An IUD placement is an in-office, short procedure where a healthcare professional places a small T-shaped object known as an IUD in the uterus for birth control for many years. IUDs are one of the most effective contraceptive methods as their effectiveness is 99% when it is being used appropriately. There are two main types of IUDs; amongst these, there are two major types: hormonal IUDs and copper IUDs. Hormonal IUDs release a low dose of Progestin which helps to make the cervical mucus to thicken to block sperm from gaining access to the egg, and also suppresses the lining of the uterus to reduce the chances of implantation. A Copper IUD has a copper wire wrapped around it to hinder sperm and cumulative conception.
Indications
Long-Term Contraception: IUDs render permanent protection to any pregnancy every day for a maximum of 3-10 years, based on the type used.
Non-Compliance with Other Contraceptive Methods: Applicable for those persons who may have problems remembering to take the conventional combined oral contraceptives.
Heavy Menstrual Bleeding (Menorrhagia): Levonorgestrel releasing IUS, certain type of hormonal contraceptive IUDs, have also been shown to reduce menstrual flow, therefore used in management of menorrhagia.
Contraindications
Pregnancy or suspected pregnancy: IUDs are not recommended for the pregnant women. An IUD insertion during pregnancy intensifies the likelihood of having hazardous complications like miscarriage, sepsis, or ectopic pregnancies.
Current pelvic infection:This includes genital and pelvic Inflammatory disease (PID), cervicitis or any infection affecting the female reproductive organs. Insertion of IUD increases the risk of these infections.
Unexplained vaginal bleeding:To determine the source of vaginal bleeding during or after sex, it’s crucial to consult a physician. If you are unsure of the reason behind your bleeding, IUDs might not be the option for you.
Certain uterine abnormalities: It is advised not to use IUDs if you suffer from diseases that alter the condition and shape of your uterus including fibroids and serious endometriosis.
Outcomes
Equipment
Intrauterine device (IUD)
Speculum
Tenaculum
Uterine sound
Antiseptic solution
Sterile gloves
Scissors
Patient preparation
Pre-procedure planning:
Consultation: When consulting your gynecologist, the screening is done as a primary step and or inquire about your past years’ sexual activity to be able to know your degree of vulnerability to the STIs. Before the use of an IUD, a pregnancy test is often required to be negative before the device is inserted.
Informed consent: Before undergoing IUD insertion, you will have to fill an informed consent form after the gynecologist has explained the benefits and the risks to you.
Patient position
Dorsal lithotomy is preferred position for IUD insertion.
Technique
Levonogestrel-releasing IUS (Mirena and Skyla) insertion technique:
Patient preparation before IUD insertion
Step 1: Preparation of procedure:
Explain the procedure, benefits, and potential side effects.
Obtain informed consent.
Infection Prevention:
Use aseptic techniques throughout the procedure.
Equipment’s:
Collect all the necessary equipment’s required for intrauterine device insertion.
Step 2: Prepare the patient:
The patient should be placed on the examination table in lithotomy position. keep the patient draped as a way of avoiding compromise of the patient’s privacy.
Step 3: Insert the Speculum:
Begin by placing a clean speculum into the vagina to allow visualization of the cervix.
Wash the cervix and vagina with an antiseptic solution.
Step 4: Stabilize the Cervix:
Apply a tenaculum for the cervix stabilization. Step 5: Measure Uterine Depth:
Use a uterine sound to check on any alteration in the depth of the uterine cavity and ensure correct placement of IUS.
Step 6: Prepare the IUS:
As per the manufacturer’s instructions, load the IUS to its applicator. It commonly entails using a slider to fold the device arms back into the insertion tube.
Step 7: Insert the IUS:
With fingers facing upwards, slide the loaded applicator through the cervical canal and into the uterine fundus.
Recheck that the IUS is at the appropriate depth as assessed by the length of the uterine sound.
Step 8: Release the IUS:
However, it is necessary to hold the applicator firmly for the releasing of the IUS which can be done by pulling backward the slider or any other sort of mechanism attached to it.
These arms will expand and fold in a T fashion within the uterine cavity of the IUS.
Step 9: Remove the Applicator: Carefully removing the applicator from uterus and cervix. Cut the IUS strings to the desired length whereby these strings are to be left about 2-3 cm long and inserted into the vaginal canal.
Step 10: Post-Insertion:
Check Placement:
Make sure the patient is comfortably settled and then check the position of the IUS strings.
Follow-Up:
Arrange a review appointment in 4-6weeks to confirm the position of the IUS and also to address any concern.
Copper T380 IUD insertion technique:
Copper T IUD device
Step 1: Patient Preparation:
Check that the patient has emptied the bladder before the start of the procedure.
Place the patient comfortably on the operation table (lithotomy position).
Step 2: Sterile Technique:
Insert a speculum to visualize the cervix.
Step 3: Sounding the Uterus:
Placing a uterine sound to determine the extent of the endometrial canal which ideally should lie between 6-9cm. It also aids in locating where the IUD is to be placed or inserted and to check if there are any barriers.
Step 4: Loading the IUD:
Take a sterile pack that contains the copper T380 IUD.
