Gynecology Book


Intrauterine Device Insertion

Aka: Intrauterine Device Insertion, IUD Placement
  1. See Also
    1. Intrauterine Device
  2. Preparation
    1. Informed Consent
      1. See Intrauterine Device
      2. Contraindications
      3. Adverse effects
    2. Infection risk reduction
      1. Screen for Gonorrhea and Chlamydia before placing
      2. Antibiotic prophylaxis is not indicated
        1. Not indicated for routine prevention
        2. Not indicated for SBE Prophylaxis
    3. Pretreatment
      1. Misoprostol
        1. Previously Misoprostol (Cytotec) was recommended prior to IUD insertion to make the insertion easier
        2. No longer recommended due to no benefit in recent trials and risk of adverse effects
        3. Edelman (2011) Contraception 84(3): 324-39 [PubMed]
    4. Analgesia
      1. Ibuprofen 600-800 mg po 1 hour before procedure
    5. Timing of placement
      1. May be placed at any time in cycle
    6. Labs
      1. Document negative urine HCG prior to procedure
  3. Preparation: Equipment for procedure
    1. Betadine or hibiclens poured into pack of 4x4 gauze
    2. Sterile exam gloves
    3. Sterile equipment on tray
      1. Uterine sound
      2. Vaginal speculum
      3. Ring forceps
      4. Suture scissors (long)
      5. Single tooth tenaculum
      6. Sterile IUD package
  4. Technique: Placement
    1. Prepare IUD prior to starting procedure
      1. Use sterile technique
      2. Review insertion technique in package insert
    2. Place vaginal speculum
    3. Prepare vaginal wall with betadine or hibiclens
    4. Apply tenaculum at anterior (12:00) cervical position
    5. Insert and remove uterine sound
      1. Confirm depth of Uterus at least 6 cm
      2. Clears path for IUD insertion
    6. Place IUD according to package insert
      1. Each IUD uses a proprietary insertion device
    7. Cut IUD threads 2-3 cm from cervical os

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