The American College of Obstetricians and Gynecologists (ACOG) has issued a committee opinion on the clinical challenges of long-acting reversible contraceptive (LARC) methods, helping obstetrician-gynecologists and other gynecologic care providers to understand the diagnosis and management of common clinical challenges and possible complications associated with LARC. ACOG recommends the following:
• Routine misoprostol before intrauterine device (IUD) insertion in nulliparous women is not recommended, although it may be considered with difficult insertions.
• When IUD strings are not visualized, pregnancy should be excluded and a backup method of contraception and emergency oral contraceptives (if appropriate) should be recommended until the IUD is confirmed to be properly located in the endometrial cavity.
• Management of the nonfundal IUD varies depending on the position of the device and the patient’s symptoms. An IUD located within the cervix is partially expelled; given the increased risk of complete expulsion, the IUD should be removed (and replaced if the patient desires).
• If a woman becomes pregnant with an IUD in place, the IUD should be removed if strings are visible or if the IUD is within the cervix.
• Whenever an implant is not palpable, pregnancy should be excluded and the woman should be counseled to use a backup method of contraception until the presence of the implant is confirmed; emergency oral contraceptives, if appropriate, should be recommended.
• When the implant is not palpable, removal should not be attempted until implant location is determined.
American College of Obstetricians and Gynecologists. Clinical challenges of long-acting reversible contraceptive methods. Committee Opinion No. 672. Obstet Gynecol. 2016;128:e69–77.
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