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INTRODUCTION AND REMOVAL OF IUDS.
Since the methods of administration for different types of IUDs are different from each other, you should get acquainted each time and follow the instructions for the technique of introducing IUDs.
The following IUD instructions apply to all types of intrauterine devices.
1. Explain to the patient what the procedure for administering the IUD is.
2. Conduct a thorough gynecological (bimanual) examination to exclude pregnancy and inflammatory diseases of the genital organs, establish the position of the uterus, which is especially important for the prevention of its perforation. Perforation most often occurs in the uterine fundus, at an angle of 90 ° from the axis of the uterus. The retrograde uterus left out of attention is often the cause of perforation with the introduction of an IUD.
3. Thoroughly treat the vagina and cervix with an antiseptic solution after examining the cervix using gynecological mirrors. You can use a solution of iodine with a dilution of 1: 2.500, and with iodine sensitization, a solution of benzalkonium chloride, hexachlorophen, sodium chloride or others.
4. In some cases, at this stage, local cervical analgesia can be performed.
5. Place cervical forceps on the upper lip of the cervix approximately 1.5–2.0 cm from its external pharynx and close them slowly. The use of forceps is optional, but it is most indicated for stenosis of the internal pharynx of the cervix or a sharp anterior or posterior position of the uterus.
6. Carefully insert the uterine probe into the uterine cavity. Put a cotton swab on the cervix after inserting the probe to the bottom of the uterus, then remove the probe and swab at the same time, which allows you to determine the length of the uterine cavity with an accuracy of 0.25 cm.
7. Enter the IUD into the conductor, following aseptic rules.
8. Insert the conductor with the IUD into the uterine cavity through the cervical canal until it touches the bottom of the uterus, while providing a strong, careful traction on the conductor.
The most important rule when introducing an IUD is: everything that is done during the insertion and removal of an IUD can and should be done slowly and with great care.
9. Insert the IUD into the uterine cavity.
10. Cut the threads of the IUD, leaving approximately 5 cm from their length; threads can always be trimmed later on.
11. Some experts recommend that the patient palpate the IUD threads immediately after the procedure, which is one of the elements for further prevention of possible expulsion or displacement of the IUD.
12. Special care is required when administering an IUD to nulliparous women, t.
to. among these patients the most frequent vaso-vagal reactions and pain during and after administration, which may require immediate removal of the IUD. The development of these symptoms is explained by certain emotional reactions, the narrowness of the cervical canal, the relatively small size of the uterine cavity, the presence of a history of syncopal seizures, etc. Due to the increased risk of developing inflammatory diseases of the pelvic organs when using an IUD, nulliparous women who want to have children in the future are usually weak candidates for intrauterine contraception.
IUD extraction technique
It is recommended to remove the IUD on average after 3-4 years, although, for example, Multilode-375 is recommended to be removed after 5 years, Sorre r-T 380A - after 8 years. The following is a series of recommendations for removing an IUD.
• When removing the IUD using the usual method, it is recommended to remove the IUD during menstruation, which greatly facilitates this procedure.
• To prevent thread breakage, remove the IUD slowly by light and constant traction. If at the same time you feel a lot of resistance, probe the uterine cavity for 30 seconds, and then rotate the probe 90 °.
• If it is not possible to remove the IUD by careful traction, expand the cervix using special dilators. To reduce soreness, paracervical blockade can be performed before this. Expansion can also be done with the help of kelp. To fix the cervix and straighten the uterus, curved posteriorly or anteriorly, it is recommended that cervical forceps be placed on the cervix.
• If it is impossible to visualize the IUD threads, they can be detected in the uterine cavity using narrow forceps.
• If there is an IUD in the uterus, the uterine cavity can be probed with forceps - the so-called. alligators (which make it possible to capture the threads or the Navy itself), Novak's hook or curette. Exactly following these instructions in the presence of threads in the uterine cavity or their breakage can prevent the need for removal of the IUD in stationary conditions. When using intrauterine contraception longer than the recommended time, the possibility of pain due to the introduction of an IUD into the uterine wall or narrowing of the cervical canal should be considered.
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INTRODUCTION AND REMOVAL OF IUDS.
- ABDOMINAL HYSTERECTOMY WITH BILATERAL REMOVAL AND WITHOUT REMOVAL OF APPLICATIONS
This operation is performed in the presence of benign and malignant diseases requiring removal of the internal genital organs. The operation can be performed with the preservation or removal of the ovaries from one or both sides. If there is a benign pathology, then the question of removing the ovaries must be discussed in detail with the patient before the operation. In the presence of malignant pathology
- Monitoring patients using an IUD
During the first week after the introduction of the IUD, sexual activity and intense physical activity are not recommended. The first follow-up examination of a doctor is carried out after 7-10 days to check for the presence of threads, to make sure that the IUD is installed correctly and to allow sexual activity without using an additional method of contraception. An ultrasound is also performed to clarify the location of the IUD in the uterine cavity.
