Heavier bleeding, indicating possibility of anemia. Remove if pregnancy has occurred due to risk of ectopic pregnancy or if exposed to conditions that substantially increase risk of pelvic inflammatory disease. Perform thorough medical history & pelvic exam to exclude contraindications ie, vag & cervical infections. Take vag & cervical culture prior to insertion of IUD to prevent pelvic inflammatory disease. Perform pelvic exam to determine position of IUD for correct insertion. Re-examine after 1 mth for proper placement of IUD & signs of infection. Pelvic inflammatory disease during IUD use should be treated w/o delay. Assess excessive bleeding or dysmenorrhea during the 1st cycle after insertion. Consider possibility of uterus perforation during insertion.
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