Intrauterine Contraceptive Device Removal

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  • No need for contraception
  • Pregnancy confirmed (early)
  • Pelvic infection
  • Before loop electrosurgical excision procedure conization
  • Patient intolerance: Pain, bleeding, other
  • Manufacturer recommendations
  • Advanced pregnancy (second or third trimester).
  • Suspected extrauterine location.
  • Speculum
  • Ring forceps
  • Nonsterile gloves
  • Cytobrush or similar instrument (if strings are not visible)
  • Small hemostats or alligator forceps (if strings are not visible)

Additional Equipment for Invasive Removal Techniques

  • Water-based antiseptic
  • Cervical tenaculum
  • Uterine sound
  • Double IUD extractor or flexible IUD hook

Optional Equipment

  • NSAID, to be taken before procedure.
  • Lidocaine 2% without epinephrine may be used to perform a submucosal or paracervical block (optional). Additional equipment includes a 10-mL syringe, a needle extender with a 22-gauge long needle, Monsel's solution, and cotton-tipped swabs.
  • Cervical dilators.

Neurovascular Supply of the Cervix

  • 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, manipulation of the endocervix 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

  • Provide contraception, preconception, or hormone replacement and menopause counseling as appropriate.
  • If the patient desires to continue IUC device use, there is no need for delay of insertion.
  • Other than slight discomfort and the possibility of vasovagal reactions, no significant complications are associated with routine IUC device removal.
  • With invasive instrumentation, perforation, infection, and bleeding (all rare) may occur.
  • Risk for miscarriage is significant if the IUD is removed during pregnancy.
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