contraceptive is entered into uterine space by the method "withdrawals" or "pushing out" in the middle of a uterus. At disclosure it after input it is quite often possible to hear characteristic click, and only after that the conductor is removed.
The kind of Naval Forces Multiloud-375 and 250 is on sale already inserted into the conductor, and the design is in sterile packaging. This intrauterine means is issued three sizes and it is entered by a retraction method.
The medicamentous type of Naval Forces of Progestasert-T with the content of progesterone is made in sterile packaging, hormone begins to be emitted progesterone gradually after input in an intrauterine cavity from the lower part of tiny intrauterine means with a constant speed. Such type of Naval Forces is easily entered into a uterus by way of withdrawal.
Nova-T is the kind of Naval Forces executed in the form of a letter "T". It is characterized by the content of levonorgestrel which after input is emitted from the lower part of this intrauterine means with a constant speed.
Contraindications of use of Naval Forces
Naval Forces cannot be applied in the following cases:
- if the risk of infection with various infections and their subsequent transfer sexually is too high;
- to women, the suffering diseases of inflammatory character of various bodies of a small pelvis, and also with a postabortive or puerperal endometritis;
- at a purulent acute cervicitis, at a hlamidiozny or gonorrheal infection;
- to pregnant women, and also persons at whom pregnancy existence can be suspected.
At the same time intrauterine means can be used as a post-coital contraceptive within five days which passed after the unprotected sexual intercourse. However VMV women for whom endometria cancer is diagnosed are forbidden to use, there are vaginal bleedings of pathological character, and also to persons at whom the uterus cancer is revealed.
The choice of Naval Forces has to be especially careful for women, suffering from a leukorrhea without cervicitis or a heavy vaginal infection in a recurrence stage, a purulent infectious cervicitis. Also intrauterine contraceptives are not recommended to the childless women subject to big risk to catch sexually transmitted infectious diseases. Other relative contraindication for use of Naval Forces – existence of AIDS or other diseases bringing immune system to an unstable state, and also a disease of anemia though the Naval Forces including progestins are capable to reduce menstrual blood loss considerably. Intrauterine means are not recommended to women with painful or plentiful periods, a uterus, small by the sizes, suffering from a stenosis of a neck of uterus and also to persons who already had one extrauterine pregnancy.
Before introduction of intrauterine contraceptives it is desirable to make gynecologic inspection which can reveal contraindications of use of Naval Forces such as a pathological structure of a uterus or existence biomes.
Principles of introduction of intrauterine means
If existence of pregnancy is excluded, then intrauterine means can be entered into any period of a menstrual cycle. In cases when pregnancy existence is suspected, it is recommended to wait for approach of the following menstrual cycle. Most often intrauterine means are entered into the woman's uterus for 3-8 days, at the very beginning of a menstrual cycle or on the expiration of a certain period after abortion. It is after the delivery recommended to wait several months, and only then to enter intrauterine contraceptives.
Naval Forces enter in the following situations in the absence of pregnancy:
- The first ten minutes after the happened childbirth as afterwards to enter Naval Forces already risky owing to reduction of a uterus and there is a great risk of an ekspulsiya
- In half a year after the delivery if new pregnancy is excluded, and the woman all this period or refused sexual intercourses, or at contacts the condom was used, or the woman used vulval spermitsida
- Right after the made abortion if it became earlier, than in 12 weeks after conception of a fruit if artificial legal, or the misbirth is not characterized by complications
- In any day of the menstrual period if existence of pregnancy is completely excluded, and the woman constantly used before any contraceptives
Introduction of Naval Forces and preventive antibioticotherapia
Now antibiotics with the preventive purpose are appointed in cases when the woman is exposed to big risk to catch infections which are transmitted sexually. If an antibioticotherapia is appointed, it is necessary to consider the following factors:
- The woman during this period should not have the infectious diseases having acuity and also not to have contraindications to use of antibiotics and introduction of Naval Forces
- Are recommended internal reception of doxycycline
- During breastfeeding the woman is recommended to accept erythromycin
As a rule, intrauterine means are entered at once after physiological childbirth if they passed without complications, and reductions of a uterus have normal character, at the same time the risk of approach of uterine bleeding has to be absent. After a placenta exit intrauterine means are consistently entered manually, their introduction is a convenient and safe method, at the same time the risk of infection does not arise. To prevent development of inflammatory complications, it is necessary to follow strictly rules of an asepsis to which obligatory use of long sterile gloves belongs.
Such technique of input of Naval Forces has a side effect it is the overestimated frequency of an ekspulsiya of intrauterine contraceptives. At the same time the probability of approach ekspulsiya frequency in the Naval Forces containing copper is significantly lower, than a similar indicator when using a loop of Lipps, owing to it further explanations concern only means Soar of r - T 380A.
