Papers CONTRACEPTION intrauterine device (IUD) Papers CONTRACEPTION intrauterine device (IUD)

Papers CONTRACEPTION intrauterine device (IUD) CHAPTER I INTRODUCTION A. Background Indonesia is a country which is seen from the number of inhabitants in the fourth position in the world, with a growth rate which is still relatively high. Essence of the task Family Planning (KB) in this case has been very clear that lowering fertility in order to reduce the burden of development to realize the happiness and prosperity for the people and nation of Indonesia. As mentioned in Law 10 of 1992 on Population Development and Family Welfare Development, the definition of family planning awareness raising efforts and community involvement through the maturing age of marriage, birth control, fostering family resilience and family welfare in order to realize a small family, happy and prosperous. Based on data from the Demographic and Health Survey 2002 - 2003, contraceptive prevalence rate (contraceptive prevalence rate / CPR) increased from 57.4% in 1997 to 60.3% in 2003. In 2015 the population of Indonesia is only reaching 255.5 million people. However, if there is a one percent decline, the population reached 264.4 million people or more. Whereas if family planning services could be improved with an increase of 1% CPR, the population of this country about 237.8 million people (Kusumaningrum, 2009). In the early 70s a woman in Indonesia on average have 5.6 children during her reproductive life. Results of Indonesia Demographic and Health Survey (IDHS) showed the TFR (Total Fertility Rate) in the period of 2002 of 2.6 means that the average potential of births by women of childbearing age children numbered 2-3. In 2007, the TFR rate unchanged at 2.6 children. Now this is in addition to young families who strictly limit the child, there are many who do not want to use family planning with their own reasons as many assume many children sustenance. This means that there are two opposing views, which will affect the offspring or the number of children each (Kusumaningrum, 2009). According to the 2002-2003 Demographic and Health Survey in 2003, is widely used contraceptive injection method (49.1 percent), the pill (23.3 percent), IUD / spiral (10.9 percent), implants (7.6 percent), MOW (6.5 per cent), condoms (1.6 percent), and MOP (0.7 percent) (Kusumaningrum, 2009). Contraceptives are very useful in planning programs but keep in mind that not all contraceptives match circumstances. To that end, each person should be able to choose a suitable contraceptive for him. Contraceptive services (PK) is one type of family planning services are available. The majority of family planning acceptors and pay their own choosing various methods of contraception available. Another factor that affects the choice of contraceptives among other pair of factors (age, lifestyle, desired family size, experience with methods of contraception ago), health factors (health status, menstrual history, family history, physical examination, pelvic examination), factor methods of contraception (effectiveness, side effects, cost), level of education, knowledge, family welfare, religion, and the support of the husband / wife. These factors will also affect the success of family planning programs. This is because any method of contraception chosen or have different effectiveness. Strategy to increase the use of long-term contraceptive method (LTM) such as IUDs, were less effective, which is evident by the number of participants that the IUD KB steadily declining from year to year. Based on BKKBN Central Java Province, the number of participants KB IUD continues to decline from the 2004 552 233 to 529 805 in 2005 and 498 366 in 2006. In the development of IUD use does tend to decrease from year to year (Imbarwati, 2009). Based on the above data, the IUD is one of the types of contraceptives are an alternative option for people who want family planning. Therefore, the authors are interested in writing a paper on contraceptive intrauterine device (IUD). B. Formulation of the problem Based on the above background, the formulation of the problem is: 1. What is the definition of Intrauterine Contraceptive Device? 2. What are the types of contraceptive IUD?

