Intrauterine Device Insertion

HISTORY:

Presents for intrauterine device ‍insertionchange

Current contraception: ‍none ‍ for the last ‍ years

Reason for ‍choosingchanging IUD: ‍



Last menstrual period: ‍ ‍daysweeksmonths ago

Menstrual cycles: ‍ days, ‍regularirregular

Menstrual symptoms: ‍nonepainheavy bleeding

G‍01234 P‍01234 A‍01234

Desire for pregnancy in the next year: ‍yesno



Sexual activity: ‍activeinactive, ‍ partners, ‍menwomenmen and women

Condom use: ‍alwayssometimesno

History of STIs: ‍none ‍

Last Pap smear: ‍ ‍monthsyears ago ‍never

HPV vaccination: ‍up-to-dateincompleteunvaccinated



Contra-indications: ‍none

‍pregnancy

‍active PID or high PID risk

‍postpartum endometritis (<3 months)

‍recent septic abortion (<3 months)

‍uterine anomalies/fibroids distorting the cavity

‍progestin-sensitive cancers (e.g., breast)

‍unexplained vaginal bleeding

‍acute viral hepatitis or severe cirrhosis

‍uterine or cervical neoplasia



EXAM:

General appearance: ‍well-appearing

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Pelvic:

- External genitalia: ‍normal, ‍inguinal lymphadenopathy

- Vagina: ‍normal, discharge ‍normal, ‍malodorous

- Cervix: ‍normal

- Uterus: ‍normal, ‍no cervical motion tenderness

- Adnexa: -R ‍normal, -L ‍normal

- Tests performed: ‍Pap test, ‍HPV DNA, ‍vaginal culture, ‍chlamydia/gonorrhea, vaginal pH ‍< 4.5> 4.5, whiff test with KOH ‍negative

- Performed with chaperone



ASSESSMENT:

Intrauterine device insertion ‍successfully completedcomplicatedwith difficulty



PLAN:

- Pregnancy test prior to insertion

- STI screening prior to insertion

IUD Insertion:

- Type: ‍MirenaParagard

- Consent: informed of potential risks including perforation, expulsion, or infection, benefits of long-term contraception discussed, consent obtained

- Preparation: cervix cleaned with ‍betadinechlorhexidine

- Anesthesia: ‍noneparacervical block with ‍cc of ‍lidocaine

- Procedure: Uterine depth measured at ‍ cm, IUD inserted, strings trimmed to ‍ cm

- Tolerance: ‍well toleratedpelvic pain

- Instructions: expect some spotting or mild cramping initially, check strings monthly, use backup contraception for the first week

- Return if abdominal pain, fever, or if the strings can no longer be felt

- Follow-up: Return in ‍4612 weeks or if complications/concerns arise