Which of the following option is contraindication of IUD insertion?

NORCET 3 - 2022 (Shift-2)

Obstetrics & Gynaecology (E5)

Easy

Appeared in: NORCET 3 - 2022 (Shift-2)

Explanation

Unexplained vaginal bleeding is an absolute contraindication for IUD insertion.
This symptom requires investigation before the procedure to rule out serious underlying pathology, such as pregnancy, malignancy (cervical or endometrial cancer), or pelvic inflammatory disease (PID).
Inserting an IUD without a diagnosis could delay treatment for a serious condition or exacerbate an existing infection.
According to the WHO Medical Eligibility Criteria (MEC), unexplained vaginal bleeding is a Category 4 condition for IUD initiation, meaning it represents an unacceptable health risk.

Option B: A history of multiple pregnancy is not a contraindication for future IUD use. IUDs are inserted for contraception after a pregnancy has concluded.
Option C: Lactation is not a contraindication. Both copper IUDs and hormonal IUDs are considered safe for use during breastfeeding.
Option D: Gestational hypertension is a condition of pregnancy and does not preclude the use of an IUD after delivery.

Visual 1: Table: WHO Medical Eligibility Criteria (MEC) for Contraceptive Use, highlighting categories 1-4 for IUDs.
Visual 2: Flowchart: Pre-procedural assessment for IUD insertion, showing the step where unexplained vaginal bleeding leads to further investigation rather than 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.
Patient safety is paramount. Always perform a thorough history and assessment before any procedure, including IUD insertion, to identify contraindications.
Unexplained vaginal bleeding is a red flag that requires a full workup, including a pelvic exam, appropriate imaging (like ultrasound), and potentially a biopsy, to establish a diagnosis before proceeding with an intrauterine procedure.
What if? If the unexplained bleeding was investigated and found to be due to benign endometrial polyps, the course of action would change. The polyps might be removed first, and then an IUD could be considered. If the cause was heavy menstrual bleeding with no pathology, a hormonal IUD (like Mirena) might even be recommended as a treatment.

How to Approach the Question

Identify the core of the question: It asks for a contraindication, which is a reason not to perform a procedure.
The procedure is IUD insertion, a common form of contraception.
Review the options in the context of patient safety. An IUD is placed inside the uterus.
Analyze each option: 'Unexplained vaginal bleeding' suggests a potential underlying problem (like cancer or infection) that could be worsened or masked by an IUD. This is a major safety concern.
Options like 'Multiple pregnancy' and 'Gestational Hypertension' are related to a past pregnancy and don't affect postpartum contraception choices.
'Lactating women' is a common patient group seeking contraception, and IUDs are known to be safe for them.

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