DEVELOPMENTDEVELOPMENT ININ

INTRAUTERINEINTRAUTERINE

DEVICESDEVICES

( ( IUDIUD ) )

Presented BY :Presented BY :

AHMAD NOOR, PHARM.DAHMAD NOOR, PHARM.D

AHMED ALTAYAR, PHARM.DAHMED ALTAYAR, PHARM.D

Lecture outlines : Lecture outlines :

What is the IUD ?how does it work ?What is the IUD ?how does it work ? The types of IUD’s The types of IUD’s Advantages & disadvantages Advantages & disadvantages History & development of IUD’sHistory & development of IUD’s The most IUD’s used today The most IUD’s used today Insertion of the IUD’sInsertion of the IUD’s

Introduction Introduction

At the beginning as you know it is a happiness for every At the beginning as you know it is a happiness for every parent’s to have a baby , but in the same time it is very parent’s to have a baby , but in the same time it is very important to put in mind all other factors that may important to put in mind all other factors that may effect the family life either : health , economical or even effect the family life either : health , economical or even social problems ,which increase in cases of a large and social problems ,which increase in cases of a large and uncontrolled number of family members , from this uncontrolled number of family members , from this point of view the need for a way to control the number point of view the need for a way to control the number of of birth was established , to improve the population life- was established , to improve the population life-style style

Our responsibility as pharmacists appear in Our responsibility as pharmacists appear in development and searching for different techniques to development and searching for different techniques to control pregnancy ,and we will talk today about one of control pregnancy ,and we will talk today about one of this ways and its development this ways and its development

What is an ( IUD ) ?

It is a small, flexible, plastic device that contains either metal e.g. copper or hormones e.g. progesterone and is inserted into the uterus to prevent pregnancy.

How dose it work ?

It may : -Block sperm from reaching or fertilizing

the egg -Make the lining of the uterus unsuitable

for implantation . -interfere with the ovulation process We do not know which of these actions is

most important for preventing pregnancy and most likely all of them work together.

Types of ( IUD ) :There are two main categories of

IUD’s: 1. Medicated:  These forms of IUD use

hormones or metals to prevent conception. progesterone and Copper plated IUDs are considered medicated because they have abilities to hinder fertilization.

2. Non Medicated:  This category includes all other forms of IUD no matter shape or size.

Advantages and the Disadvantages of ( IUD )

Advantages: - Once inserted , remain in place . - Remains effective while in place. - it prevents pregnancy for long period - does not interfere with sexual activity.

Disadvantages : - May cause bleeding and cramping . - Increased risk of octopic pregnancy. - Doesn't prevent sexual transmitted

diseases. - it is not recommended for women who - it is not recommended for women who

have heavy or long period have heavy or long period

What is the history of (IUD)?

-Camel riders in the Middle East are the first recorded users of the IUD or Intrauterine Device.  It was common knowledge that if you placed small stones in the uterus of your camel, it would not become pregnant even during its periods of high sexual activity.

Hippocrates, the original Greek doctor, also wrote : small piece that could be put into the uterus of a woman with the help of a small tube can prevent pregnancy .

In 1909 a German physician named Richard Richter began to build IUDs from small bronze rings and silk thread.  Richter, as well as many other doctors versions of the IUD was too large for widespread use and caused painful infections.

In 1930, Ernest Grafenberg improved Richter's idea  making the contraptions smaller, avoiding most infections and making the device more comfortable.

By the early 1960’s many other forms/designs of IUD were invented and were constructed of safer materials.

-Since 1998 worldwide, several new intrauterine devices (IUDs) are under development or in the early marketing phase .

These new devices contain various modifications designed to improve patient continuation and physician satisfaction. Modifications include those designed to facilitate easier insertion and removal, decrease the rates of accidental expulsion, and reduce complaints of pain or bleeding

a. Lippes-Loopb. Saf-T-Coilc. Dana-Super    Dana cuprumd. Copper-Te. Copper-7 f. Multiloadg. Progesterone IUD

What are the most cu ( IUD ) used today?

Today two types of cu IUD are used mostly Multiload (left) and cupper T (right) :

What is the hormonal (IUD) used today?

Late last year the FDA approved the intrauterine device (IUD) Mirena. Mirena is a T-shaped that releases small amounts of the hormone (levonorgestrel) to block conception, Mirena only needs to be replaced once every five years. The others, in contrast, must be changed yearly.

A new IUD available in Europe & US uses a synthetic hormone to achieve a high rate of long-acting contraception.

WHAT ARE THE NEW DEVELOPMENT IN

( IUD ) ? Developers are designing devices to

address the disadvantages issue by modifying IUD size, shape, and flexibility.

