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Long-Acting Reversible Contraceptive (LARC)
Methods
Obstet
Gynecol; ePub 2016 Sep;
ACOG
Committee on Gynecologic Practice September 5, 2016
The American College of Obstetricians
and Gynecologists (ACOG) has issued a committee opinion on
the clinical challenges of long-acting reversible
contraceptive (LARC) methods, helping
obstetrician-gynecologists and other gynecologic care
providers to understand the diagnosis and management of
common clinical challenges and possible complications
associated with LARC. ACOG recommends the following:
• Routine misoprostol before intrauterine device (IUD)
insertion in nulliparous women is not recommended, although
it may be considered with difficult insertions.
• When IUD strings are not visualized, pregnancy should be
excluded and a backup method of contraception and emergency
oral contraceptives (if appropriate) should be recommended
until the IUD is confirmed to be properly located in the
endometrial cavity.
• Management of the nonfundal IUD varies depending on the
position of the device and the patient’s symptoms. An IUD
located within the cervix is partially expelled; given the
increased risk of complete expulsion, the IUD should be
removed (and replaced if the patient desires).
• If a woman becomes pregnant with an IUD in place, the IUD
should be removed if strings are visible or if the IUD is
within the cervix.
• Whenever an implant is not palpable, pregnancy should be
excluded and the woman should be counselled to use a backup
method of contraception until the presence of the implant is
confirmed; emergency oral contraceptives, if appropriate,
should be recommended.
• When the implant is not palpable, removal should not be
attempted until implant location is determined.
Citation: American College of
Obstetricians and Gynecologists. Clinical challenges of
long-acting reversible contraceptive methods. Committee
Opinion No. 672. Obstet Gynecol. 2016;128:e69–77.
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