- Intrauterine devices (IUDs)
In the past 30–40 years, along with oral contraceptives, intrauterine contraceptives (IUDs), which are introduced by a specialist doctor into the uterine cavity, are quite widely used. An IUD is an elastic, usually flexible, spiral made of plastic, copper, silver or gold. There are also IUDs that contain artificial progesterone. Operating principle
- The mechanism of contraceptive action of the IUD
According to numerous studies, the so-called aseptic inflammation develops in the endometrium against the background of an intrauterine contraceptive due to a reaction to a foreign body, characterized by lymphocytic and leukocyte infiltration of the endometrium, the presence of plasma cells, increased permeability of the vascular wall and stagnation, most pronounced in places
- Ovarian removal
In some cases, it is possible to remove only the ovary without the fallopian tube (in young women who have not fulfilled the childbearing function) from one or both sides (ovariectomia bilateralis, dextra seu sinistra). Technique of execution. Laparotomy, removal of the uterine appendages from the abdominal cavity from one or both sides are performed in the same way as with adnexectomy. Clips are superimposed on your own bundle
- Tubal Removal
Pipe removal (Fig. 67) can be performed on one or both sides (salpingoectomia bilateralis, dextra seu sinistra). Technique of execution. After laparotomy and revision of the pelvic organs, appendages of the corresponding side are removed from the abdominal cavity. Clips (one or two) are placed on the wide ligament of the uterus, closer to the tube, and the uterine end of the tube. The pipe above the clamps is cut off and they
- REMOVING OVARIAN CYST
This operation is performed for benign ovarian formations, when the formation itself can be removed, and it is desirable to maintain the ovary. This situation is especially real in women of reproductive age. Surgeons operating on the pelvic organs do not cease to be amazed at the functionality of small areas of healthy ovarian tissue. Therefore, when there is a technical possibility and
- Removal of the uterus
Removal of the uterine appendages on both sides (adnexectomia bilateralis) is usually done with the uterus. However, in some situations, it is possible to perform bilateral adnexectomy without a uterus. Uterine appendages can be removed for various indications: more often in the presence of a tumor of both or one ovary (Fig. 66), inflammatory processes with tubo-ovarian formations and others. More often produced
- FULL REMOVAL OF THE OIL SEAL
This operation necessarily accompanies surgery for ovarian cancer. It is important that during all these operations, the abdominal cavity is opened by an extensive longitudinal section, preferably from the womb to the xiphoid process. Through a transverse incision, it is difficult to perform a complete omentectomy, and often the result of such difficult operations is incomplete removal of the omentum affected by metastases. If remote
- FULL VAGINAL REMOVAL
An indication for this operation is a malignant lesion of the vagina. It is often performed in combination with a transabdominal hysterectomy or Wertheim hysterectomy. This is the only possible treatment after a complete pelvic irradiation has already been performed for recurrent vaginal microinvasive carcinoma. Planning such an operation after radiation therapy is very difficult.
- REMOVAL OF UTERINE FIBER (MIOMECTOMY)
Myomectomy is indicated for patients suffering from infertility and wanting to have a baby if the cause of infertility is uterine fibroids or if, for whatever reason, complete removal of the uterus is contraindicated. The physiological consequences. After removal of the fibrous tumor from the uterus, normal physiological relationships between the endometrium and myometrium are restored, which contributes to
- Surgical removal of fat.
There are also several methods for surgical removal of adipose tissue itself. Sometimes the very cause of obesity can be removed surgically. So, for example, in Itsenko-Cushing's disease, one adrenal gland is removed, and the other, if necessary, is irradiated to reduce its activity. This leads to a complete cure for obesity. Resection of excess adipose tissue is already done
- Endotracheal tube removal
Once respiratory support is discontinued, the need for continued endotracheal intubation should be assessed regardless of this. Although virtually all patients experience temporary swallowing problems after extubation, those patients should not be extubated for whom long-term difficulties in protecting the airways after removal of the tube (for example, with deep
- Pipe removal.
Stage 1. Uterus fixation. The surgeon (X) removes the uterus with his hand into the wound, passes it to the assistant, punctures the peritoneum with a ligature “holding” under the round ligament in the avascular zone at the site of attachment of the ligament to the uterus from the side of the removed tube. It is possible to fix the uterus by flashing with absorbable suture in the bottom area with a Z-shaped suture to a depth of 1 cm. Assistant (A) provides visibility while holding
- LAPAROSCOPIC REMOVAL OF UNSTROUSED ECTOPIC PREGNANCY
This operation has become a frequent and effective way to treat a pathological condition that previously required laparotomy and prolonged hospitalization. Patients usually complain of amenorrhea, lower abdominal pain, and spotting from the vagina. In such a situation, laparoscopy can be both an additional diagnostic tool and a surgical treatment.