The probability of emergence of an ekspulsiya decreases in the following cases:
- if intrauterine means are entered into a uterus within the first ten minutes after a placenta exit;
- it is necessary to exempt a cavity of the uterus from the clots which accumulated in it manually;
- intrauterine means have to howl are established manually in a cavity of the uterus;
- Naval Forces need to be arranged on an uterine fundus, it is high in her cavity;
- The experienced doctor has to enter Naval Forces;
- it is necessary to administer intravenously the drug causing reduction of a uterus.
If Soar of r - T 380A to enter threads directly after the delivery, it is recommended to leave them directly in a cavity of the uterus. If the woman in a month after introduction cannot independently palpate them, then position of Naval Forces of the name Soar of r - T 380A is defined by method of sounding of an intrauterine cavity. It is necessary to consider that within a month after last childbirth approach of new pregnancy is considered the improbable fact. If threads of Naval Forces during sounding can be palpated, the doctor without special work can quickly take them from an intrauterine cavity, and afterwards – from a neck of uterus. In all other cases it is already possible to leave intrauterine means which existence is confirmed with sounding in a cavity of the uterus without any fears.
Many women right after introduction of intrauterine means note nausea or considerable pains therefore it is recommended to come to medical clinic together with the spouse or the partner who after procedure can accompany the woman home.
After introduction of uterine means it is necessary to check the provision of their threads still before you were going to leave an office of the doctor. Learn to determine independently length of threads, at the same time they from an outside pharynx in a neck of uterus usually act on two centimeters. If at a palpation of already entered Naval Forces you can feel their plastic parts, or implementation of a palpation becomes impossible, the risk of approach of undesirable pregnancy considerably increases. Threads are recommended to be checked regularly within several months after input of Naval Forces in a uterine cavity, and at identification of disturbance of their situation it is recommended to use additional contraceptives to the following address to the doctor.
Do not forget about a possibility of development of various inflammatory processes, and also risk of infection. At pains in the bottom of a stomach, temperature increase, various allocations from a vagina immediately address the specialist. Remember that similar inflammatory diseases – a direct way to infertility or chronic pelvic pains.
Surely you monitor all changes of periods and disturbances in a menstrual cycle, timely address the gynecologist at the slightest concern because of disturbance of health. Pay attention to such symptoms as emergence from a vagina of plentiful mucous or bloody allocations, strengthening of pains during monthly, developing of menstrual bleedings. Remember that Naval Forces can be removed at any time, it is enough to see a doctor only. You should not forget that unpleasant symptoms when using of the given method of control of birth rate are shown, as a rule, in the first two-three months after introduction of intrauterine means, and then at many women they pass.
Do not try to remove Naval Forces independently as extraction of an intrauterine contraceptive, safe for you, is possible only the experienced doctor and only in sterile clinical conditions. Always you monitor manifestations of the following signs:
- the periods delay – this fact can demonstrate pregnancy approach;
- developing of bleedings or bloody allocations;
- emergence of pains in the lower part of a stomach, and also pain during sexual intercourse;
- existence of pathological allocations, infections and inflammatory processes;
- the febricula including such signs as a fever, fervescence, weakness;
- impossibility of a palpation of threads of Naval Forces, their lengthening or shortening.
Complications when using Naval Forces
Among all cases of extraction of Naval Forces in a proximate cause of this fact emergence of bloody allocations or developing of bleedings, especially on the first year of use of these means of prevention of undesirable pregnancy is 5-15%. For extraction of Naval Forces the general weakness, pallor of skin, allocation of blood clots during the period between two periods, steady and long bleedings can be symptoms. Anyway, at bleedings the intrauterine contraceptive is recommended to be removed even if its introduction is not an origin of this problem.
If there are problems of various character, adhere to the following recommendations:
- even before input of intrauterine contraception it is necessary to carry out sounding with the maximum care, it is important to pick up a probe of the necessary size correctly;
- when developing severe pain during input of Naval Forces in or the subsequent two-day period, and also during periods, this intrauterine means is recommended to be removed; if pains not really strong, then it is possible to remove them by means of aspirin;
- if there is a partial ekspulsiya of an intrauterine contraceptive, it needs to be removed, and then in case of lack of pregnancy if inflammatory processes are not observed, it is recommended to establish new Naval Forces;
- at inflammatory diseases at the woman of bodies of a small pelvis it is necessary to take Naval Forces, to carry out the corresponding treatment which duration not less than three months, and then to enter new contraceptive intrauterine means into a uterus;
- in case of developing of severe pains at once after introduction, at a loss of consciousness, a cardiac standstill, spasms, vazo-vagal reactions it is necessary to enter intramusculary atropine and any anesthetic to support a heart tone, in hard cases of Naval Forces it is necessary to remove surely;
- if existence of Naval Forces in a uterine cavity causes discomfort because of the big size, it can be taken and replaced with an intrauterine contraceptive of the smaller size quietly;
- at a misbirth it is necessary to diagnose at first pregnancy, then to remove Naval Forces, after that to evacuate a cavity of the uterus, having excluded an extrauterine pregnancy; if the extrauterine pregnancy is diagnosed, the woman needs to be directed to urgent operation;
- at the wrong disclosure of an intrauterine contraceptive it is necessary to remove Naval Forces, and then it is easy to enter new means.
