Thursday, 26 January 2017

Intrauterine device (IUD) insertion

IUDs are equivalent to tubal sterilization at preventing pregnancy (over 99%effective); in addition to vasectomy, they are the most cost-effective method of long-term contraception.
📍📗The most popular IUDs in use are the copper T380A IUD (Paraguard) and two levonorgestrel-releasing (IUS) intrauterine systems (Mirena and Skyla).
📍📘You should know that during the insertion of an IUD, some women go into vasovagal shock. To manage this, you need to:

👉Stop the procedure, lower the head and/or raise the legs.
You MUST make positional changes before removing the device (exam question- VIP)
👉The IUCD/IUS MAY need to be removed.
👉An assistant should monitor vital signs.
👉Ensure a clear airway.
👉Oxygen and suction as required.
Usually the shock resolves with the above steps but if it persists:
💉Consider use of atropine 0.6 mg/ml IV for persistent bradycardia.
💊Consider use of adrenaline (epinephrine) 1:1000 IM (1mg/nl) for management of anaphylaxis.
💊Automated external defibrillator (AED) should be available.
💊Arrange ambulance transfer if there is no swift improvement.

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