Guidelines for medical officer for IUCD insertion

Guidelines for medical officer for IUCD insertion

As you all know that intrauterine contraceptive device ( IUCD ) is one of the most effective reversible contraceptive method.

Some important contraindication for its use are :-

1. Pregnancy

2. Pelvic inflammatory disease ( PID )

3. Abnormal vaginal bleeding.

4. Cancer of cervix or uterus.

5. H/O ectopic pregnancy.

6. Congenitally malformed uterus.

7. Pelvic tumours.

8. Valvular heart disease.

Cu T should be inserted with care if patient had cesarean section in last three months.

Counselling

Every client should be counselled to help decide to plan his / her family and to choose a method based on informed choice. Whenever possible spouse/partner should be counselled.

Once a client has chosen Cu T as a method for family planning, provide her relevant information and clarify her doubts.

                    1  The likely problems during Cu T insertion and for few months after insertion.

2. Effectively period.

3. Need to check whether Cu T is in place .

4. Need to come for follow up after periods , after 3 months ,every year and report if there is problem like some pain abdomen ,if she misses her period or if she has continuous vaginal bleeding or if she cannot feel the thread.

Timing of Cu T insertion :-

• -Within some days of last menstrual period ( LMP ) .
• -4-6 weeks postpartum ( after ruling out pregnancy ).
• -Immediately after MTP / abortion.
• -During lactational amenorhoea (after ruling out pregnancy)

Pelvic examination:-

• Ask the client to empty the bladder and lie on examination table on her back with flexed knees.

• Autoclave equipments should be ready before hand .

• Wash and scrub hands and wear sterile gloves.

• Inspect external genitalia and look for any wart, boil,growth or discharge.

• Clean the introitus and do the pelvic examination to see the size and direction of uterus and to rule out any pelvic infection or tumour.

• Insert Sim's speculum.

• Retract anterior vaginal wall with anterior vaginal wall retractor and inspect cervix for any infection,growth,polyp or discharge.

• Clean the cervix.

• Hold the anterior lip of cervix with volsellum and give gentle traction downwards.

• Insert uterine sound gently ( if uterus is ante verted the curve of the sound should be facing abdomen ). Introduce sound gently into uterus till a slight resistance of fundus of uterus is felt. Determine the length of uterus by placing finger against the sound at the level of external os. . It is normally between 6 – 9 cm.

• Load the Cu T.

• Align the flange and the folded arms of Cu T in a horizontal position.

• Adjust the flange at the measured length of uterus.

• Grasp the volsellum and introduce loaded Cu T with plunger into the uterus till a slight resistance is felt.

• Hold the volsellum and plunger with one hand and withdraw the tube downwards.

• Again gently push the insertion tube until a slight resistance is felt.

• Remove the plunger.

• Withdraw insertion tube gently.

• Cu T the strings 2 – 3 cm. from exernal os.

• Remove the volsellum and speculum.

• Wash the gloved hands . Remove the gloves and put them for sterilisation.

The above guidelines are prepared by Dr Sadhna Rajvanshi

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Dr Marwah