April 21st, 2018

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Title:
Levonorgestrel Intrauterine Device Placement: Survey of United States Obstetrician-Gynecologists
Authors:  Sabrina N. Wyatt, M.D., Yan Li, B.S., Jeff M. Szychowski, Ph.D., and Todd R. Jenkins, M.D.
  OBJECTIVE: To assess practice patterns of U.S. providers regarding levonorgestrel intrauterine device (IUD) placement techniques.

STUDY DESIGN: Members of the Society for Academic Specialists in General Obstetrics and Gynecology and the Ryan Residency Program Faculty were surveyed regarding practices for levonorgestrel IUD placement.

RESULTS: Of 363 invitations to participate, we received 132 responses. Survey responders practiced throughout the U.S., varied from 0–5 to 21+ years of practice, and were 81% female. Evaluation of adherence to manufacturer’s placement instructions revealed that only 7.5% of respondents always perform every recommended technique. Bimanual examination was always performed by 75% of respondents, with only 13% reporting rarely or never performing. Only 36% of respondents reported always changing into sterile gloves, and 36% have patients return for string checks. Tenaculum use and use of uterine sound prior to placement were steps eliminated by 30% and 20% of physicians, respectively. Use of ultrasound for placement evaluation during, immediately after, or at a later date was rare: only 2% of respondents answered anything other than “rarely” or “never.” Sixty-seven percent responded that they “rarely” or “never” premedicate patients for placement; 33% said they “always” or “frequently” premedicate. Of those, 48% use paracervical block and 92% use ibuprofen.

CONCLUSION: Among providers in the U.S., placement of levonorgestrel intrauterine devices is performed using varied techniques. Further investigation to determine best practices among these variations is warranted.
Keywords:  clinical practice guideline; clinical practice patterns; contraception; family planning; intrauterine devices; levonorgestrel; practice guideline; practice patterns, physicians’
   
   
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