Ultrasound guidance is an important element in the painless placement and safe extraction of intrauterine contraceptives
ESC Congress Library. Bajka M. May 10, 2018; 208076; ESC36 Disclosure(s): Occasionally, MB works as rewarded medical consultant for Bayer.
Michael Bajka
Michael Bajka
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Objective: To date, no intervention has been found to consistently reduce pain during or after the placement of a modern intrauterine contraceptive (IUC). We explored the ultimate pain reduction achievable with the use of ultrasound guidance combined with further measures to optimize women's comfort during routine IUC placement. Design and methods: Prospective non-randomized open single operator trial. All placements were performed by one very experienced OB/GYN. First 24 months (period one): cervix grasper (tenaculum) replaced with transabdominal ultrasound (TAS) guidance combined with moderate urinary bladder filling (MBF). Subsequent 24 months (period two): in addition, application of low-dose misoprostol combined with oral diclofenac six to 12 hours before placement, avoidance of separate cervix dilation and contact with the internal fundus, proceeding slowly. Primary endpoints: individual's pain score, correct IUC positioning. Secondary endpoints: occurrence of perforation, the need for tenaculum or separate dilation. Results: A total of 290 IUC placements, 133 in period one, 157 in period two. All 183 placements and 107 replacements could be successfully completed. Average pain score (scale 0 to 10) overall 0.552 (period one 0.617, period two 0.497, p = 0.016). No perforation occurred. A tenaculum was only needed in six placements (2.1 %). Separate dilation regularly used in period one (100 %) could be avoided in 152 of 157 placements in period two (3.2 %). Conclusion: In routine IUC placement by an expert, TAS guidance with MBF combined with further measures was the key to effectively managing women's discomfort and achieving an average pain score substantially below 1.000.
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