IUD placement

The intrauterine device (IUD) is the main method of family planning and birth control measures in China. Because of its simplicity, economy, safety and recyclability, it has been accepted by the majority of women in China. Family planning surgery includes birth control, sterilization and re-pregnancy surgery. Commonly used in birth control surgery are IUD placement and removal, early pregnancy abortion and mid-term pregnancy termination. Sterilization is the use of surgical methods to block fertility to achieve permanent contraception, women commonly used tubal ligation. Re-pregnancy is a kind of surgery that belongs to the family planning category because of the infertility caused by obstruction of the fallopian tube or the need for re-fertility due to some reasons after tubal ligation. Surgery requires less pain, safety, reliability, side effects, and is easily accepted. Therefore, the indications must be strictly controlled. The operation requirements are based on the principle of quasi-light, thin and fine, to minimize tissue damage and reduce complications. The variety of birth control devices is constantly updated. The aim is to find new safe and reliable methods for better contraceptive and lower side effects. There are dozens of different types and initial intrauterine devices that are used worldwide. New intrauterine devices are being developed. Although they have different shapes, they can be roughly divided into two categories. 1. Inert intrauterine device: made of inert raw materials, such as metal, plastic, silica gel, nylon, etc., the pregnancy rate of the belt and the high rate of unringing, have stopped production in 1993. 2. Active intrauterine device: The second generation of IUDs widely used at home and abroad contain active substances such as metals, hormones, drugs and magnetic substances. Domestic products include copper IUD and progesterone IUD. Treatment of diseases: complications of birth control surgery Indication Women of childbearing age who require an intrauterine device (IUD) without a contraindication can be placed. Contraindications 1. Severe systemic disease. 2. Acute and chronic genital tract inflammation. Acute and chronic pelvic inflammatory disease, vaginitis, acute cervicitis and severe cervical erosion should not be placed. 3. Reproductive organ tumors. Malignant tumors, uterine fibroids cause uterine deformation and more menstruation. 4. Uterine malformation, uterine dysplasia Double uterus is not clear type can not be placed. 5. The cervix is too loose, severe old cervical laceration or uterine prolapse. Cervical internal mouth relaxation or II to III degree uterine prolapse caused by various reasons. 6. The uterine cavity is less than 5.0cm or greater than 9.0cm, which should not be placed, but after the abortion and postpartum placement. 7. genital inflammation, acute pelvic inflammatory disease, vaginitis, acute cervicitis and severe cervical erosion should not be placed. 8. Menstrual disorders frequently occur in menstruation, menorrhagia, irregular vaginal bleeding or severe dysmenorrhea. 9. Pregnancy. Preoperative preparation 1. Preoperative examination Detailed medical history, last menstrual date and gynecological examination, laboratory test for vaginal trichomoniasis, fungus, vaginal cleanliness, if necessary, cervical scraping to check cancer cells. Anyone with trichomoniasis or fungi should be cured before placing. 2. Measure body temperature, pulse, and perform a full physical examination if necessary. 3. Time selection 1 month after clean 3~7d; 2 3 months after delivery, 6 months after cesarean section; 3 After artificial abortion, normal delivery placenta delivery, if there is no abnormality during cesarean section; 4 lactating amenorrhea should be placed after pregnancy; 5 After spontaneous abortion or mid-term pregnancy induction, it needs to be placed 3 to 7 days after the next menstrual period. 4. Instruments: vaginal speculum, disinfection forceps, cervical forceps, uterus probe, cervical dilator 3 ~ 6 set, place the ring, take the ring, small curette and other disinfection. 5. Disinfection of the IUD: metal is boiled or autoclaved or soaked in 75% ethanol for 30 min. Plastic or nylon was immersed in 75% ethanol or 1:1000 negerin solution for 30 min. 6. Empty the bladder before surgery. Surgical procedure (1) Disinfect the external vagina as usual and spread the sterile towel. (2) Vaginal examination to check the size, position, inclination and attachment of the uterus. (3) Use the vaginal speculum to dilate the vagina, expose the cervix, wipe the cervical secretions, disinfect the cervix with iodine and ethanol, and disinfect the cervical canal with iodine and ethanol swabs. (4) Clamp the anterior lip of the cervix and pull it horizontally. If the uterus is excessively tilted forward, clamp the posterior lip of the cervix forward to reduce the angle between the uterus and the cervix. (5) Support the cervical pliers with the left hand, hold the uterus probe with the right hand, gently penetrate into the uterine cavity along the direction of the uterus and go straight to the bottom of the uterus. Measure the depth