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Intrauterine Devices (IUDs)
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Goals

Section 1

- Introduction
- Objectives
- IUD/IUCD Use
- Safety
- Overview
- Early IUDs
- Copper IUDs
- Mechanisms
- Failure Rates
- Comparison
- Method Costs
- Characteristics
- Characteristics
- PID
- Incidence Rate
- Reducing Risk
- Perforations
- Ectopic
> Expulsions
- Rates

Section 2
Section 3

Summary

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Section 1 - Intrauterine Devices (IUDs)

Expulsions

Partial or unnoticed expulsion may result in
irregular bleeding and/or pregnancy

Factors contributing to expulsion:

  • Provider's skill at placement of IUD at the top
    of the uterine cavity
  • Age and parity of woman
  • Time since insertion
  • Timing of insertion

Slide 18


The expulsion of an IUD is not in itself a medical complication. However, a partially expelled device could result in irregular bleeding. Further, an expelled or partially expelled IUD that goes unnoticed leaves the client believing she is protected from pregnancy when she is not. Providers should understand the factors that can contribute to the risk of an IUD being expelled.

Several factors influence expulsion rates, including the skill of the provider, the woman’s age and parity, the length of time since insertion and the timing of insertion.

Many studies indicate that the provider’s ability to place the IUD correctly at the top of the uterine cavity, or fundus, may be the most important factor in determining the risk for expulsion. In some studies, higher expulsion rates were associated with providers whose skills were inadequate.

Studies also show that younger women who have never given birth are more likely to expel an IUD than older women with children. In general, the risk of IUD expulsion is greatest during the first few months after the IUD is inserted, while the woman’s body is adjusting to the device. Thereafter, the risk decreases. However, contractions of the uterus during the first few months after the insertion or during later menstrual periods can push the IUD downward, expelling it either partially or totally. It is recommended that users check after each menses for the presence of IUD marker strings to ensure that the IUD is still in place. Next we will discuss expulsion rates as they relate to timing of insertion.

 

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