Intrauterine Contraceptive Device Insertion

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  • The ideal candidate for an IUC is a parous woman in a stable, mutually monogamous relationship, with no sexually transmitted disease (STD) risk factors who is looking for long-term but reversible birth control. The patient should be willing to check for the presence of IUC threads on a monthly basis.
  • Contraception for women who cannot remember to take or who cannot tolerate oral contraceptives, who wish to maintain fertility, and who want to avoid systemic hormones.
  • Women with contraindications to hormonal therapy for contraception.
  • Women with endometriosis, dysmenorrhea, or hypermenorrhea or significant anemia.
  • Some contraindications are relative, and some apply to only one or the other type of IUD.
  • Contraindications and potential contraindications include (these vary by IUD type):
    • Pregnancy
    • Postseptic abortion or puerperal sepsis or postpartum endometritis
    • Uterine cavity malformations
    • Genital bleeding of unknown cause
    • Recent STD or PID, including HIV, HPV, herpes, and Chlamydia
    • Pelvic tuberculosis
    • Known or suspected ovarian, uterine, or cervical neoplasia
    • Malignant or benign gestational trophoblastic disease
    • Breast cancer
    • Less than 4 weeks post partum
    • High risk for STD infection
    • Active liver disease or hepatitis
    • Thromboembolic disease
    • History of breast cancer
    • Migraine with focal neurologic symptoms
    • Allergy to copper or other components of the IUD
    • Wilson's disease
    • Desire for only short-term contraception
  • The desired prepackaged IUC (ParaGard, LNG IUS)
  • Speculum
  • Sterile basin with cotton balls moistened with a water-based antiseptic
  • Ring forceps
  • Cervical tenaculum
  • Uterine sound
  • Nonsterile gloves (for bimanual examination before insertion procedure)
  • Sterile gloves (for IUC insertion phase)
  • Sterile towel to cover tray
  • Long suture scissors

Optional Equipment

  • Nonsteroidal anti-inflammatory drug
  • Lidocaine 2% without epinephrine, 10-mL syringe, needle extender with a 22-gauge long needle, Monsel's solution, and cotton-tipped swaps (optional for anesthesia)
  • Cervical dilators

Neurovascular Supply of the Cervix

  • Blood is supplied to the cervix via the cervical branches of the uterine arteries, which are branches of the internal iliac arteries. The cervical arteries lie at the 3 o'clock and 9 o'clock positions on the cervix.
  • Because of the rich nerve supply to the cervix, endocervical manipulation can cause a reflex bradycardia and a vasovagal response in some women.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

  • Give the patient a copy of the IUC handout provided by the manufacturer, including the name and design, the date of insertion, and the recommended date for removal.
  • Reiterate the major concerns and what to watch for.
  • Discuss the following:
    • The patient should check for the presence of IUC strings after each menstruation.
    • The patient should be clear on the signs and symptoms of IUC expulsion, infection, and other possible complications.
    • Reiterate that the IUC will not protect her from STD, and that she must take precautions to avoid these infections.
  • Remove the IUC when the patient desires pregnancy, or as indicated by the manufacturer.
  • Vasovagal reaction
  • Perforation
  • Uterine bleeding and cramping
  • Spontaneous expulsion
  • Embedded or lost intrauterine device string
  • Partner discomfort (due to IUC strings)
  • Contraception failure
  • Pelvic inflammatory disease
  • Actinomyces
  • Ovarian cysts
  • Hormonal side effects and use during lactation
  • Pap smears/cervical dysplasia
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