Pregnancy Exclusion Criteria
Pregnancy Exclusion Criteria for IUD / Nexplanon Placement
Ideally, insertion of IUD / Nexplanon should take placeless than or equal to 7 days since the start of LMP since it reliably excludes pregnancy, If patient does not meet criteria for Method A on date of scheduled insertion, she will need to have Method B to Rule out Pregnancy and should have her Insertion Day adjusted.
Excluding pregnancy — Method A
Pregnancy can be reasonably excluded if a client answers YES to any of the following questions:
1. Have you abstained from sexual intercourse since your last menstrual period?
2. Have you had a normal menstrual period within the past seven days?
3. Have you been using a reliable form of contraception consistently and correctly?
4. Have you had a miscarriage or abortion within the past seven days?
5. Have you had a baby within the past four weeks?
6. Have you had a baby within the past six months AND are you are fully or nearly-fully breastfeeding AND have you not had a menstrual period since the delivery?
Excluding Pregnancy - Method B
A urine pregnancy test (UPT) must be ordered and documented to be negative 2 weeks after the last intercourse.
Date of Last Intercourse (DLI):
Date of Negative UPT (Must be at least 14 days after DLI):
A systematic review of studies evaluating the performance of a pregnancy checklist compared with urine pregnancy test to rule out pregnancy concluded the negative predictive value of a checklist similar to the one above was 99 to 100 percent. Tepper NK, Marchbanks PA, Curtis KM; Use of a checklist to rule out pregnancy: a systematic review. Contraception 2013; 87:661,