3. What are the advantages and disadvantages of IUD contraceptives? 4. What side effects and indications kontara KB IUD? 5. How do IUD insertion? C. Destination The purpose of the preparation of this paper, namely: 1. Knowing IUD contraception 2. Knowing how to work, advantages, disadvantages and contraindications IUD 3. Knowing how to work and use / IUD insertion. CHAPTER II LITERATURE REVIEW A. Contraception Contraception derived from the word counter means 'prevent' or 'against' and the conception of meaningful meeting between mature egg cells and sperm cells resulting in pregnancy. The purpose of contraception is to avoid or prevent the occurrence of pregnancy as a result of a meeting between a mature egg with sperm. Contraceptive services (PK) is one component in the service population / family planning. In addition to contraceptive services (PK) also contained service components of population / family planning such as communication and education (IEC), counseling, infertility services, sex education (sex education), pre-wedding consultation and wedding consultations, genetic counseling, testing and adoption of malignancy ( Kusumaningrum, 2009). No single method of contraception is safe and effective for all clients because each individual has the appropriateness and suitability for each client. But in general terms the ideal contraceptive method is as follows: a. Safe, meaning will not result in serious complications if used. b. Efficient, in the sense that when used according to the rules would be able to prevent pregnancy. c. Can be accepted, not only by clients but also by the cultural environment in the community. d. Affordable by the community. e. Discontinued when that method, the client will soon return of fertility, except for permanent contraception (Kusumaningrum, 2009). Various methods of contraception 1. Simple Method Contraceptive devices can be simple without coitus interruptus and periodic abstinence. While contraceptive devices / drugs one of which can be done by using a condom (Kusumaningrum, 2009). 2. Modern Methods / Effective a. Hormonal Contraception orally: Pills Injection / injection subcutis: Implant (intrauterine device under the skin = AKBK) b. Intra Uterine Devices (IUD, IUD) c. Contraception Steady In women: Radiation, Operative (Women Operative Medical / MOW), mechanically fallopian tube blockage. In men: Operative (Operative Medical Male / MOP), a mechanical blockage of the vas deferens, vas deferens blockage chemically (Kusumaningrum, 2009). Based on the long effectiveness, contraception can be divided into: a. LTM (Long Term Contraception Methods), which are included in this category is the type of implant / implants, IUDs, MOP, and MOW. b. Non LTM (Long Term Non Contraceptive Methods), which are included in this category are condoms, pills, injections, and other methods in addition to methods that are included in the LTM (Kusumaningrum, 2009). B. IUD Definition Intrauterine device (IUD) is a T-shaped tool made of plastic with the bottom there is a smooth strap which is also made of plastic. As the name implies IUD is inserted into the uterus to prevent pregnancy. Installation can normally be ambulatory and still continue to be in the womb to be issued

again. IUD prevents sperm meets an egg cell is not a way to change the inner lining of the uterus becomes difficult to be reached by the sperm (Kusmarjadi, 2010). Intrauterine device (IUD / IUD) is a contraceptive device that is placed in the womb of a relatively more effective when compared with the method of pills, syringes and condoms. Intrauterine device made of plastic elastic, twisted copper or copper mixed with silver. Metal coil causes a reaction with anti-fertility use time can reach 2-10 years, with the working methods of preventing the entry of motile spermatozoa / sperm into the fallopian tubes. Installation and revocation of contraception should be done by medical personnel (doctors or midwives trained), can be worn by all women of reproductive age but should not be used by women who are exposed to sexually transmitted infections (Imbarwati, 2009). IUD is a plastic device that is inserted into the uterus and prevents pregnancy by disrupting uterine environment and inhibit fertilization or implantation (ILUNI School of Medicine, 2010). IUD (intrauterine device) or spiral, or in English is Intra-Uterine Devices, abbreviated IUD is a device made of polyethylene with or without metal / steroids are placed in the womb. Installation can be for 3-5 years and can be removed at any time if the client wishes to have a child. The IUD works by preventing sperm meeting with the egg (Kusumaningrum, 2009). C. The types Type of IUD used in Indonesia, among others, are: a. Copper-T T-shaped IUD, made of polyethelen where in the copper wire wrapped smooth. This refined copper coil has the effect of anti-fertility (anti-conception) is quite good (Imbarwati, 2009). b. Copper-7 IUD is shaped figure 7 with a view to facilitate installation. This type of vertical shaft has a diameter of 32 mm and added coils of copper wire 200 mm2 surface area, the same function with refined copper windings on the Copper-T IUD (Imbarwati, 2009). c. Multi load IUD is made of plastic (polyethelene) with two left hands and right wing-shaped flexible. Length from the upper end to the lower end of 3.6 cm. Given rolls of copper wire rod with a surface area 250 mm2 or 375 mm2 to increase effectiveness. There are three types of multi-load size of the standard, small, and mini (Imbarwati, 2009). d. Lippes loop IUD is made of polyethelene, or spiral-shaped letter S continued. For ease of control, mounted on the tail yarn Lippes loop consists of 4 different types according to the length of the top. A type size of 25 mm (blue thread), Type B 27.5 mm (black thread), C-type measuring 30 mm (yellow yarn) and type D sized 30 mm and thickness (white thread). Lippes loop has a low failure rate. The advantage of this type of IUD use is when a perforation occurs, rarely cause injury or intestinal blockage, because the material is made of plastic (Imbarwati, 2009). Spiral can survive in the uterus and inhibits conception to 10 years old. After that must be removed and replaced. Spiral material most commonly used is plastic or mixed plastic copper. There are two types of IUDs and the IUD with copper IUDs with hormones (known as IUS = Intrauterine System). Copper IUD (copper) copper particles releasing to prevent pregnancy while IUS releases the hormone progestin (Kusmarjadi, 2010). Copper spiral type T (copper release) prevents pregnancy by disrupting the movement of sperm to reach the uterus cavity and can be worn for 10 years. Progestasert IUD (releasing progesterone) is only effective for one year and can be used for emergency contraception (ILUNI School of Medicine, 2010). D. The workings of IUD The workings of the spiral kontrasepasi: Inhibit the ability of the sperm to enter the fallopian tubes Influence of fertilization before ovum reaches the uterine cavity Prevent the sperm and ovum meet with making difficult sperm into the female reproductive organs and reduce sperm for fertilization. The IUD works primarily to prevent sperm and ovum meet, although the IUD makes it difficult

