Cervical bleeding with cervical stabilization during IUD placement: allis clamp versus single-tooth tenaculum, a randomized control trial

Arch Gynecol Obstet. 2023 Apr;307(4):1015-1019. doi: 10.1007/s00404-022-06784-x. Epub 2022 Dec 7.

Abstract

Objective: To evaluate whether the use of an atraumatic Allis clamp will result in less bleeding than the standard single-tooth tenaculum for cervical stabilization during intrauterine device (IUD) placement.

Methods: A single-blinded randomized controlled trial was conducted during insertions of IUDs between March 2017 and March 2018. University of Kentucky Institutional Review Board (IRB 16-1110-P3K) approval was obtained. Physicians were randomized to use either an Allis clamp or a single-tooth tenaculum for cervical stabilization. A post-procedure questionnaire was used to collect outcome measures as well as demographic and obstetric-related factors.

Results: Of the ninety-five participants, there was no difference in age, self-identified race/ethnicity, or the evaluated obstetric factors between the groups. 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 (RR = 0.113, CI = [0.037, 0.3481], p < 0.0001). There was no difference in IUD insertion success rates between the two clamps. There was no difference in the number of interventions needed to obtain hemostasis including indirect pressure, silver nitrate, monsel's solution, or stitch for hemostasis. Pain scores did not differ based on clamp type or age of patient, but were significantly different based on parity (p < 0.001) and IUD type (p < 0.003).

Conclusion: Decreased incidence of bleeding from cervical stabilization device, with unchanged insertion success using the Allis clamp can be an alternative to the single tooth tenaculum in the procedure of IUD insertion.

Trial registration number: The trial was retrospectively registered on 1/11/22 (trial registration number NCT05187078).

Keywords: Allis clamp; Cervical stabilization; Intrauterine device; Single-tooth tenaculum.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anesthetics, Local
  • Female
  • Hemorrhage
  • Humans
  • Intrauterine Devices* / adverse effects
  • Pain* / etiology
  • Pregnancy
  • Surgical Instruments / adverse effects

Substances

  • Anesthetics, Local

Associated data

  • ClinicalTrials.gov/NCT05187078