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Intrauterine Devices (IUDs)
Introduction Contents Post-Test References Go To Presenter Info


Section 1
Section 2
Section 3

- Introduction
- Objectives
- Reducing Risk
- Training
- Timing
- Prevention
- Insertion Steps
- Perforation
- Cramping
- Bleeding
> Strings
- Pregnancy
- STIs and PID
- Removal
- Discontinuation
- Hormonal


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Section 3 - Insertion Guidelines and Management Issues

Management of Missing Strings

  • Determine risk of pregnancy
  • Perform pelvic exam; probe for strings in cervical canal
  • Give choice of another contraceptive method
  • Tell client to check for strings after next menses

Insert another IUD if expulsion is confirmed and:

  • Woman is not pregnant
  • There is no damage from perforation

Slide 41

Missing IUD strings may be a sign that the IUD has been expelled or has perforated the uterus. If a client says her IUD strings are missing, the health care provider should determine her risk of pregnancy by asking the woman when she last felt the strings and if she has had unprotected intercourse since that time. Next, perform a pelvic exam to determine if the strings are high in the cervix or hidden by a fold in the vagina. Often the strings can be located by probing the cervical canal with cotton swabs or narrow forceps. Gently rotate the instrument to draw the strings down.

Although not absolutely necessary, an ultrasound or X-ray can be used to locate the IUD if the strings cannot be found. If there is a risk that the woman is pregnant however, an X-ray should not be used. The client should be provided another contraceptive method to use until her next menses. If the strings have retracted into the uterus, they may fall back into place during menstruation. Tell the client to check for strings after her next menses.

If the strings are still not present after the next menstrual period, the client should see a physician for further examination. If pregnancy and a perforated uterus are ruled out and the IUD has been expelled, another IUD can be inserted immediately. If the IUD has perforated the uterus, refer the client to a hospital for treatment.



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