Peer Responses:
Length: A minimum of 275 words per post, not including references
Citations: At least one high-level scholarly reference in APA per post from within the last 5 years
During my OB rotation, I have assisted and performed many procedures, including Nexplanon placement and removal, intrauterine device (IUD) placement and removal, and many PAP smears. An IUD placement of the Mirena seems to be the second most popular birth control method chosen among the patients I have seen during this rotation. The Mirena is a levonorgestrel-releasing 52mg IUD that releases 20 mcg/day and gradually decreases to 10 mcg/day at year five (Madden, 2022). An IUD is T-shaped with a polyethylene frame that is 32 by 32 mm wide (Madden, 2022). The collar of the IUD has 52mg of levonorgestrel within the vertical stem. There is a string attached to the tail end of the stem for removal (Madden, 2022). The entire device contains barium so that it is discoverable on a radiograph in case of migration within the uterus (Madden, 2022). The Mirena can stay within the uterus for up to 8 years to prevent pregnancy or 5 years when used to treat heavy menstrual bleeding (Madden, 2022; Mirena, 2023).
Insertion of the Mirena IUD takes training and practice for successful insertion. Before insertion, the provider must screen the patient for contraindications which include known or suspected pregnancy, post-coital contraception, congenital or uterine abnormalities such as fibroids, known or suspected breast cancer or progestin sensitive cancers presently or in the past, known or suspected uterine or cervical malignancy, liver disease, cervicitis, vaginitis, postpartum endometritis, or pelvic inflammatory disease (Mirena, 2023). Risks, benefits, and non-contraceptive effects should be discussed, screen for sexually transmitted infections, and a pregnancy test should be obtained before insertion (Bartz & Pocius, 2023). Antibiotic therapy and the use of analgesics are not necessary for the procedure. Nonsteroidal anti-inflammatory medication such as ibuprofen 800 mg can be administered before the insertion to assist with pain (Bartz & Pocius, 2023).
A pelvic exam is performed to determine the size and position of the uterus and to assess for any active signs of genital infections (Bartz & Pocius, 2023). A speculum is inserted, the cervix is visualized, cultures are obtained, and the cervix is cleaned with an antiseptic solution (Bartz & Pocius, 2023). A single-toothed tenaculum is used to grasp the anterior lip of the cervix to assist with proper angling of the uterus and ease of placement of the IUD (Bartz & Pocius, 2023). Sounding the uterus is the next step in the IUD placement process. Sounding includes placing gentle traction on the tenaculum, and the uterine sound is passed through the cervix until it meets the fundus of the uterus. The uterus depth is then measured to ensure that the IUD device will fit appropriately in length (Bartz & Pocius, 2023). Once the uterus measurement is obtained, the Mirena package is opened, and sterile gloves are dawned (Mirena, 2023).
The Mirena is then loaded into the insertion tube by pushing the slider on the device until it meets resistance and covers the Mirena arms. The flange on the insertion tube is then positioned by sliding it to the measured uterine depth obtained during sounding (Mirena, 2023). The insertion tube of the Mirena device is then placed into the cervix until the flange is 1.5-2 cm from the cervix, and a pause is then necessary. The slider on the Mirena device is then slid back to lower the insertion tube and open the arms of the Mirena (Mirena, 2023). A pause for 10 seconds is then completed to allow the arms to expand and open completely. Then the entire Mirena device is moved forward until the flange meets the cervix (the measured depth of the uterus during sounding), and the tip of the insertion device meets the fundus (Mirena, 2023). The Mirena is then released by sliding the withdraw inserter down to dispense the Mirena from the insertion tube. The insertion tube is further withdrawn from the Mirena, down the strings until the strings are left outside the cervix (Mirena, 2023). The strings are then cut to about 3 cm, so it is visible outside the cervix. The Mirena is now in place, and a follow-up appointment should be within 4-6 weeks to assess placement and to check for the string (Mirena, 2023).
References
Bartz, D. A., & Pocius, K. D. (2023). Intrauterine contraception: Insertion and removal (C. A. Schreiber & K. Eckler, Eds.). UpToDate. Retrieved March 22, 2023, from https://www.uptodate.com/contents/intrauterine-contraception-insertion-and-removal?search=iud%20insertion%26source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
Madden, T. (2022). Intrauterine contraception: Background and device types (C. A. Schreiber & K. Eckler, Eds.). UpToDate. Retrieved March 22, 2023, from https://www.uptodate.com/contents/intrauterine-contraception-background-and-device-types?search=Mirena%26source=search_result&selectedTitle=2~79&usage_type=default&display_rank=1#H2153865820
Mirena. (2023, January). Mirena® insertion and removal. Bayer. Retrieved March 22, 2023, from https://www.mirenahcp.com/insertion-and-removal
Peer Responses: Length: A minimum of 275 words per post, not including reference
Need help Working on This or a Similar Assignment?
We specialize in custom-written, original papers. No prewritten essays here—order your plagiarism-free and AI-free paper today for guaranteed originality.