WEBVTT

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[silence]

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This leader permits the projectionist

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to adjust focus and sound
for the picture that follows

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the insertion and removal
of the intrauterine device or IUD.

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This IUD is the Lippes loop.

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It is a small, flexible plastic device.

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It rests in the uterine cavity and is
highly effective in preventing pregnancy.

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The Lippes loop is designed
to be straightened out

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and inserted through a plastic tube.

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As shown on this model,
the tube called the inserter

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is slipped into the cervical canal
and the device is pushed into the uterus.

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Once inside the uterine cavity,
the IUD recoils to its original shape

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and may remain in place for many years.

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The threads enable the patient
to determine that the IUD is in place.

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They also permit easy removal.

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The IUD differs
from all other methods of contraception

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in that, once inserted,
it requires little further attention.

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As shown in these drawings,
the technique of insertion depends

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on the doctor's ability
to locate accurately

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the position of the uterus,
the anterior position, the mid position,

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the posterior position,

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and to place the IUD
in the frontal plane of the uterine cavity.

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The instruments needed for insertion
are the speculum, the sponge forceps,

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the inserter, the plunger, and the IUD.

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The metal instruments are sterilized.

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Since the plastics cannot be boiled,
they are sterilized in iodine solution.

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Preparation of the solution is as follows.

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To tap water,

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tincture of iodine
is added until an orange color is obtained.

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Yellow is not strong enough.

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The plastic equipment should be immersed

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in the orange iodine solution
for five minutes before using.

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The sterile tray is set up for the patient.

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The clinical procedure
begins with the insertion of the speculum.

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Then the physician takes
a Papanicolaou smear

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if none was obtained during the last year.

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Next, he performs a bimanual examination
to detect any abnormalities

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and to note the uterine position.

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With the routine examination completed,
the speculum is reinserted.

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The cervix is swabbed with cotton.

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Sterile gloves are put on
before handling the Lippes loop.

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Because the plastic
devices have a limited ability to recoil,

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the IUD is placed in the inserter
immediately before the actual insertion.

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The IUD should be loaded
so that when the black indicator

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is horizontal at the cervical os,
the IUD will extrude in the frontal plane.

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The inserter is slipped gently
into the cervical canal past

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the internal os

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and the IUD is inserted.

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The plunger is removed first

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so that the strings will not be caught
and the device accidentally pulled out.

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On some patients,

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abdominal pressure will simplify insertion
by straightening an anterior uterus.

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Press, hold, push in.

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Occasionally, the uterus may need
to be straightened with a tenaculum.

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A uterine sound will help
to confirm the position of the uterus.

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The inserter passes easily
into the straightened uterus

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and the IUD  is inserted.

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A fluoroscopic view of the pelvis shows

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the speculum with a Lippes loop entering
the frontal plane of the uterine cavity.

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In the normal procedure,
after the routine examination,

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the speculum is reinserted.

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The cervix is swabbed with cotton.

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The inserter is pushed in gently
to the black rubber mark

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and the IUD is inserted.

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The ID may cause increased menstrual flow
during the third three months.

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The plunger
and then the inserter are removed.

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The strings should be in place
at the cervical os.

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The IUD can be removed easily
by pulling the strings.

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In brief review,

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if the physician notes accurately
the position of the uterus,

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if he places the IUD so that it will enter
the frontal plane of the uterine cavity,

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insertion  is performed without difficulty.