IUCD should not be inserted if?

Hariyana-CHO-2021

Obstetrics & Gynaecology

Medium

Appeared in: Hariyana-CHO-2021

Explanation

The correct option is 'All of the above' because each listed sign is a significant contraindication to IUCD insertion.
Pain on cervical movement (cervical motion tenderness) is a classic sign of Pelvic Inflammatory Disease (PID), an absolute contraindication.
An enlarged and tender uterus raises suspicion for pregnancy or endometritis, both of which preclude IUCD placement.
A hard, non-mobile cervix that bleeds on touch is a red flag for cervical malignancy or severe cervicitis, requiring investigation before insertion.
Inserting an IUCD in the presence of these conditions can lead to serious complications, including worsening of infection, septic abortion, or delayed diagnosis of cancer.

Option A: This option is correct in that painful cervical movement is a contraindication, but it is incomplete. The other options also list valid contraindications.
Option B: Similar to option A, an enlarged and tender uterus is a valid reason to avoid IUCD insertion, but it is not the only reason listed. The question implies finding all correct contraindications.
Option C: This option describes signs suspicious for cervical cancer or severe inflammation, which is a definite contraindication. However, it is not the only correct statement among the choices.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Contraindications for IUCD Insertion as background academic context rather than a clinical decision trigger.
A nurse's primary role during contraceptive counseling and pre-procedural assessment is patient safety. Thoroughly screening for contraindications prevents serious harm.
Accurate documentation of the pelvic exam findings (e.g., 'no cervical motion tenderness,' 'uterus anteverted, mobile, non-tender') is crucial legal and clinical proof that a proper assessment was done.
What if? A patient has a history of PID treated over a year ago and is now in a monogamous relationship with no symptoms. In this case, after counseling, an IUCD is generally considered safe to insert as the history of a treated PID is not an absolute contraindication, unlike an active infection.

How to Approach the Question

First, analyze the question stem. It asks for conditions under which an IUCD 'should not' be inserted, meaning you are looking for contraindications.
Evaluate each option individually. Ask yourself, 'Is this a valid reason to avoid placing an IUCD?'
Consider Option A: 'Cervical movement is painful.' This is cervical motion tenderness, a sign of PID. An IUCD is contraindicated.
Consider Option B: 'Uterus is enlarged and tender.' This could be pregnancy or infection. An IUCD is contraindicated.
Consider Option C: 'Cervix is not mobile, hard or bleeds to touch.' These are warning signs for cancer. An IUCD is contraindicated until this is ruled out.
Recognize that options A, B, and C are all correct contraindications. Therefore, the most comprehensive and accurate answer is 'All of the above'.

Concept Tested & Keywords

Concept Tested: Contraindications for IUCD Insertion
Stem keywords: IUCD, inserted
Lead-in keywords: should not
Negative lead-in flag: The question uses the negative phrase 'should not', asking for reasons to avoid the procedure.

QjTm3igTmnKCgOr3hTUIrM

E6 Gynecology Williams p. 118-146

E6 Parks TextBook of Preventive & Social Medicine part 1 — Subpart C (pp 404-604 of 604) p. 191-193