The use of long-acting reversible contraceptive (LARC) methods has shown a steady increase in the United States. The major factors for increasing acceptance include high efficacy, ease of use, and an acceptable adverse effect profile. Since these methods require placement under the skin (implantable device) or into the uterus (intrauterine devices [IUDs]), unique management issues arise during their usage. Recently, the American College of Obstetricians and Gynecologists (ACOG) released a committee opinion addressing several of these clinical challenges—among them: pain with insertion, what to do when the IUD strings are not visualized, and the plan of action for a nonpalpable IUD or contraceptive implant.1 In this article we present 7 cases, and successful management approaches, that reflect ACOG’s recent recommendations and our extensive clinical experience.
Overcoming LARC complications: 7 case challenges
The strings to your patient’s intrauterine device (IUD) are “missing.” Clinical experience and ACOG direction guide the management plans for this and more potential encounters with IUDs and implants.
Dr. Kattan is Assistant Professor, Department of Obstetrics and Gynecology, University of Massachusetts Medical School−Baystate, and Family Planning Section Head, Department of Obstetrics and Gynecology, Baystate Medical Center, Springfield, Massachusetts.
Dr. Burkman is Professor, Department of Obstetrics and Gynecology, University of Massachusetts Medical School−Baystate, and a practicing generalist obstetrician-gynecologist at Baystate Medical Center. He is an OBG Management Contributing Editor.
The authors report no financial relationships relevant to this article.