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Who is not appropriate for Mirena
Use of Mirena is contraindicated in women with: known or suspected pregnancy and cannot be used for post-coital contraception; congenital or acquired uterine anomaly, including fibroids if they distort... Continue below
For complete insertion instructions, please refer to the accompanying full Prescribing Information for Mirena. Review the preparatory steps to ensure that the patient is appropriate for Mirena. Follow the insertion instructions exactly as described in order to ensure proper placement and avoid premature release of the intrauterine device (IUD) (Mirena)from the inserter. Once released, Mirena cannot be reloaded.
Proceed with the insertion only after completing the preparation steps and ascertaining that the patient is appropriate. Ensure use of aseptic technique throughout the entire procedure.
With the patient comfortably in lithotomy position, do a bimanual exam to establish the size, shape, and position of the uterus.
Gently insert a speculum to visualize the cervix.
Thoroughly cleanse the cervix and vagina with a suitable antiseptic solution.
Prepare to sound the uterine cavity. Grasp the upper lip of the cervix with a tenaculum forceps and gently apply traction to stabilize and align the cervical canal with the uterine cavity. Perform a paracervical block, if needed. If the uterus is retroverted, it may be more appropriate to grasp the lower lip of the cervix. This tenaculum should remain in position and gentle traction on the cervix should be maintained throughout the insertion procedure.
Gently insert a uterine sound to check the patency of the cervix, measure the depth of the uterine cavity, confirm cavity direction, and detect the presence of any uterine anomaly. If you encounter any difficulty or cervical stenosis, use dilatation, and not force, to overcome resistance. If cervical dilatation is required, consider using a paracervical block. The uterus should sound to a depth of 6 to 10 cm. Insertion of Mirena into a uterine cavity less than 6 cm by sounding may increase the incidence of expulsion, bleeding, pain, perforation, and possibly pregnancy.
Move slider all the way to the forward position to load Mirena
Advancing insertion tube until flange is 1.5 to 2 cm from the cervix
Do not force the inserter. If necessary, dilate the cervical canal.
Move the slider back to the mark to release and open the arms
Move Mirena into the fundal position
Move the slider all the way down to release Mirena from the insertion tube
Mirena insertion is now complete. Prescribe analgesics, if indicated. Record the lot number in the patient records.