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IUD technology has come a long way since the first plastic devices, such as the Lippes
Loop, appeared on the scene in the 1960s. Towards the end of that decade, it was discovered
that adding copper to the plastic made the IUD more effective in preventing pregnancy
and caused bleeding problems to occur less frequently.
The first copper-bearing IUDs were produced in the early 1970s, but they required replacement
every 2 to 3 years. Further research at the end of the 1970s produced IUDs with larger
quantities of copper: among the better known examples are TCu-380A, TCu-220C, and Multiload-375.
These devices not only reduced the incidence of side-effects compared with previous IUDs,
but also had significantly longer life spans and lower failure rates.
This video demonstrates the insertion technique for the TCu-380A IUD, which has been shown
in a Cochrane review to be more effective than other IUDs.
Have ready, in an easy-to-reach position, a vaginal speculum, the IUD to be inserted
and the applicator on a sterile surface.
Ensure that the woman is in a comfortable position. You should have already explained
the procedure to the woman and responded to her questions and concerns.
This helps the woman to relax, making insertion easier and less painful.
Perform a pelvic examination to rule out genital tract infections or abnormalities as well
as to ascertain the position of the uterus. You will need to follow appropriate infection-prevention
procedures, including the use of sterile instruments and cleaning of the *** with a water-based
antiseptic such as chlorhexidene.
Insert the speculum into the *** to have a clear view of the ***. Cleanse the surface
of the *** with an antiseptic swab.
Grasp the upper lip of the *** with a tenaculum forceps to allow, if needed, application of
gentle traction to straighten the angle between the cervical canal and uterine cavity.
Assess the angle of the cervical passage and depth of the uterine cavity by gently inserting
a uterine sound through the *** until you feel the sound has touched the fundus.
Note the depth of the uterus by counting the number of notches on the sound visible from
the ***.
The TCu-380A IUD comes with its inserter in sterile packaging. Using the "no-touch technique",
load the IUD into the inserter while both the IUD and the inserter are still in the
package. Here is how it is done. Pull back the inserter tube to let the IUD lie freely
in the loading capsule. Then, by squeezing on the sides of the loading capsule, bring
the horizontal arms of the IUD close to its vertical body.
Now push the inserter tube forward to capture the body and the two arms of the IUD in the
inserter tube.
Once the IUD is captured, it should be inserted into the uterus within a few minutes. Push
the blue *** on the inserter tube to a point that corresponds to the depth of the
uterus you had measured with the sound. Remove the loading capsule, but maintain traction
on the two strings at the lower end of the IUD to keep the device in position. Introduce
the plunger into the inserter tube until it reaches the lower end of the IUD.
Holding the tenaculum forceps with one hand to ease passage for the inserter tube, introduce
the loaded inserter tube into the cervical canal until the blue *** reaches the mouth
of the ***. Holding the plunger steady, pull back the inserter tube a couple of centimeters
to release the arms of the IUD inside the uterus. Then, first remove the plunger and
then the inserter tube.
The final step in the procedure is to cut the synthetic threads to about 2 cm from the
***.