Safety and Efficacy of an Atraumatic Uterine Cervical Traction Device: A Pilot Study

Hélène Legardeur, Gessica Masiello-Fonjallaz, Martine Jacot-Guillarmod, Patrice Mathevet, Hélène Legardeur, Gessica Masiello-Fonjallaz, Martine Jacot-Guillarmod, Patrice Mathevet

Abstract

Introduction: Alignment of the uterine cervix with the vaginal canal is often required during insertion of an intrauterine contraceptive device (IUD). Currently available instruments are traumatic tenacula, which can cause pain and bleeding and represent an obstacle for certain patients to pursue their medical follow-up. A novel investigational cervical vacuum tenaculum, enables atraumatic traction of the cervix using a semi-circular suction pad, designed to conform to the anatomical shape of the external cervical os. Suction is generated by manually pulling out a sliding tube in a vacuum chamber. Methods: We performed a single arm non-comparative pilot study to assess the safety and efficacy of the cervical vacuum tenaculum in 13 women receiving an IUD. Data on procedural efficacy, safety, patient-reported pain scores at specific time points during IUD insertion procedure and patient satisfaction were collected prospectively. Results: Insertion of IUD was successful with use of the study device in 7 of the 13 enrolled patients (54%). No bleeding or only limited ecchymosis were caused by the device. No adverse events were reported. Participants reported very little pain (mean Visual Analog Scale <10) when applying the device. Participants who achieved IUD insertion with the device reported strong overall satisfaction with the procedure. Conclusions: The suction-based atraumatic tenaculum can be used to manipulate the cervix during IUD insertion with satisfactory efficacy and safety. The results of this pilot study support further studies of this device in larger populations comparing with standard single-tooth tenaculum. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT04441333.

Keywords: atraumatic tenaculum; bleeding; cervix; intrauterine contraceptive device; pain.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Legardeur, Masiello-Fonjallaz, Jacot-Guillarmod and Mathevet.

Figures

Figure 1
Figure 1
The suction-based atraumatic tenaculum used in the study. 1. Main body; 2. Slider ring to apply and release suction; 3. Sliding tube to generate vacuum; 4. Semi-circular suction pad for affixation to the cervix.
Figure 2
Figure 2
Study flow chart.

References

    1. Lopez LM, Bernholc A, Zeng Y, Allen RH, Bartz D, O'Brien PA, et al. . Interventions for pain with intrauterine device insertion. Cochrane Database Syst Rev. (2015) CD007373. 10.1002/14651858.CD007373.pub3
    1. Kucukgoz Gulec U, Khatib G, Guzel AB, Akil A, Urunsak IF, Ozgunen FT. The necessity of using tenaculum for endometrial sampling procedure with pipelle: a randomized controlled study. Arch Gynecol Obstet. (2014) 289:349–56. 10.1007/s00404-013-3005-7
    1. Doty N, MacIsaac L. Effect of an atraumatic vulsellum versus a single-tooth tenaculum on pain perception during intrauterine device insertion: a randomized controlled trial. Contraception. (2015) 92:567–71. 10.1016/j.contraception.2015.05.009
    1. Karaman E, Çim N, Alkiş I, Yildirim A, Yildizhan R. Rectal indomethacin use in pain relief during hysterosalpingography: a randomized placebo controlled trial. J Obstet Gynaecol Res. (2016) 42:195–201. 10.1111/jog.12863
    1. Potter J, Rubin SE, Sherman P. Fear of intrauterine contraception among adolescents in New York City. Contraception. (2014) 89:446–50. 10.1016/j.contraception.2014.01.011
    1. Dawood A, Raslan M. A new technique for minimizing cervical trauma and enhancing surgical performance in gynecological procedures requiring cervical dilatation. Int J Gynecol Clin Pract. (2017) 4:126. 10.15344/2394-4986/2017/126
    1. Johnson LT, Johnson IM, Heineck RJ, Lara-Torre E. Allis compared with tenaculum for stabilization of the cervix during iud placement: a randomized controlled trial [20]. Obstetr Gynecol. (2015) 125:6S–7. 10.1097/01.AOG.0000463550.01588.fd
    1. Speedie JMM, Mansour D, Landy R, Clement KM. A randomised trial comparing pain and ease of use of two different stabilising forceps for insertion of intrauterine contraception. J Fam Plann Reprod Health Care. (2016) 42:241–6. 10.1136/jfprhc-2016-101446
    1. Crawford M, Davy S, Book N, Elliott JO, Arora A. oral ketorolac for pain relief during intrauterine device insertion: a double-blinded randomized controlled trial. J Obstet Gynaecol Can. (2017) 39:1143–9. 10.1016/j.jogc.2017.05.014
    1. Elkhouly NI, Maher MA. Different analgesics prior to intrauterine device insertion: is there any evidence of efficacy? Eur J Contracept Reprod Health Care. (2017) 22:222–6. 10.1080/13625187.2017.1317340
    1. Perez-Lopez FR, Martinez-Dominguez SJ, Perez-Roncero GR, Hernandez AV. Uterine or paracervical lidocaine application for pain control during intrauterine contraceptive device insertion: a meta-analysis of randomised controlled trials. Eur J Contracept Reprod Health Care. (2018) 23:207–17. 10.1080/13625187.2018.1469124
    1. Turok DK, Simmons RG, Cappiello B, Gawron LM, Saviers-Steiger J, Sanders JN. Use of a novel suction cervical retractor for intrauterine device insertion: a pilot feasibility trial. BMJ Sex Reprod Health. (2018) bmjsrh-2017-200031. 10.1136/bmjsrh-2017-200031. [Epub ahead of print].

Source: PubMed

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