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Insertion timing
IUD insertion can occur at multiple timepoints in a woman's reproductive lifespan: 1) Interval insertion, the most common, occurs remote from pregnancy; 2) Post-abortion or post-miscarriage insertion occurs following an abortion or miscarriage when the uterus is known to be empty; 3) Postpartum insertion occurs after a woman gives birth either immediately, while the woman is still in the hospital, or delayed, up to 6-weeks following delivery, following either vaginal delivery or cesarean delivery. Insertion timing changes the risk of IUD expulsion.[1][2][3][4][5]
Insertion and removal procedure
During the insertion procedure, health care providers use a speculum to find the cervix (the opening to the uterus) and then use an insertion device to place the IUD in the uterus. The insertion device goes through the cervix. The procedure itself, if uncomplicated, should take no more than five to ten minutes.[6]
For immediate postpartum insertion, the IUD is inserted following the removal of the placenta from the uterus. The uterus is larger than baseline following birth, which has important implications for insertion. After vaginal deliveries, insertions can be done using placental forceps, a longer inserter specialized for postpartum insertions, or manually, where the provider uses their hand to insert the IUD in the uterus. After cesarean deliveries, the IUD is placed in the uterus with forceps or manually during surgery prior to suturing the uterine incision.[5][2][7]
Generally, the removal is uncomplicated and reported to be not as painful as the insertion because there is no instrument that needs to go through the cervix.[8] This process requires that the health care provider to find the cervix with a speculum and then use ring forceps, which only go into the vagina, in order to grasp the IUD strings and then pull the IUD out.
IUD placement and removal can be taught both by manufacturers and other training facilities.[9]
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- ^ "Long-Acting Reversible Contraception: Implants and Intrauterine Devices". www.acog.org. Retrieved 2020-04-13.
- ^ a b Okusanya, Babasola O; Oduwole, Olabisi; Effa, Emmanuel E (2014-07-28). "Immediate postabortal insertion of intrauterine devices". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd001777.pub4. ISSN 1465-1858. PMC 7079711. PMID 25101364.
{{cite journal}}: CS1 maint: PMC format (link) - ^ "Early Pregnancy Loss". www.acog.org. Retrieved 2020-04-13.
- ^ Lopez, Laureen M; Bernholc, Alissa; Hubacher, David; Stuart, Gretchen; Van Vliet, Huib AAM (2015-06-26). "Immediate postpartum insertion of intrauterine device for contraception". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.cd003036.pub3. ISSN 1465-1858.
- ^ a b Jatlaoui, Tara C.; Whiteman, Maura K.; Jeng, Gary; Tepper, Naomi K.; Berry-Bibee, Erin; Jamieson, Denise J.; Marchbanks, Polly A.; Curtis, Kathryn M. (2018-10). "Intrauterine Device Expulsion After Postpartum Placement". Obstetrics & Gynecology. 132 (4): 895–905. doi:10.1097/aog.0000000000002822. ISSN 0029-7844.
{{cite journal}}: Check date values in:|date=(help) - ^ "What's an IUD insertion like?". www.plannedparenthood.org. Retrieved 2018-03-29.
- ^ Whitaker, Amy K.; Chen, Beatrice A. (2018-01). "Society of Family Planning Guidelines: Postplacental insertion of intrauterine devices". Contraception. 97 (1): 2–13. doi:10.1016/j.contraception.2017.09.014. ISSN 0010-7824.
{{cite journal}}: Check date values in:|date=(help) - ^ Barnes, Zahra. "This Is What to Expect After Getting Your IUD Removed". SELF. Retrieved 2018-03-30.
- ^ "Clinical Education and Training". www.acog.org. Retrieved 2019-08-21.