FIGURE 38-3 Insertion of ParaGard T 380A. The uterus is sounded, and the IUD is loaded into its inserter tube not more than 5 minutes before insertion. A blue plastic flange on the outside of the inserter tube is positioned from the IUD tip to reflect uterine depth. The IUD arms should lie in the same plane as the flat portion of the oblong blue flange. A.The inserter tube, with the IUD loaded, is passed into the endometrial cavity. A long, solid, white inserter rod abuts the base of the IUD. When the blue flange contacts the cervix, insertion stops.
B. To release the IUD arms, the solid white rod within the inserter tube is held steady, while the inserter tube is withdrawn no more than 1 cm. C. The inserter tube, not the inserter rod, is then carefully moved upward toward the top of the uterus until slight resistance is felt. At no time during insertion is the inserter rod advanced forward. D. First, the solid white rod and then the inserter tube are withdrawn individually. At completion, only the threads should be visible protruding from the cervix. These are trimmed to allow 3 to 4 cm to extend into the vagina. (Reproduced with permission from Stuart GS: Contraception and sterilization. In Hoffman BL, Schorge JO, Bradshaw KD, et al: Williams Gynecology, 3rd ed. New York, McGraw-Hili Education, 2016.) the Food and Drug Administration (FDA), but it is no longer distributed by the manufacturer.
he irst progestin implants contained levonorgestrel (LNG), and systems are still available outside the United States. Jadelle, originally named Norplant-2, provides LNG and contraception for 5 years through two subdermally implanted Silastic rods. Ater this time, rods may be removed and if desired, new rods inserted at the same site (Bayer Group, 2015). Jadele is approved by the FDA, however, it is not marketed or distributed in the United States. Sino-implant II is a two-rod system with the same amount (150 mg) of LNG and same mechanism of action asJadele but provides 4 years of contraception. Sinoimplant II is manufactured in China and approved for use by 20 countries in Asia and Mrica (FHI 360, 2012).
Like the etonogestrel implant, these systems are placed subdermally on the inner arm approximately 8 cm from the elbow and have similar removal steps. Implants vary regarding their insertion technique, and manufacturer instructions should be consulted. Both implant systems are highly efective (Sivin, 1998; Steiner, 2010).
he forerunner of these implants was the Norpant System, which provided LNG in six Silastic rods implanted subdermally. The manufacturer stopped distributing the system in 2002.
Few data compare the LNG and etonogestrel implants. In one, eicacy and discontinuation rates by 2.5 years of use were similar (Bahamondes, 2015).
Unscheduled bleeding is common with progestin-only methods and described on page 689. Device-specific adverse efects derive mainly from malpositioning. First, branches of the medial antebrachial cutaneous nerve can be injured during implant or needle insertion that is too deep or during exploration for a lost implant. Clinically, numbness and paresthesia over the anteromedial aspect of the forearm are noted (Wechselberger, 2006).