Long Acting Reversible (LARCs)
Intra uterine devices (IUD or IUCD)
How can safe insertion of IUCD be inserted?
- The Risk of perforation is related to the competence of healthcare professional.
- The number of insertions done year is related to the risk of perforation.
- Those less than 10 in a 10 years period have higher risk.
- Need for certification, recertification, trained and be conversant in anaphylaxis update and basic life support.
- Valid consent should be taken prior to insertion.
- Chaperone should be present.
Intervention to ease IUCD insertion
- Nulliparity, No history of vaginal delivery, anxiety and lenght of time since last pregnancy or last menses are factors that may predict pain during insertion.
- Cervical priming Agent- Cochrane review has shown that none of the priming agents reduce pain including misoprostol.
- Prophylatic oral analgesia- Some evidence to show NSIAD`s may relieve post insertion pain BUT NOT pain during insertion.
- Tissue forceps- Application facilitates IUCD insertion by stabilsing the cervix and reducing flexion angle of the uterus
- Local Anaesthetics block can be offered for those that required cervical dilatation.
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