PPIUCD Insertion Instruments and Techniques

Instrument Selection

The American College of Obstetricians and Gynecologists recommends using ring forceps or Kelly placental forceps for PPIUCD insertion after vaginal delivery, as they provide optimal fundal placement and lower expulsion rates compared to other insertion methods 1, 2
Ring forceps or Kelly placental forceps are the recommended instruments for grasping the IUD wings during insertion after vaginal delivery, with additional ring forceps used to grasp and stabilize the anterior lip of the cervix 1, 2, 3
Manufacturer's inserter can be used but has shown higher rates of partial expulsion (10.8% vs 5.0%) and lower IUD retention at 6 weeks (72.2% vs 83.7%) compared to forceps 1, 4

Change into new sterile gloves before beginning the procedure, and remove the IUD from its original inserter 1, 2
Cut the IUD strings to approximately 10-12 cm, and cleanse the cervix with betadine or another antiseptic solution 1, 2, 5
Use a hand or retractor to visualize the cervix, and grasp the anterior lip of the cervix with ring forceps 1, 2
Carefully grasp the IUD wings with ring or Kelly placental forceps, and pass the device through the cervix with gentle cervical retraction and under full visualization 1, 2
Palpate the uterine fundus abdominally to confirm fundal placement of the device 1, 4

Higher IUD retention rates at 6 weeks (83.7% with forceps vs. 72.2% with inserter), and lower rates of partial expulsion (5.0% with forceps vs. 10.8% with inserter) 1, 4
Better ability to achieve high fundal placement, which decreases expulsion rates, and more precise control during insertion compared to manual insertion 1, 2

Transabdominal ultrasound may be useful to guide insertion and ensure fundal placement after vaginal delivery, and high fundal placement of the IUD has been shown to decrease expulsion rates 1, 2
Proper training specific to immediate postpartum IUD placement is recommended for providers, and expulsion rates are higher with immediate postpartum insertion compared to interval insertion but can be minimized with proper fundal placement using appropriate instruments 1, 3