Intra-Uterine Device (IUD) insertion

• CLINICAL & PRACTICAL SKILLS VERTICAL MODULE

• UQU 5Med-- 2019-2020
➢ Objectives of the session

• To know and practice the steps of Insertion of intrauterine

contraceptive devise (IUD).
➢ Overview

• Intrauterine device insertion is an outpatient procedure that should be

performed by trained healthcare professionals. 
•  Intrauterine devices (IUDs) are an effective and increasingly popular form
of reversible contraception.
• The IUDs currently available include the copper T380A IUD (Paraguard)
and levonorgestrel-releasing intrauterine systems (Mirena).
➢ Periprocedural Care

• Patient Education & Consent

• Pre-Procedure Planning (History including history of STIs and medical
history and sensitivity to cupper).
➢ Equipment

• Speculum
•  Single-tooth tenaculum
•  Uterine sound.
• Antiseptic solution.
• Sterile gloves
• Scissors.
• If insertion occurs in the immediate postpartum period, ring forceps are
needed.
➢ Patient Preparation

• Anesthesia
No anesthesia or analgesia is indicated for insertion of either the copper T380A or the
levonorgestrel-releasing IUDs.
• Positioning
IUD insertion is best accomplished with the patient in dorsal lithotomy position.
• Timing of Insertion
An IUD can be inserted at any time during the menstrual cycle (pregnancy should be
excluded by pregnancy test).
Ideally, IUD insertion should occur within the first 7 days of menstrual cycle to
decrease the risk of concurrent pregnancy. Also, insertion during the follicular phase is
associated with fewer requests for IUD removal secondary to pain or irregular bleeding
than insertion during the luteal phase
➢ Patient Preparation

• Anesthesia
No anesthesia or analgesia is indicated for insertion of either the copper T380A or the
levonorgestrel-releasing IUDs.
• Positioning
IUD insertion is best accomplished with the patient in dorsal lithotomy position.
• Timing of Insertion
An IUD can be inserted at any time during the menstrual cycle (pregnancy should be
excluded by pregnancy test).
Ideally, IUD insertion should occur within the first 7 days of menstrual cycle to
decrease the risk of concurrent pregnancy. Also, insertion during the follicular phase is
associated with fewer requests for IUD removal secondary to pain or irregular bleeding
than insertion during the luteal phase
➢ Technique

• Start with performing bimanual examination to ascertain uterine size

and direction.
• Insert bivalve speculum to gain clear visualization of the cervix.
•  Clean the cervix and adjacent vagina with povidone-iodine or
chlorhexidine.
• Grasp the anterior lip of the cervix using a single-tooth tenaculum, then
perform gentle traction to facilitate uterine sounding and insertion of the
device.
• Use a uterine sound to assess the size of the uterine cavity
➢ Cupper IUD

• The copper T380A packaging is opened by an assistant, taking care to

maintain the sterility of the package contents.
• Load the IUD into the insertion tube and insert the sring into the bottom
of inserting tube .
➢ Cupper IUD insertion
• The insertion tube is grasped at the open end and the blue flange is set to
the level to which the uterus sounds..
• The insertion tubing is then rotated so that the horizontal arms of the IUD
are parallel to the long axis of the blue flange. 
➢ Cupper IUD insertion
• The loaded insertion tube is passed through the cervical canal until
resistance is met at the uterine fundus and the blue flange should be at
the external cervical os.
• With the solid white rod steady, the insertion tubing is withdrawn
approximately 1 cm, releasing the IUD
➢ Cupper IUD insertion
• The insertion tube is then gently moved up to the fundus of the uterus,
ensuring placement of the IUD at the level of the fundus. Holding the
insertion tubing steady, withdraw the white rod. Then, gently withdraw
the insertion tubing.
➢ Cupper IUD insertion

• Usinglong-handled scissors, the strings are then trimmed so that

approximately 3 cm are visible extending, from the external cervical os.
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• The packaging is opened by an assistant, taking care to maintain the sterility of
the package contents. Care is taken to ensure the arms of the IUD are in a
horizontal position
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• The threads on the handle of the IUD insertion device are then released from
the groove in the handle of the insertion device. While pushing the slider toward
the insertion tubing, the strings at the base of the IUD handle should be pulled,
which will retract the IUD arms into the insertion tubing. 
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• The threads are then secured in the thread cleft
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• The flange on the insertion device is then set at the level to which the uterus
sounds. This is accomplished by sliding the flange over the marked increments
on the IUD insertion tube
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• One hand is then used to provide gentle downward traction on the tenaculum.
While continued upward pressure is applied to the green slider on the IUD
handle, the insertion tubing is placed into the vagina at the level of the external
cervical os. The insertion tubing is then gently advanced until the flange is
approximately 1.5-2 cm from the external cervical os
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• Next, the slider on the handle is pulled backward to the level of the raised mark
on the insertion handle, expelling the IUD arms from the insertion tubing, and
wait 10 seconds to allow the arms to open completely
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• The insertion tubing is then advanced until the flange is at the external cervical
os, thereby advancing the IUD to the level of the uterine fundus 
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• While holding the insertion device steady, the slider is pulled all the way down
to release the IUD. The IUD handle and insertion tubing are then gently
retracted from the uterus and cervix. The strings will remain in place. 
➢ Levonorgestrel-Releasing Intrauterine
System (Mirena) Insertion
• Following removal of the insertion device, the IUD strings will be readily
visualized in vagina. Using long-handled scissor, the strings are then trimmed so
that approximately 3 cm are visible, extending from the external cervical os. 
➢ complications

•  Expulsion.
• Method failure and ectopic pregnancy
• Uterine perforation
• Vasovagal episode as a result of cervical or uterine manipulation 
➢ Monitoring & Follow-up

•  Follow-up visit in approximately 4 weeks.

• Check for any symptoms.
• Check the presence of the thread coming out the cervix.
• No antibiotic prophylaxis is indicated for IUD insertion
Thank you

• CLINICAL & PRACTICAL SKILLS

• UQUMed-5- 2019-2020