Intrauterine Contraceptive Device Insertion

Published on 31/05/2015 by admin

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Last modified 31/05/2015

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Chapter 246 Intrauterine Contraceptive Device Insertion

DESCRIPTION

Placement of an intrauterine contraceptive device (IUCD).

INDICATIONS

Elective, desiring contraception. (The IUCD is associated with an efficacy rate that is comparable to sterilization and oral contraceptives.) The IUCD may be a particularly good choice for women with diabetes, thromboembolism, menorrhagia, or dysmenorrhea. The copper IUCD may be preferable for those breastfeeding or with breast cancer or liver disease. The copper IUCD may be placed up to 5 days after unprotected intercourse as an emergency contraceptive measure. The progestin-releasing IUCD may be used as a treatment for menorrhagia in selected patients.

CONTRAINDICATIONS

Active cervical infection, acute sexually transmitted disease, allergy to any component of the device, dysfunctional uterine bleeding (undiagnosed), dysmenorrhea, genital actinomycoses, history of ectopic pregnancy (relative), immediate postpartum period (less than 8 weeks), immunocompromise (relative), IUCD in situ (unremoved), malignancy (uterine or cervical, known or suspected), multiple sexual partners (relative), pelvic inflammatory disease (PID) (current or past 3 months), pregnancy (known or suspected), sexually transmitted disease (current), uterine cavity malformation, vaginitis, Wilson disease (copper IUCD only).

REQUIRED EQUIPMENT

• Intrauterine contraceptive device in sterile package
• Skin (vaginal) preparation materials (iodine-based antibacterial solution [e.g., Betadine] or other suitable cleansing agents)
• Vaginal speculum
• Tenaculum
• Uterine sound (optional)
• Nonsterile examination gloves
• Scissor (long)
• Sterile gloves (optional with “no touch” technique)

TECHNIQUE

The discomfort of an IUCD insertion may be decreased by premedicating with a single oral dose of a nonsteroidal anti-inflammatory agent given in doses usually used to treat dysmenorrhea or through the use of 2% intracervical lignocaine gel. Before beginning the procedure, the size, shape, and location of the uterus should be determined. The cervix should be visualized with the aid of a speculum and then disinfected. In patients who are parous without significant uterine flexion, a tenaculum is often not needed.

The technique used to place the contraceptive device in its proper location in the uterine cavity varies slightly based on the device. Each use follows the same general sequence of steps: loading the IUCD into its carrier or placement device, placing the IUCD in position in the uterine cavity, withdrawing the placement instrument leaving the IUCD behind, verifying correct placement, and trimming the marker sting(s).

ParaGuard T380A

The IUCD must be loaded into its insertion device, which may be accomplished using either sterile gloves or a “no touch” technique. With sterile gloves the device is grasped, folded, and inserted into the distal end of the insertion tool. In the “no touch” method the same ends must be accomplished, but manipulating the IUCD through the outer package wrapper carries them out.

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