sperm into the female reproductive organs and reduce sperm for fertilization (Muhammad, 2008). E. Weaknesses and strengths Intrauterine devise (IUD) has the advantages of: Highly effective in preventing pregnancy, disposable continue to function until opened Highly effective. 0.6 to 0.8 kehamilan/100 women in the 1st year (1 failure in 125-170 pregnancies) Prevention of pregnancy for a long period until 5-10 years Does not affect sexual intercourse There are no hormonal side effects with cut-380A Does not affect the quality and volume of milk Can be installed immediately after delivery or abortion (if no infection) Can be used until menopause There is no interaction with drugs Helps prevent ectopic pregnancy Relatively expensive Comfortable (does not need to be remembered as if taking the pill) Can be opened at any time (by a doctor) Can be worn by all women of reproductive age Immediate function (IUD can be effective immediately after installation) Side effects are low Can be safely breastfeed Do not perceived by the user or the partner (Kusmarjadi, 2010). Highly effective (0.5 to 1 pregnancy per 100 women after one year usage) Do not forget to factor disrupted Method of long-term (up to 10 years of protection by using Copper T 380A) Reduce visits to the clinic Less expensive than pills in the long run (Kusumaningrum, 2009). IUDs for women who: Wanting contraceptives with a high level of effectiveness, and long-term Do not want any more children or want to space children Breastfeeding Being in postpartum and not breastfeeding Being in the post-abortion Has a low risk for STDs Can not remember to take a pill every day Prefers not to use hormonal methods or that are not allowed to use it. Who really needs emergency contraception (Kusumaningrum, 2009). IUD contraceptive weaknesses are: Should not be used by women who are exposed to infectious Common side effects menstrual cycle changes, menstruation and much longer, inter-menstrual bleeding, pain during menstruation more Another complication: pain and spasms for 3 to 5 days after installation, heavy bleeding during menstruation or allowing them cause anemia, perforation of the uterine wall (very rare if correct installation) Does not prevent STIs including HIV / AIDS There is good use in women with STIs or who frequently change partners Pelvic inflammatory disease occurs after IUD wearing women with STIs, PID can lead to infertility Medical procedures, including pelvic examination is necessary in IUD insertion Less pain and bleeding (spotting) occurs immediately after IUD insertion. Usually disappear within 1-2 days Clients can not remove the IUD by himself. Trained personnel who can take (Muhammad, 2008). Perhaps the IUD out of the uterus unnoticed (often happens when the IUD is inserted immediately after delivery) Women should examine the position of IUD threads from time to time (Imbarwati, 2009). While the effect, among others, a sense of cramps and back pain for a while until a few hours after installation. Some women experience light bleeding and pain until a few weeks after installation.