At least six new devices are under development, or have recently been introduced, outside the US.

These devices include:

Cu Cu safe safe 300300

Fincoid35Fincoid350 0

Soft-TSoft-TMultiload Multiload mark 2mark 2

GynefiGynefixx

ICFICFDD

CuSafe 300CuSafe 300The CuSafe 300 is a T-shaped copper IUD with The CuSafe 300 is a T-shaped copper IUD with flexible, uniquely shaped arms. flexible, uniquely shaped arms.

Both ends of the device's transverse arms curve Both ends of the device's transverse arms curve inward to reduce uterine tissue irritation. In inward to reduce uterine tissue irritation. In addition, its mono filament tail is welded into the addition, its mono filament tail is welded into the shaft, instead of knotted, to reduce ectocervical shaft, instead of knotted, to reduce ectocervical abrasion abrasion

device's flexible design facilitate easier ,less device's flexible design facilitate easier ,less painful insertion and removal, aslo the curved painful insertion and removal, aslo the curved "fundal-seeking" arms resist expulsion."fundal-seeking" arms resist expulsion.

carries a recommended life span of 5 years.carries a recommended life span of 5 years. Advantages in comparison to copper T 380A IUD:Advantages in comparison to copper T 380A IUD: the inserter is about one third smaller than that the inserter is about one third smaller than that

of the copper T 380A IUD. of the copper T 380A IUD. These improvements should make the CuSafe These improvements should make the CuSafe

300 easy to insert and remove.300 easy to insert and remove. pain and bleeding occurred significantly less pain and bleeding occurred significantly less

frequently among CuSafe IUD users, also the frequently among CuSafe IUD users, also the CuSafe had low and statistically significant CuSafe had low and statistically significant decrease rates of pregnancy and expulsiondecrease rates of pregnancy and expulsion

Fincoid-350Fincoid-350

The Fincoid-350, devised in Finland, is The Fincoid-350, devised in Finland, is also designed to resist accidental also designed to resist accidental expulsion. expulsion.

The IUD has a plastic skeleton The IUD has a plastic skeleton comprised of two parts: curved comprised of two parts: curved horizontal arms, and a copper coated horizontal arms, and a copper coated vertical stem. The resultant movable vertical stem. The resultant movable joint easily constricts and expands with joint easily constricts and expands with uterine contractions, adjusting to uterine contractions, adjusting to variations in uterine size and shape. The variations in uterine size and shape. The Fincoid-350 comes in two sizes: Fincoid-350 comes in two sizes: standard and short.standard and short.

Sof-TSof-T

The Sof-T, manufactured and approved for use The Sof-T, manufactured and approved for use only in Switzerland, is a copper IUD with a unique only in Switzerland, is a copper IUD with a unique shape to enhance effectiveness. The device has shape to enhance effectiveness. The device has soft, flexible knobs, or occlusion bodies, on each soft, flexible knobs, or occlusion bodies, on each end of its flexible transverse arms. These knobs end of its flexible transverse arms. These knobs theoretically block the entrances into the fallopian theoretically block the entrances into the fallopian tubes.tubes.

Two dimensional ultrasound must be used for Two dimensional ultrasound must be used for insertion , however, to ensure exact placement of insertion , however, to ensure exact placement of the device. The device's potential ability to the device. The device's potential ability to occlude the fallopian tubes could, in theory, occlude the fallopian tubes could, in theory, reduce the incidence of tubal infection and ectopic reduce the incidence of tubal infection and ectopic pregnancy.On the other hand, the knobs may pregnancy.On the other hand, the knobs may incompletely block the fallopian tubes and result incompletely block the fallopian tubes and result in higher rates of ectopic pregnancy.in higher rates of ectopic pregnancy.

About 1,200 women currently wear the device. About 1,200 women currently wear the device. Limited data indicate that the annual expulsion Limited data indicate that the annual expulsion rate ranges between 0.3% and 3.5%, removals for rate ranges between 0.3% and 3.5%, removals for pain or bleeding range from 0% to 1.4%pain or bleeding range from 0% to 1.4%

Multiload Mark IIMultiload Mark II

The Multiload Mark II is an updated version of the The Multiload Mark II is an updated version of the original Multiload 375 (ML 375). original Multiload 375 (ML 375).

The original device has a record of dependability, with The original device has a record of dependability, with low patient cessation rates due to pregnancy, expulsion low patient cessation rates due to pregnancy, expulsion or bleeding and pain. The ML 375 has been associated or bleeding and pain. The ML 375 has been associated with problematic insertions, however, because its arms with problematic insertions, however, because its arms do not fit into the inserter; the arms are open during do not fit into the inserter; the arms are open during insertion, making placement more difficult.insertion, making placement more difficult.the new inserter's diameter is smaller than the original the new inserter's diameter is smaller than the original model. model.

