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In recent years, use of highly effective reversible contraceptives has risen — and subdermal contraceptive implants as well as intrauterine contraceptives (IUCs) both have excellent safety records. To aid in the management of clinical challenges with these contraceptives, the American College of Obstetricians and Gynecologists (ACOG) has published new algorithms. Key points include the following:
For nulliparous women, routine use of misoprostol before IUC placement is generally not recommended.
When IUC strings cannot be located, pregnancy must be excluded and alternative contraception recommended until the proper location of the IUC in the endometrial cavity is confirmed.
An IUC located within the cervix should be removed (and replaced with …