of the uterine cavity and gently swing it to both sides to estimate the width of the uterine cavity. (6) Select the appropriate IUD model according to the size of the uterus. (7) Place the IUD: Place the selected IUD on the release ring (upper ring fork or upper ring forceps), gently feed the uterine cavity into the uterine cavity to the bottom of the palace, and pass through the cervix When the upper ring is slightly flat, it is consistent with the longitudinal axis of the uterine cavity, in order to prevent the ring from twisting in the uterine cavity. After the ring is placed at the bottom of the palace, the ring is released. The IUD with tail wire exposes the tail wire 2cm outside the cervix and the rest is cut off. The arrangement of the nursery flower and the V-shaped and T-shaped IUDs is different from the placement of the birth control ring. The IUD is placed in the casing of the inserter, and the middle shaft is inserted into the cannula, and the tip is in contact with the IUD, and the cannula is placed in the device. Place the center of the uterus into the center of the uterus, then fix the central axis, then gently withdraw the cannula, and finally remove the central axis. (8) GyneFixINIUD placement method: 1 After routine disinfection to find the location of the uterus, use the tissue clamp to clamp the anterior or posterior lip of the cervix (the anterior uterus clips the posterior lip of the cervix, the posterior lip of the posterior uterus). Straighten the uterine axis and probe the uterine cavity with a dedicated uterine probe. 2 Hold the rear end of the placer and remove the IUD and the placer from the package. 3 Adjust the position of the locating handle to the length of the uterine cavity measured. To exclude the effects of tissue elasticity at the base of the uterus, the set length was 0.5 cm longer than the measured depth of the uterine cavity. 4 Pass the placer through the cervix until the top of the placement tube contacts the bottom of the uterus, and continue to push forward slightly to insert 1 cm into the full length. At this point, the surgical thread summary on the insertion needle and the IUD is simultaneously inserted into the myometrium. 5 After fixing the placer so that it is tight against the bottom of the uterus, slowly pull out the insertion inserter and slowly pull out the placement tube. Gently pull the tail wire to determine if the tip of the IUD is fixed in the muscular layer of the uterine fundus. Then cut the tail wire 1.5 to 2.0 cm from the outside of the uterus. (9) Observe the uterine cavity without bleeding, wipe the cervix and vagina, remove the cervical forceps and vaginal speculum. complication 1. Pain: Duodenal contraction often causes pain, especially when the selected IUD is too large or not placed in the fundus, the pain is strongly obvious, and a smaller model IUD should be removed or replaced. 2. Bleeding: A small amount of irregular bleeding after the device is caused by contact between the IUD and the uterine wall, causing uterine contraction, partial damage of the endometrium, no need to deal with. If the amount of bleeding is too large or the amount of menstruation is too much, and the bleeding time is long, you should be alert to the presence of infection. Remove the IUD if necessary and give anti-inflammatory treatment. 3. Infection: 2 to 3 days after surgery, the abdominal pain is gradually intensified, and the body temperature is elevated. There is bloody drainage in the vagina. After the diagnosis is confirmed, the IUD should be taken out and treated with anti-infection. Infections are often caused by improper handling or unsanitary care after placement, so the principle of sterility should be strictly observed during the operation. Once the infection is combined, anti-inflammatory treatment is actively administered. 4. Uterine wall injury: IUD causes damage to the uterine wall. It can be completely penetrated or partially invaded in the uterine wall. It occurs in the following situations: (1) The position and flexion of the uterus were not ascertained. (2) Operational rudeness: It occurs in the uterus during lactation, and the IUD is worn from the bottom of the palace, especially at the two corners. Once the diagnosis of IUD ectopic should be removed in time, according to the ectopic position through the abdomen or transvaginal removal. 5. IUD incarceration: If the IUD is too large and the fracture causes the IUD to be partially or completely embedded in the muscle wall, it should be removed in time. 6. De-ringing and belt pregnancy: It is related to the skill level of the surgeon, the size of the IUD and the materials produced. Subjects with loose uterine cervix, excessive physical exertion, excessive size, and menorrhagia after placement of IUD are also likely to cause IUD shedding. IUD is not placed at the end of the uterus or IUD is too small, located below or on one side of the uterine cavity, IUD ectopic and uterine malformation, lactation can lead to pregnancy. If you fall off or bring a pregnancy, you should be advised to switch to other methods of contraception.

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