Allis Clamp for Cervical Stabilization During Intrauterine Device Insertion: Time for a Change [6G

Abstract

INTRODUCTION: Intrauterine devices (IUDs) are a common choice for contraception. A cervical stabilization device is recommended to provide cervical traction and to reduce the uterocervical angle. The device instructions recommend using a single tooth tenaculum. A tenaculum is a traumatic clamp which causes bleeding at the clamp site. We hypothesized that use of an atraumatic Allis clamp would require less hemostatic interventions. METHODS: The study was a randomized control trial of 95 IUD insertions. The physicians were randomized to use the Allis clamp or a tenaculum for cervical stabilization. The primary outcome was cervical site bleeding after clamp removal. Other outcomes were the number of interventions required for hemostasis and success of IUD placement. Statistical analyses were performed using the Fisher exact test and Chi-squared test. RESULTS: Bleeding was present after clamp removal in 3 (6.3%) insertions using an Allis clamp and 26 (55.3%) insertions using a single tooth tenaculum, P<.0001. Bleeding was absent in 45 (93.8%) insertions using an Allis clamp and 21 (44.7%) insertions using a single tooth tenaculum, P<.0001. There was no difference in the number of interventions required for hemostasis when bleeding occurred after clamp removal. There was no difference in IUD insertion success rates between the two clamps. CONCLUSION: The Allis clamp can be successfully used in place of a single tooth tenaculum for cervical stabilization during IUD insertion. The Allis clamp is associated with less bleeding and less need for hemostatic interventions after clamp removal. The Allis clamp is a better device for cervical stabilization during IUD insertion.