How is postpartum intrauterine device (IUD) insertion performed?

Updated: Nov 29, 2018
  • Author: Sarah Hagood Milton, MD; Chief Editor: Christine Isaacs, MD  more...
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Answer

Answer

Following delivery of the placenta, an assessment is performed by the provider to assess for uterine hemorrhage, atony, or signs of infection. If any of these conditions are present, insertion should be delayed. If the patient delivered vaginally, the IUD may be inserted using the steps outlined above.

Alternatively, the IUD may be removed from the insertion device, grasped with ring forceps, and placed though the dilated cervix and up to the level of the fundus, taking care to ensure that the horizontal arms of the IUD point toward the cornua. The provider also may place the IUD manually. No significant differences in complications, infection, or expulsion between various modes of insertion have been found. [54]

If the IUD is inserted immediately following a cesarean delivery, the IUD is removed from the insertion tubing and is similarly placed either manually or using ringed forceps. The IUD strings are then pushed inferiorly into the vagina and the hysterotomy is then closed. In this setting, trimming of strings can be delayed to the postpartum visit.


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