An intervention to manage difficult IUD insertions
Awarded 2012
Complex Family Planning Fellowship Research
Amna Dermish, MD
The University of Utah

Objectives: To assess whether a targeted educational intervention, with skills training in cervical dilation and paracervical anesthesia, will increase IUD insertion success rates.
Study Design: This was a prospective study of an intervention aimed at improving IUD insertion success among a group of advanced practice clinicians (APCs) at family planning clinics in Utah. Data were collected on IUD insertions in eligible women during 2 observation phase: phase 1 occurring prior to the intervention, and phase 2 following. APCs were recruited from among current employees at the clinics.
Results: We recruited 261 patient participants for each phase of the study, and 13 clinicians participated in the intervention. Patients in both phases had similar characteristics. During phase 1, 33/261 insertions were unsuccessful (12.6%). This dropped to 10/261 during phase 2 (3.8%). Insertion failure was over 3 times more likely in the pre-intervention compared to post-intervention group (OR=3.48 95% CI 1.48-9.28, p = 0.002). Inability to pass the sound was the top reason cited for an unsuccessful insertion prior to the intervention. Nulliparity was associated with an increased risk of insertion failure during phase 1, but not during phase 2.
Conclusions: Participation in the training intervention resulted in a significant decrease in the rate of failed IUD insertions among the clinicians in this study. Increasing use of IUDs necessitates further investigation into methods to improve insertion techniques for all clinicians, especially in settings with documented high insertion failure rates.