Sometimes menstruation can be a lot of the copper IUD (Kusmarjadi, 2010). Spiral does not protect from various diseases are transmitted through sexual intercourse, including HIV / AIDS. Not only that, the spiral will aggravate your illness, causing serious complications, such as inflammation of the cervix that can make you lose fertility (infertility) (Zahra, 2008). IUD use should be made at the time: a. Any time in the menstrual cycle, which can be ensured client is not pregnant. b. The first day to 7 menstrual cycle. c. Soon after birth, during the first 48 hours or after 4 weeks postpartum, after 6 months when using a lactation amenorrhea method (LAM). d. After a miscarriage (immediately or within 7 days) if no symptoms of infection. e. For 1 to 5 days after unprotected intercourse (Imbarwati, 2009). Weakness of IUD use is the need to return control to check the position of the IUD threads from time to time. Time IUD controls that must be considered are: a. 1 month after installation b. 3 months later c. every 6 months d. when a missed period 1 week e. bleeding a lot or other special complaints (Imbarwati, 2009). F. Side effects The first week, there may be a little bleeding. There are women wearers spiral period changes, becoming more 'heavy' and longer, even more painful. But usually all the symptoms will go away on its own after 3 months (Zahra, 2008). Bleeding and cramping during the first weeks after installation. Sometimes found whitish multiply. Besides, at the time related (intercourse) occurs expulsi (IUD shifted from position) partially or completely. IUD insertion may cause discomfort and risk of infection associated with cervical (Kusumaningrum, 2009). The most dangerous health problems resulting from the use spiral is inflammation of the cervix. This mostly occurs during the first 3 months, but generally not the result of spiral itself. The sufferer is exposed to infection when fitted spiral. Here's why you should check the conditions surrounding the vagina and uterus before installing a spiral, so that if there are signs of infection could spiral canceled installation. If the condition of the cervix mediocre but you inevitably inflamed as well, perhaps fitter spiral (nurses, midwives, doctors, or anyone in the health post or clinic KB) not put up in sterile conditions or spiral completely clean and safe. Be careful choosing anywhere or on anyone asking for this service (Zahra, 2008). G. Contraindications Women who may use IUD contraception, namely: Reproductive Age The state of nulliparous Want to use long-term contraception breastfeeding women who want to use contraception After delivery and not breastfeeding Having experienced abortion and no visible infection Low risk of STIs Does not require hormonal methods Do not like to remember to take pills every day Do not want pregnancy after 1-5 days of intercourse Smokers Fat or thin (Muhammad, 2008). Do not use spiral if: are pregnant or possibly pregnant increased risk of infectious disease through sexual intercourse (when having more than one sexual partner, or if the husband / partner had another partner) have experienced birth canal or uterine infection, or infection after delivery / after abortion outside the womb ever pregnant (pregnancy in the fallopian canal) Got menstrual "heavy" (blood coming out very much) diserat extreme pain very lack of red blood (anemia)

 have never been pregnant (Zahra, 2008). Contraindications female contraceptive IUD users, namely: Pregnant or suspected pregnancy Infection of the cervix or pelvic cavity, including venereal disease Ever had pelvic inflammatory Patients with abnormal vaginal bleeding History of ectopic pregnancy People with genital cancer (Kusumaningrum, 2009). Condition in which a woman is not supposed to use the IUD are: Pregnancy Sepsis Abortion postseptik in the near future anatomical abnormalities that interfere with the uterine cavity Bleeding that can not be described it tropoblastik malignant disease Cervical cancer, breast cancer, endometrial cancer Pelvic inflammatory disease PMS (premenstrual syndrome) and immunocompromised last 3 months (decreased immunity) Pelvic tuberculosis (ILUNI School of Medicine, 2010). Women are not allowed to use the IUD are: Are pregnant Vaginal bleeding of unknown Moderate genital infections (vaginitis, cervicitis) The last three months are experiencing or frequently suffer from PRP or septic abortion Congenital abnormalities or abnormal uterine benign uterine tumors that are able to affect the uterine cavity malignant trophoblastic disease Known pelvic tubercular genital cancer The size of the uterine cavity is less than 5 cm (Muhammad, 2008). H. How to use or installation IUD can be fitted at any time during the menstrual period if the woman is not pregnant. For women after childbirth, IUD insertion immediately (10 minutes after expulsion of the placenta) to prevent easy copotnya IUD. IUDs can also be fitted 4 weeks after giving birth without risk factors perforation (tearing of the uterus). For breastfeeding women, IUD with progestin should not be used until 6 months after delivery. IUDs can also be installed as soon as the first quarter of SAB, but recommended to be delayed until after the complete involution of the second quarter abortion. Once an IUD is inserted, a woman should be able to check the thread IUD after every period (ILUNI School of Medicine, 2010). Working procedure of IUD Installation Wisdom: 1) Officers must be prepared on the spot. 2) There must be a request and consent from potential participants. 3) examination of the enclosed space, clean, and well-ventilated. 4) The tools are available: a. Gyn bed b. Weight scales c. Sphygmomanometers and stethoscopes d. IUD sets of sterile e. Crooked f. Light g. KB Card (kl, K IV) h. Books and registration administration KB i. Table with sterile duk