As directed by the manufacturer, load the IUD into the inserter tube, making that the IUD’s arms are folded into the tube.
Step 5: Insertion of the IUD:
Fixing of cervix is done by using a tenaculum. Slide in the inserter tube with the attached IUD into the cervical canal until it reaches the marked length for a suitable IUD size for that patient.
Remove the IUD by stabilizing the inserter and pulling out the cap of the insertion tube until the IUD is in place.
Check that both the wing of the IUD is in ‘T’ shape.
Step 6: Final check:
Withdraw the inserter completely.
Trim the strings of the IUD to approximately 2-3 cm protruding outside the cervical area.
Withdraw the speculum and ensure that the patient is comfortable.
Step 7: Post-Insertion
Observation:
Observe the patient for a few minutes and see if any reaction happens.
Give directions when and how do use it (i.e., post insertion instructions and any sign of complication such as severe pain, heavy bleeding and infection signs).
Follow-Up:
In addition to the first appointment a follow-up appointment must be arranged usually 4-6 weeks after IUD insertion to assess the position of the IUD and deal with any complications.
Laboratory tests
Pregnancy Test: A negative pregnancy test is needed before starting the IUD insertion procedure.
Sexually Transmitted Infections (STI) Screening: A test for STIs such as gonorrhoea and chlamydia in order to minimize the likelihood of infection during the insertion steps. Pap Smear:PAP test is used as screening tool to identify cervical cancer cells or precancerous cells in women. Blood Tests: The doctor might recommend for further blood tests, to evaluate other diseases that might make the process difficult.
Complications
Pain and cramping: This is one of the most frequently reported side effects of IUD placement. This can be eased by having readily available pain relievers.
Infection: Post-IUD insertion, the chance of infection remains slightly elevated, with the likelihood being highest within the span of 20 days. Symptoms of the inflammation include fever, intense lower abdominal pain, and abnormal vaginal discharge.
Bleeding changes: The hormonal IUDs may lead to irregular menstrual cycle, which may manifest as light bleeding or spotting, or perhaps even non-occurrence of menstruation within the first few months after the IUD has been inserted. Copper IUDs might result in increased blood flow or prolonged bleeding.
Expulsion: An IUD can spontaneously migrate out of the uterus, which may go unnoticed. This is most likely to happen in the first few months after insertion, so the patient must follow up and regularly monitor any changes.
Perforation: It is the cases where the IUD can puncture the uterine wall. This is especially common in women that have never been pregnant or have thin endometrial lining. Perforation can be determined by symptoms such as excessive pain during the insertion of the diaphragm, profuse bleeding, and nausea.
An IUD placement is an in-office, short procedure where a healthcare professional places a small T-shaped object known as an IUD in the uterus for birth control for many years. IUDs are one of the most effective contraceptive methods as their effectiveness is 99% when it is being used appropriately. There are two main types of IUDs; amongst these, there are two major types: hormonal IUDs and copper IUDs. Hormonal IUDs release a low dose of Progestin which helps to make the cervical mucus to thicken to block sperm from gaining access to the egg, and also suppresses the lining of the uterus to reduce the chances of implantation. A Copper IUD has a copper wire wrapped around it to hinder sperm and cumulative conception.
Long-Term Contraception: IUDs render permanent protection to any pregnancy every day for a maximum of 3-10 years, based on the type used.
Non-Compliance with Other Contraceptive Methods: Applicable for those persons who may have problems remembering to take the conventional combined oral contraceptives.
Heavy Menstrual Bleeding (Menorrhagia): Levonorgestrel releasing IUS, certain type of hormonal contraceptive IUDs, have also been shown to reduce menstrual flow, therefore used in management of menorrhagia.
Pregnancy or suspected pregnancy: IUDs are not recommended for the pregnant women. An IUD insertion during pregnancy intensifies the likelihood of having hazardous complications like miscarriage, sepsis, or ectopic pregnancies.
Current pelvic infection:This includes genital and pelvic Inflammatory disease (PID), cervicitis or any infection affecting the female reproductive organs. Insertion of IUD increases the risk of these infections.
Unexplained vaginal bleeding:To determine the source of vaginal bleeding during or after sex, it’s crucial to consult a physician. If you are unsure of the reason behind your bleeding, IUDs might not be the option for you.
Certain uterine abnormalities: It is advised not to use IUDs if you suffer from diseases that alter the condition and shape of your uterus including fibroids and serious endometriosis.
Intrauterine device (IUD)
Speculum
Tenaculum
Uterine sound
Antiseptic solution
Sterile gloves
Scissors
Pre-procedure planning:
Consultation: When consulting your gynecologist, the screening is done as a primary step and or inquire about your past years’ sexual activity to be able to know your degree of vulnerability to the STIs. Before the use of an IUD, a pregnancy test is often required to be negative before the device is inserted.
Informed consent: Before undergoing IUD insertion, you will have to fill an informed consent form after the gynecologist has explained the benefits and the risks to you.
Patient position
Dorsal lithotomy is preferred position for IUD insertion.
