OG21.2 | IUCD Insertion and Removal — Summary & Reflection

KEY TAKEAWAYS

IUCDs — CuT 380A (up to 10 years) and LNG-IUS (up to 5 years) — are among the most effective reversible contraceptives. Patient selection uses WHO MEC categories 1–4; absolute contraindications (MEC 4) include current pregnancy, active pelvic/cervical infection, distorted uterine cavity, and unexplained vaginal bleeding. Timing options are interval (within 12 days of cycle), post-abortion (immediate), and postpartum (within 48 hours or after 4–6 weeks). The insertion technique requires bimanual examination, uterine sounding (6–9 cm normal), flange calibration, no-touch plunger-withdrawal to fundal depth, and thread trimming to 2–3 cm. Removal grasps the threads under direct vision; missing threads require ultrasound then X-ray to distinguish coiled threads, expulsion, or perforation. Key complications are expulsion, perforation (requires surgical removal), PID (treat with antibiotics, defer device removal to 72 hours), and ectopic pregnancy (emergency — exclude in any pregnant IUCD user). The NMC SH competency requires simulation-lab demonstration before clinical practice.

REFLECT

Reflect on your simulation session using Kolb's cycle. Concrete Experience: recall one specific step during the insertion sequence that felt uncertain or required correction — was it the sounding technique, the no-touch discipline, or the arm-release? Reflective Observation: what was the consequence of that uncertainty — did the task-trainer flag an error, or did your supervisor redirect you? Abstract Conceptualisation: what anatomical principle or technique rule underlies the correct action for that step? Active Experimentation: what specific adjustment will you make in the next practice session to consolidate that step? Write 3–5 sentences in your logbook after each simulation.