From the Guidelines
To perform uterine sounding for a Skyla (levonorgestrel-releasing intrauterine system), a bimanual examination and cervical inspection are essential, but uterine sounding itself is not explicitly required as a separate step before insertion, according to the guidelines 1.
Pre-Insertion Requirements
Before inserting a Skyla IUD, several steps and considerations are crucial for safe and effective placement:
- Determining the patient's pregnancy status
- Conducting a blood pressure evaluation if hormonal contraception is being considered
- Performing a bimanual examination and cervical inspection to assess the uterus and cervix for any abnormalities or conditions that might contraindicate IUD placement, such as purulent cervicitis or current chlamydial infection or gonorrhea 1
- Considering the patient's medical history, including conditions like liver disease, thrombogenic mutations, and iron-deficiency anemia, although screening for these conditions is not necessarily required before IUD insertion 1
Uterine Sounding
While the provided evidence does not explicitly discuss uterine sounding as a required step for Skyla IUD insertion, clinical practice often involves assessing uterine depth and direction to ensure proper placement and minimize risks like perforation.
- The procedure typically involves using a uterine sound after placing a speculum and cleansing the cervix.
- The depth and direction of the uterus are determined to guide the insertion of the IUD, ensuring it is placed correctly at the fundus.
- For Skyla, which is 28 mm wide and 30 mm long, a uterine depth of at least 6 cm is often considered necessary for proper positioning, although this specific measurement is not mentioned in the provided guidelines.
Key Considerations
- Bimanual examination and cervical inspection are classified as essential (Class A) for the safe and effective use of IUDs, including the levonorgestrel-releasing intrauterine system 1.
- Other examinations or tests, such as blood pressure, clinical breast examination, and laboratory tests for glucose, lipids, liver enzymes, hemoglobin, thrombogenic mutations, cervical cytology, and HIV screening, are considered based on individual patient needs and risk factors, but are not universally required before IUD insertion 1.
- The guidelines emphasize that requiring additional preventive services should not introduce barriers to contraceptive care, suggesting a tailored approach to pre-insertion assessments 1.
From the Research
Uterine Sounding for Skyla (Levonorgestrel-Releasing Intrauterine System)
To perform uterine sounding for a Skyla (levonorgestrel-releasing intrauterine system), the following are required:
- A bimanual examination to determine the uterus position
- A sounding of the uterus to determine the depth of the uterine cavity 2 However, a study in 2016 found that uterine sounding was not needed for IUD insertion, and a simplified technique without prior pelvic examination or uterine sounding was feasible 3
Alternative Methods
Alternatively, transvaginal ultrasonography can be used to confirm device placement and assess the uterine cavity 4, 3 Ultrasound guidance can also be used for the removal of retained IUDs, providing a safe and cost-effective method 5
Instrumentation
Various instruments can be used for uterine manipulation, such as the hysterophore, which provides an intra-uterine sound variable in length and direction 6