OG35.18 | IUD Procedural Skill — Summary & Reflection

KEY TAKEAWAYS

The IUCD is among the most effective reversible contraceptive methods (failure rate below 1% per year for CuT 380A; up to 10 years effective life). Patient selection uses the WHO MEC framework: absolute contraindications (Category 4) include current pregnancy, puerperal sepsis within 3 months, active PID, unexplained vaginal bleeding, uterine cavity distortion, and uterine or cervical malignancy. The CuT 380A (copper, 10-year life) is the standard device in India's RMNCH+A programme; the LNG-IUS (5-year life) reduces menstrual flow and is preferred for heavy menstrual bleeding. The critical insertion steps are: bimanual examination, cervical cleaning with aseptic technique, uterine sounding (target 6-8 cm), depth indicator setting, fundal insertion, and the withdrawal technique (tube withdrawn while rod held stationary). PPIUCD is inserted manually at vaginal delivery immediately after placental delivery, or through the uterotomy at caesarean section. Mild-to-moderate IUCD-associated PID is treated with antibiotics while leaving the device in situ. Missing threads require transvaginal ultrasound as the first investigation. If an IUCD user has a positive pregnancy test, ectopic pregnancy must be actively excluded by urgent ultrasound.

REFLECT

Reflect on the challenge of IUCD counselling in India's national family planning programme. The copper IUCD is among the most effective, cost-effective, and equitable contraceptive methods available — yet IUCD use in India remains low (NFHS-5: 2.1% of contraceptive users). What do you think are the main barriers — misconceptions about safety, provider bias toward sterilisation, community cultural factors, or healthcare system gaps? How would you counsel a woman who believes that the IUCD 'causes infections' or 'always falls out'? Consider the PPIUCD programme: what unique ethical tensions arise when contraceptive counselling must happen in the antenatal period but the decision is often revisited or declined at the time of delivery under the pressure of labour? How would you ensure that your PPIUCD counselling respects autonomy while maximising uptake of an effective service?