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Johnson Lee Taylor DO; Johnson, Isaiah Micah MD; Heineck, Robert Jason MD; Lara-Torre, Eduardo MD
Obstetrics & Gynecology: May 2015
doi: 10.1097/01.AOG.0000463550.01588.fd
Monday, May 4, 2015: PDF Only

INTRODUCTION: Intrauterine device (IUD) placement requires applying an instrument on the cervix to stabilize the uterus. Pain or associated complications using different devices for stabilization has not been studied. Our primary aim was to compare pain perception immediately after IUD placement using an Allis clamp compared with a single-tooth tenaculum. Secondary aims included difference in pain 10 minutes after the procedure, bleeding that requires treatment from the instrument, and use of an alternative instrument.

METHODS: A randomized controlled trial of women undergoing placement of an IUD at the Carilion Clinic Residency Gynecology Clinic. Participants were randomized to have an Allis or a tenaculum used at the time of IUD insertion. Pain was measured using a visual analog scale immediately after instrument application and 10 minutes after the procedure. Associated complications with instrument placement were measured. Statistical analysis was performed using the Fisher's exact test and the t test.

RESULTS: Seventy-eight women were enrolled (38 Allis, 40 tenaculum). There was no difference in pain with median, interquartile range, immediately (23.5 mm, 8–55 mm compared with 31.5 mm, 7.5–69.5 mm, P=.39) or at 10 minutes after clamp placement (4.5 mm, 1–15 mm compared with 9 mm, 2.5–27 mm, P=.16) or a need to switch instruments (one compared with zero, P=.48). The tenaculum group required more interventions to stop bleeding with pressure (greater than 30 seconds) or cauterization (1 compared with 15, P<.001).

CONCLUSION AND IMPLICATION: There was no difference in pain between clamps. There was more bleeding requiring intervention using the tenaculum. Routine use of the Allis clamp during IUD insertion may decrease the incidence of instrument-related bleeding.

Financial Disclosure: The authors did not report any potential conflicts of interest.

© 2015 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.