Intrauterine Contraceptive Device Removal

Published on 30/05/2015 by admin

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Last modified 30/05/2015

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Chapter 247 Intrauterine Contraceptive Device Removal

DESCRIPTION

Removal of an intrauterine contraceptive device (IUCD).

INDICATIONS

Elective, desiring a return to fertility or to replace a device after its approved lifespan. IUCDs should also be removed in the face of active pelvic inflammatory disease, unrelenting side effects, or an intrauterine pregnancy (if possible). The IUCD does not have to be removed from an asymptomatic patient in whom actinomycosis is found on cervical cytology.

CONTRAINDICATIONS

Unstable or uncooperative patient or those in whom the presence of an IUCD cannot be confirmed.

REQUIRED EQUIPMENT

• Skin (vaginal) preparation materials (iodine-based antibacterial solution [e.g., Betadine] or other suitable cleansing agents)

• Vaginal speculum

• Nonsterile examination gloves

• Uterine packing forceps or other long forceps

• IUD or “crochet” hook (optional)

• Cervical cytology brush (Cytobrush or similar) (optional)

TECHNIQUE

The discomfort of an IUCD removal 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. The cervix should be disinfected if reinsertion of a new device if planned.

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