Insertion of IUD can be done in all of the following conditions, except?

AIIMS CRE SNO - 2023

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS CRE SNO - 2023

Explanation

Unexplained vaginal bleeding is an absolute contraindication for IUD insertion as per gynecological guidelines.
The primary reason is the need to first rule out serious underlying causes such as pelvic inflammatory disease (PID), uterine or cervical malignancy, or other pelvic tumors.
Inserting an IUD without a diagnosis could potentially worsen an existing infection or delay the diagnosis and treatment of cancer.

Option B: Multiparity, or having had multiple births, is not a contraindication for IUD use.
Option C: Hypertension is not a contraindication for copper IUDs. It is also generally not a contraindication for progestin-releasing IUDs as the hormonal effect is primarily local with minimal systemic absorption.
Option D: Diabetes Mellitus is not a contraindication for IUD use. Both copper and hormonal IUDs are considered safe and effective for women with diabetes.

Visual 1: Table: WHO Medical Eligibility Criteria for IUDs - A chart showing the different categories of risk (1-4) and where conditions like unexplained bleeding, hypertension, and diabetes fall.
Visual 2: Infographic: Red Flag Symptoms in Gynecology - A visual guide highlighting symptoms like unexplained vaginal bleeding that require immediate investigation before procedures like IUD insertion.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for Intrauterine Device (IUD) insertion as background academic context rather than a clinical decision trigger.
A nurse's primary role during contraceptive counseling is to conduct a thorough patient history and screening. Asking specifically about abnormal bleeding patterns is a critical safety check before IUD insertion.
Patient education is key. The nurse must explain why investigating the bleeding is necessary before placing the IUD, ensuring the patient understands the potential risks of proceeding without a diagnosis.
What if? If a patient with hypertension also had a distorted uterine cavity due to large fibroids, the distorted cavity would be the contraindication, not the hypertension itself.

How to Approach the Question

First, identify the negative framing of the question, indicated by the word 'except'. This means you are looking for the option that is the exception—the one condition that is a contraindication.
Review each option and evaluate its status as a contraindication for IUD insertion.
Recall the absolute and relative contraindications for IUDs. Absolute contraindications are conditions where the method should not be used under any circumstances.
Recognize that 'unexplained vaginal bleeding' is a major red flag in gynecology and an absolute contraindication for most intrauterine procedures until a cause is identified.
Eliminate the other options. Multiparity, controlled hypertension, and diabetes are not considered contraindications for IUD use.

Concept Tested & Keywords

Concept Tested: Contraindications for Intrauterine Device (IUD) insertion.
Stem keywords: IUD insertion, conditions
Lead-in keywords: except
Negative lead-in flag: The question uses the word 'except', asking to identify the one condition that is a contraindication for IUD insertion.

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