 Sym speculum Sonde uterus Lidi fan and cotton first aid to taste. Spark plugs / dilatator Hegar Kogel pliers Pincet and scissors The steps: 1) Provide information to prospective participants about the benefits, side effects and how to cope with side effects. 2) Implement the general anamnesis, family, media and obstetrics. 3) Carry out general inspection covers weigh, tensimeter measure. 4) Allowing applicants to empty the bladder urine. 5) Prepare the necessary tools. 6) Allowing applicants to lie in bed gynaecologi with Lithotomi position. 7) Officer handwashing 8) Wear gloves right and left 9) Clean the vagina with a cotton first aid 10) Carry out the examination to determine the state position of the uterus. 11) Install the sym speculum. 12) Use the pliers to clamp the cervix Kogel. 13) Enter the sonde in the womb to determine the size, position and shape of the uterus. 14) IUD inserter that already contain added slowly to the uterine cavity, and then push that plugger in IUD released into the inserter. 15) Cut out the IUD so long stringy 5 cm 16) Speculum sym IUD removed and the thread is pushed to the side cervix. 17) Participants are welcome trimmed and lay 5 minutes 18) The tools are cleaned 19) Officers handwashing 20) Give an explanation to the participants the symptoms that may occur / experienced after IUD insertion and when to control 21) Creating a memorandum of services 22) Submit a memorandum of services to participants to be forwarded to the administrative ministry. 23) Record the data and services in card for notebook reported to the Medical Records (Imbarwati, 2009). Note: a. When the time feels pamasangan no obstruction, not forced (stop) consultation with a doctor. b. When the sonde into the uterus and when the fundus is not felt, the possibility of perforation, remove the sonde, and consult a doctor. c. Remove the sonde and see blood or mucus discharge limits, this is the length of the uterine cavity. Normal size of 6-7 cm. d. When the uterine size less than 5 cm or more than 9 cm do not installed (Imbarwati, 2009). IUD Removal Procedure General purpose: In order to remove the IUD patients who receive prompt delivery, satisfied, and according to the needs. Specific objectives: Mother prepare to quickly get to know the side effects IUD removed. Wisdom:

1) Officers must be ready to place 2) There must be a request and consent from potential participants. 3) examination of the enclosed space, clean, and well-ventilated. 4) The tools that should be available in full accordance with the standards specified: a. Pedestal table with sterile duk. b. Right and left gloves c. Cotton sticks, cotton adequate first aid. d. Cocor duck / speculum e. Tampons pliers. f. Close duk sterile g. Crooked h. Light i. Weight scales j. Sphygmomanometers and k. Stethoscope The steps: 1) Provide information to prospective participants about the benefits, side effects and how to cope with side effects. 2) Implement the general anamnesis, family, media and obstetrics. 3) Carry out general inspection covers weigh, measure tensimeter. 4) Prepare the necessary tools. 5) Allowing applicants to lie in bed gynaecologi with Lithomi position. 6) Clean the vagina with lysol 7) Carry out the examination to determine the condition and position of the uterus. 8) Put speculum sym. 9) Looking for IUD thread then removed with pliers tampon 10) After the successful IUD removed, cleared devices. 11) Patient trimmed back 12) Give an explanation to the participants the symptoms that may happen / experienced after IUD removed and when to control 13) Submit a memorandum of services and receive payment in accordance with memorandum 14) Record the data in the card services and note books, registers KB to be reported to the Medical Records (Imbarwati, 2009). CHAPTER III CLOSING A. Conclusion B. Suggestion If you want to stop the use of spiral, immediately visit a health worker put it, or trained. Do not try to remove it yourself at home spiral. (Plus more yooo) REFERENCES Imbarwati. , 2009. Some Factors Relating to the Use of Participants KB KB IUD In Non IUD In District Pedurungan Semarang. http://eprints.undip.ac.id/17781/1/IMBARWATI.pdf (Accessed on Friday, December 17, 2010). ILUNI FKUI. 2010. Family Planning (KB). Http://www.klikdokter.com/medisaz/read/2010/07/05/120/keluarga-berencana--kb- (Accessed on Friday, December 17, 2010). Kusmarjadi, Didi. 2010. KB IUD (Intrauterine divece =). http://www.drdidispog.com/2010/02/kb-iudintrauterine-device.html (Accessed on Friday, December 17, 2010). Kusumaningrum, Radita. , 2009. Factors Affecting Selection of Types Used Contraception the Eligible couples. http://eprints.undip.ac.id/19194/1/Radita_Kusumaningrum.pdf (Accessed on Friday, December 17, 2010). Muhammad. , 2008. Contraception for Women (Contraseptive for Female). Http: \ IUD \ IUD.mht.Alat Contraception In The Womb (IUD) (Accessed on Friday, December 17, 2010).

Zahra. , 2008. KB Spiral. http://sekarlove.multiply.com/reviews/item/2 (Accessed on Friday, December 17, 2010).