Complications when using Naval Forces consist in a spontaneous ekspulsiya of intrauterine means which is observed approximately in 2-8% of cases. as a rule, it occurs in the first year of use. Its symptoms are: unusual allocations from a vagina, developing of pains in the lower part of a stomach, emergence of intermenstrual bleedings. After sexual intercourse at an ekspulsiya bloody allocations, dispareuniya signs can be observed, it is necessary to pay attention and to lengthening of threads, and also feeling of intrauterine means in a neck of uterus or in a uterine cavity. Remember that the ekspulsiya can not only cause discomfort in the woman, but also be a proximate cause of irritations of a penis of her partner.
If you do not observe direct symptoms of an ekspulsiya, pay attention to its possible indirect effects, including impossibility of a palpation of internal threads, pregnancy approach, a periods delay.
It is possible to allocate the following objective signs of an ekspulsiya:
- arrangement of Naval Forces in a vagina or in the cervical channel;
- in case of a partial ekspulsiya lengthening of threads of Naval Forces is observed;
- at a full ekspulsiya of a thread of Naval Forces are not visualized;
- during sounding, X-ray or ultrasonic analysis of a stomach and bodies of a basin of Naval Forces are not found.
If the partial ekspulsiya is diagnosed, then the intrauterine contraceptive needs to be taken then if inflammatory process is absent, and pregnancy did not come, then new Naval Forces can be entered at once after withdrawal old, or to wait for the next menstrual period. If the full ekspulsiya is observed and no contraindications are revealed, it is possible to enter other uterine contraceptive. The statistics shows that most less often there is an ekspulsiya of the intrauterine means containing progestins.
Quite often women complain of gradual shortening of threads, impossibility of a palpating, and also of the fact that increase in length of threads leads to irritation of a penis of the spouse or partner. These facts testify or to an ekspulsiya of Naval Forces, or to their transition to an abdominal cavity therefore inspection is necessary to define the provision of threads. The best technique – the ultrasonic research allowing to see location of threads with a big accuracy.
To redeem normal situation of the displaced threads of Naval Forces, the spiral is quite often applied. In rare instances the cervical channel is inspected by means of narrow nippers thanks to which the experienced doctor can establish location of threads of an intrauterine konratseptiv without effort. It is possible not only to grope such means, but also to remove quickly with various medical tools, including the hooks and nippers used at hysteroscopy.
In a case when threads of Naval Forces are in internal space of a uterus, this contraceptive is recommended to be removed, and then to enter new – this version or other type.
About 30% of cases of emergence of undesirable pregnancy during use of intrauterine contraceptives are directly connected with an ekspulsiya of Naval Forces, but pregnancy comes even in the presence of such means in a cavity of the uterus. If pregnancy nevertheless came, urgent extraction of an intrauterine contraceptive, by means of a pandiculation for threads, or method of careful traction is required.
The women aiming to keep pregnancy need to remember the following:
- in this case the risk of an abortion increases twice;
- the risk of development of an extrauterine pregnancy increases;
- in case of a spontaneous abortion the risk of the subsequent development of an infection considerably increases.
In case of introduction of Naval Forces the frequency of perforation of a uterus fluctuates at the level of 0,04-1,2%, and data the indicator is directly connected with a form and a kind of intrauterine konratseptiv, technology of their introduction, anatomic features of a uterine cavity, position of Naval Forces, and also competence of the doctor. At perforation of a uterus there are pains during introduction of intrauterine contraceptives, then obsolescence of threads, regular uterine bleeding is observed, and possible approach of pregnancy follows then.
Quite often diagnosis is significantly complicated as external signs of perforation of a uterus can be absent completely. Can point such objective reasons as lack of threads in the cervical channel to development of this fact, impossibility to remove this intrauterine konratseptiv even in case of its detection, identification displaced by Naval Forces during gisteroskopichesky, ultrasonic or x-ray inspection.
Often the ekspulsiya of Naval Forces is the reason of perforation of a neck of an undershirt. During gynecologic inspection the gynecologist finds konratseptiv in any of vaults of the vagina. If perforation of a neck of uterus develops, then Naval Forces at first need to be transferred to intrauterine space, and then to take this means narrow nippers from a neck of uterus. In a case when there is implantation of an intrauterine contraceptive in a neck of uterus, Naval Forces is removed by means of usual techniques. At an arrangement of this contraceptive out of a cavity of the uterus, its removal is made by a laparotomy or a laparoscopic method. The diagnosed pregnancy it is possible at desire to keep even if the exact location of Naval Forces was not established.