In addition, the inserter has three other improvements: In addition, the inserter has three other improvements: its design prevents the IUD from getting pushed beyond its design prevents the IUD from getting pushed beyond the inserter; it can function as a uterine sound; and it the inserter; it can function as a uterine sound; and it has a one handed expulsion action.has a one handed expulsion action.

These innovations may help limit the risk of uterine These innovations may help limit the risk of uterine perforation.perforation.

GyneFix®GyneFix®

The GyneFix, a "frameless" IUD, The GyneFix, a "frameless" IUD, consists of six 5 mm copper sleeves. consists of six 5 mm copper sleeves. This device was originally called the This device was originally called the Cu-Fix 390, then later the FlexiGard Cu-Fix 390, then later the FlexiGard 330®.330®.

The device has undergone 10 years of The device has undergone 10 years of testing and several modifications to its testing and several modifications to its inserter and anchoring mechanisms. inserter and anchoring mechanisms. The upper and lower copper sleeves The upper and lower copper sleeves are crimped onto the suture thread to are crimped onto the suture thread to prevent slippage. prevent slippage.

The proximal end of the suture The proximal end of the suture contains a knot that is pierced 1 cm contains a knot that is pierced 1 cm into the fundal myometrium to anchor into the fundal myometrium to anchor the device into the uterine muscle.the device into the uterine muscle.

Variations of the device for postpartum Variations of the device for postpartum use include a larger knot and a cone use include a larger knot and a cone shaped biodegradable tip that help shaped biodegradable tip that help anchor it securelyanchor it securely..

Due to its frameless design, flexibility, and Due to its frameless design, flexibility, and minimal presence in the uterine cavity, the minimal presence in the uterine cavity, the GyneFix is associated with few expulsions. GyneFix is associated with few expulsions. In addition, the device has a high In addition, the device has a high continuation rate at 1 year (90%) due to continuation rate at 1 year (90%) due to few removals for complaints of bleeding or few removals for complaints of bleeding or pain.pain.

Effectiveness depends upon proper Effectiveness depends upon proper insertion technique because the device insertion technique because the device must be securely anchored into the uterine must be securely anchored into the uterine myometrium or it will be expelled.In myometrium or it will be expelled.In addition, the device has very low expulsion addition, the device has very low expulsion rates among nulliparous women.rates among nulliparous women.

Intracervical Fixing Device (ICFD)Intracervical Fixing Device (ICFD)

The intracervical fixing device differs substantially in The intracervical fixing device differs substantially in both construction and placement from other IUDs.both construction and placement from other IUDs.

The device consists of a rod shaped, copper coated The device consists of a rod shaped, copper coated polyethylene frame that is about 4 cm long with a 5 polyethylene frame that is about 4 cm long with a 5 mm projection at the distal end. Through this mm projection at the distal end. Through this projection, the ICFD is anchored (fixed) to the inner projection, the ICFD is anchored (fixed) to the inner cervical wall using a modified tenaculum. cervical wall using a modified tenaculum.

Investigators believe the ICFD's anchoring mechanism Investigators believe the ICFD's anchoring mechanism could be improved.could be improved.

Better anchoring mechanisms could help to prevent Better anchoring mechanisms could help to prevent expulsions. One potential advantage of the device is expulsions. One potential advantage of the device is that the insertion procedure is not blind. In addition, that the insertion procedure is not blind. In addition, because of the intracervical location, the device will because of the intracervical location, the device will likely be associated with less spotting, bleeding and likely be associated with less spotting, bleeding and pain.pain.

ConclusionConclusion

Developers are designing new IUDs with Developers are designing new IUDs with modifications to help enhance patient modifications to help enhance patient and physician acceptance. and physician acceptance.

Modifications to the devices aim to Modifications to the devices aim to decrease removals due to pain and decrease removals due to pain and bleeding, make insertion and removal bleeding, make insertion and removal easier, and limit the risk of expulsion and easier, and limit the risk of expulsion and prolong the life span of the device . prolong the life span of the device .

HOW TO INSERT ( IUD )?HOW TO INSERT ( IUD )?

THANKS FOR YOUR ATTENTION!!THANKS FOR YOUR ATTENTION!!

Presented by :Presented by :

AHMAD NOOR, PHARM.DAHMAD NOOR, PHARM.D

AHMED ALTAYAR, PHARM.DAHMED ALTAYAR, PHARM.D