Levonogestrel-releasing IUS (Mirena and Skyla) insertion technique:
Patient preparation before IUD insertion
Step 1: Preparation of procedure:
Explain the procedure, benefits, and potential side effects.
Obtain informed consent.
Infection Prevention:
Use aseptic techniques throughout the procedure.
Equipment’s:
Collect all the necessary equipment’s required for intrauterine device insertion.
Step 2: Prepare the patient:
The patient should be placed on the examination table in lithotomy position. keep the patient draped as a way of avoiding compromise of the patient’s privacy.
Step 3: Insert the Speculum:
Begin by placing a clean speculum into the vagina to allow visualization of the cervix.
Wash the cervix and vagina with an antiseptic solution.
Step 4: Stabilize the Cervix:
Apply a tenaculum for the cervix stabilization. Step 5: Measure Uterine Depth:
Use a uterine sound to check on any alteration in the depth of the uterine cavity and ensure correct placement of IUS.
Step 6: Prepare the IUS:
As per the manufacturer’s instructions, load the IUS to its applicator. It commonly entails using a slider to fold the device arms back into the insertion tube.
Step 7: Insert the IUS:
With fingers facing upwards, slide the loaded applicator through the cervical canal and into the uterine fundus.
Recheck that the IUS is at the appropriate depth as assessed by the length of the uterine sound.
Step 8: Release the IUS:
However, it is necessary to hold the applicator firmly for the releasing of the IUS which can be done by pulling backward the slider or any other sort of mechanism attached to it.
These arms will expand and fold in a T fashion within the uterine cavity of the IUS.
Step 9: Remove the Applicator: Carefully removing the applicator from uterus and cervix. Cut the IUS strings to the desired length whereby these strings are to be left about 2-3 cm long and inserted into the vaginal canal.
Step 10: Post-Insertion:
Check Placement:
Make sure the patient is comfortably settled and then check the position of the IUS strings.
Follow-Up:
Arrange a review appointment in 4-6weeks to confirm the position of the IUS and also to address any concern.
Copper T IUD device
Step 1: Patient Preparation:
Check that the patient has emptied the bladder before the start of the procedure.
Place the patient comfortably on the operation table (lithotomy position).
Step 2: Sterile Technique:
Insert a speculum to visualize the cervix.
Step 3: Sounding the Uterus:
Placing a uterine sound to determine the extent of the endometrial canal which ideally should lie between 6-9cm. It also aids in locating where the IUD is to be placed or inserted and to check if there are any barriers.
Step 4: Loading the IUD:
Take a sterile pack that contains the copper T380 IUD.
As directed by the manufacturer, load the IUD into the inserter tube, making that the IUD’s arms are folded into the tube.
Step 5: Insertion of the IUD:
Fixing of cervix is done by using a tenaculum. Slide in the inserter tube with the attached IUD into the cervical canal until it reaches the marked length for a suitable IUD size for that patient.
Remove the IUD by stabilizing the inserter and pulling out the cap of the insertion tube until the IUD is in place.
Check that both the wing of the IUD is in ‘T’ shape.
Step 6: Final check:
Withdraw the inserter completely.
Trim the strings of the IUD to approximately 2-3 cm protruding outside the cervical area.
Withdraw the speculum and ensure that the patient is comfortable.
Step 7: Post-Insertion
Observation:
Observe the patient for a few minutes and see if any reaction happens.
Give directions when and how do use it (i.e., post insertion instructions and any sign of complication such as severe pain, heavy bleeding and infection signs).
Follow-Up:
In addition to the first appointment a follow-up appointment must be arranged usually 4-6 weeks after IUD insertion to assess the position of the IUD and deal with any complications.
Pregnancy Test: A negative pregnancy test is needed before starting the IUD insertion procedure.
Sexually Transmitted Infections (STI) Screening: A test for STIs such as gonorrhoea and chlamydia in order to minimize the likelihood of infection during the insertion steps. Pap Smear:PAP test is used as screening tool to identify cervical cancer cells or precancerous cells in women. Blood Tests: The doctor might recommend for further blood tests, to evaluate other diseases that might make the process difficult.
Pain and cramping: This is one of the most frequently reported side effects of IUD placement. This can be eased by having readily available pain relievers.
Infection: Post-IUD insertion, the chance of infection remains slightly elevated, with the likelihood being highest within the span of 20 days. Symptoms of the inflammation include fever, intense lower abdominal pain, and abnormal vaginal discharge.
Bleeding changes: The hormonal IUDs may lead to irregular menstrual cycle, which may manifest as light bleeding or spotting, or perhaps even non-occurrence of menstruation within the first few months after the IUD has been inserted. Copper IUDs might result in increased blood flow or prolonged bleeding.
Expulsion: An IUD can spontaneously migrate out of the uterus, which may go unnoticed. This is most likely to happen in the first few months after insertion, so the patient must follow up and regularly monitor any changes.
Perforation: It is the cases where the IUD can puncture the uterine wall. This is especially common in women that have never been pregnant or have thin endometrial lining. Perforation can be determined by symptoms such as excessive pain during the insertion of the diaphragm, profuse bleeding, and nausea.
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