Notes about cervical shock

There is an important complication to be aware of during IUCD insertion. 

Cervical Shock

This is profound bradycardia, produced by an aggressive vasovagal response to stimulation of the cervix. 

• Abandon the procedure, lower the head and/or raise the legs.
• The IUCD/IUS may need to be removed. Also remove tenaculum or anything else that may stimulate the cervix. 
• An assistant should monitor vital signs.
• Ensure a clear airway.
• Oxygen and suction as required.
• Consider use of atropine 0.6 mg/ml IV for persistent bradycardia.
• Consider use of adrenaline (epinephrine) 1:1000 IM (1mg/nl) for management of anaphylaxis.
• Automated external defibrillator (AED) should be available.
• Arrange ambulance transfer if there is no swift improvement.