Complications when using Naval Forces include exacerbations of chronic diseases of a cavity of the uterus. Acute inflammatory processes at the giving birth women occur in 1,5-7% among the giving birth women, and among not giving birth this indicator makes about 10%. Existence of inflammatory processes in a usage time of Naval Forces quite often turns out to be consequence of various infections which are usually transmitted sexually, including gonorrhea and clamidiosis. The risk of infection at use of intrauterine contraceptives is much higher, than when using other methods of contraception. Anyway at diagnosis of various inflammatory diseases the intrauterine contraceptive needs to be taken immediately, then within two weeks to carry out treatment by suitable antibacterial drugs, and control inspection is necessary afterwards.
If Naval Forces is in a uterine cavity, treatment of inflammatory processes in the bodies located in a zone of a small pelvis is not recommended as at first it is necessary to take an intrauterine contraceptive. Otherwise the probability of development of abscesses, sepsis, peritonitis, and also obturation of uterine tubes is very high. Before introduction of a new intrauterine contraceptive after elimination of inflammatory process and its reason it is recommended to wait three months.
Technique of input of Naval Forces
The modern technique of input of Naval Forces is quite simple, it is carried out only in aseptic conditions of out-patient clinic. The doctor has to make previously careful gynecologic inspection precisely to exclude a possibility of pregnancy of the patient and to be convinced of lack of inflammatory processes, and also to reveal existence of perforation of a uterus. If the uterus is located retrogradno, its more exact research will be required.
The neck of uterus and vagina need to be processed antiseptic solution, including solution of iodine or chloride of a benzalkonium. Sensitive women will need intra cervical anesthesia, after that cervical nippers need to be imposed on a neck of uterus, on her upper lip, and then slowly to close them. Further the uterine probe when it reaches a bottom of a uterine cavity is carefully entered into a cavity of the uterus, on a neck of uterus the sterile cotton plug taken along with a probe is imposed.
The intrauterine contraceptive is entered into the conductor, and then the prepared design via the cervical channel is implemented into a uterine cavity. The gynecologist has to perform each operation very slowly, observing the maximum care. When intrauterine konratseptiv it is entered, it is necessary only to cut its threads, and the patient can recommend to execute a palpation of threads of Naval Forces at once to know the standard for an arrangement of this contraceptive. In this case afterwards it will be easier for woman to define an ekspulsiya if it arises.
Technique of extraction of Naval Forces
The term of extraction of Naval Forces depends on a version and type of an intrauterine contraceptive, but, as a rule, this means needs to be taken in three-four years. It is the simplest to take Naval Forces during approach of periods as in this case such procedure is made rather easily and most without serious consequences. It is necessary to delete Naval Forces with slowly continuous easy traction, at emergence of natural resistance it is necessary to make sounding of a uterine cavity, then it is correct to turn a probe on 90 ° to expand a neck of uterus.
In difficult cases special dilators and preliminary paracervical blockade will be required, quite often expansion is made also with use of a laminaria. It is possible to impose cervical nippers that it is reliable to record it on a neck of uterus, and the uterus could be leveled. Narrow nippers will help to reveal threads of Naval Forces at impossibility of their visualization, for research of an internal cavity of the uterus it is possible to use special hooks, nippers alligators or Novak's curette. If the patient used Naval Forces longer than the put term, it is necessary to consider a possibility of growing of an intrauterine contraceptive into a wall of the cavity, and also essential narrowing of the cervical channel. The modern technique of extraction of Naval Forces includes anesthesia. At first the gynecologist has to make paracervical anesthesia, entering the patient lidocaine solution. This operation needs to be performed only in a room for medical procedures where it will be at any time possible to give in a difficult case to the patient acute management if it is required. Paracervical anesthesia is used at extraction of intrauterine contraceptives at earlier not giving birth women now, and also at risk of vazo-vagal reactions.
Doctors are recommended to carry out the following stages of paracervical blockade thus:
- before procedure it is necessary to execute inspection of the patient by means of special mirrors, and then to inspect it in the bimanual way;
- the mucous membrane of a neck of uterus and vagina needs to be cleaned antiseptic solution;
- during procedure it is recommended to take an interest at the patient whether it has complaints to dizziness, nausea, tingling in the field of vulvar lips, a ring in ears;
- process a neck of uterus, impose nippers on an upper lip, having entered the patient directly into the bay lidocaine solution in necessary proportions;
- after input of local anesthetic it is necessary to enter a needle into connecting fabric under a mucous membrane;
- in five minutes after implementation of blockade it is possible to start directly removal of Naval Forces.