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Panchal VR, Rau AR, Mandelbaum RS, Violette CJ, Harris CA, Brueggmann D, Matsuzaki S, Ouzounian JG, Matsuo K. Pregnancy with retained intrauterine device: national-level assessment of characteristics and outcomes. Am J Obstet Gynecol MFM 2023; 5:101056. [PMID: 37330009 DOI: 10.1016/j.ajogmf.2023.101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 06/11/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Although intrauterine devices provide effective contraceptive protection, unintentional pregnancy can occur. Previous studies have shown that a retained intrauterine device during pregnancy is associated with adverse pregnancy outcomes but there is a paucity of nationwide data and analysis. OBJECTIVE This study aimed to describe characteristics and outcomes of pregnancies with a retained intrauterine device. STUDY DESIGN This serial cross-sectional study used data from the Healthcare Cost and Utilization Project's National Inpatient Sample. The study population comprised 18,067,310 hospital deliveries for national estimates from January 2016 to December 2020. The exposure was retained intrauterine device status, identified by the World Health Organization's International Classification of Diseases, Tenth Revision, code O26.3. The co-primary outcome measures were incidence rate, clinical and pregnancy characteristics, and delivery outcome of patients with a retained intrauterine device. To assess the pregnancy characteristics and delivery outcomes, an inverse probability of treatment weighting cohort was created to mitigate the prepregnant confounders for a retain intrauterine device. RESULTS A retained intrauterine device was reported in 1 in 8307 hospital deliveries (12.0 per 100,000). In a multivariable analysis, Hispanic individuals, grand multiparity, obesity, alcohol use, and a previous uterine scar were patient characteristics associated with a retained intrauterine device (all P<.05). Current pregnancy characteristics associated with a retained intrauterine device included preterm premature rupture of membrane (9.2% vs 2.7%; adjusted odds ratio, 3.15; 95% confidence interval, 2.41-4.12), fetal malpresentation (10.9% vs 7.2%; adjusted odds ratio, 1.47; 95% confidence interval, 1.15-1.88), fetal anomaly (2.2% vs 1.1%; adjusted odds ratio, 1.71; 95% confidence interval, 1.03-2.85), intrauterine fetal demise (2.6% vs 0.8%; adjusted odds ratio, 2.21; 95% confidence interval, 1.37-3.57), placenta malformation (1.8% vs 0.8%; adjusted odds ratio, 2.12; 95% confidence interval, 1.20-3.76), placenta abruption (4.7% vs 1.1%; adjusted odds ratio, 3.24; 95% confidence interval, 2.25-4.66), and placenta accreta spectrum (0.7% vs 0.1%; adjusted odds ratio, 4.82; 95% confidence interval, 1.99-11.65). Delivery characteristics associated with a retained intrauterine device included previable loss at <22 weeks' gestation (3.4% vs 0.3%; adjusted odds ratio, 5.49; 95% confidence interval, 3.30-9.15) and periviable delivery at 22 to 25 weeks' gestation (3.1% vs 0.5%; adjusted odds ratio, 2.81; 95% confidence interval, 1.63-4.86). Patients in the retained intrauterine device group were more likely to have a diagnosis of retained placenta at delivery (2.5% vs 0.4%; adjusted odds ratio, 4.45; 95% confidence interval, 2.70-7.36) and to undergo manual placental removal (3.2% vs 0.6%; adjusted odds ratio, 4.81; 95% confidence interval, 3.11-7.44). CONCLUSION This nationwide analysis confirmed that pregnancy with a retained intrauterine device is uncommon, but these pregnancies may be associated with high-risk pregnancy characteristics and outcomes.
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Affiliation(s)
- Viraj R Panchal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Panchal, Ms Rau, and Drs Violette, Harris, and Matsuo)
| | - Alesandra R Rau
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Panchal, Ms Rau, and Drs Violette, Harris, and Matsuo); Keck School of Medicine, University of Southern California, Los Angeles, CA (Ms Rau)
| | - Rachel S Mandelbaum
- Division of Reproductive Endocrinology & Infertility, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Mandelbaum)
| | - Caroline J Violette
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Panchal, Ms Rau, and Drs Violette, Harris, and Matsuo)
| | - Chelsy A Harris
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Panchal, Ms Rau, and Drs Violette, Harris, and Matsuo)
| | - Doerthe Brueggmann
- Department of Obstetrics and Gynecology, University of Frankfurt Faculty of Medicine, Frankfurt, Germany (Dr Brueggmann)
| | - Shinya Matsuzaki
- Department of Gynecology, Osaka International Cancer Institute, Osaka, Japan (Dr Matsuzaki)
| | - Joseph G Ouzounian
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Ouzounian)
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA (Dr Panchal, Ms Rau, and Drs Violette, Harris, and Matsuo); Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (Dr Matsuo).
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Hysteroscopic Removal of Intrauterine Device in Pregnancy: A Scoping Review to Guide Personalized Care. Medicina (B Aires) 2022; 58:medicina58111688. [DOI: 10.3390/medicina58111688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/16/2022] [Indexed: 11/23/2022] Open
Abstract
Background and objectives: Pregnancies that occur with an intrauterine device (IUD) in situ are at increased risk for developing severe conditions which may affect the fetus and the mother. The incidence of such adverse consequences significantly drops after device removal. A scoping review of the literature was performed to highlight the risks, benefits, and outcomes of hysteroscopic removal of intrauterine devices in early pregnancy. Materials and Methods: PubMed, Scopus, and Web of Science were searched. The review included all reports from 1990 to October 2022. The research strategy adopted included different combinations of the following terms: (“hysteroscopy”) AND (“pregnancy”) AND (“intrauterine device” or “IUD”) AND (“intrauterine system” or “IUS”). A scoping review of the hysteroscopic removal of IUDs during pregnancy was performed. All studies identified were listed by citation, title, authors, and abstract. Duplicates were identified by an independent manual screening performed by two researchers and then removed. For the eligibility process, two authors independently screened the titles and abstracts of all non-duplicated papers and excluded those not pertinent to the topic. Results: PRISMA guidelines were followed. Nine manuscripts were detected, accounting for 153 patients. Most IUD removals occurred during the first trimester of pregnancy. Most of the time, the procedure was safe and without consequences. Conclusions: This review highlights the safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy. We recommend using a 3 to 5 mm hysteroscope, avoiding cervical dilation, and maintaining low infusion pressure during the procedure to avoid potential damage to the gestational sac and IUD fragment displacement. Heating the distension media to 30 °C should be considered.
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Stabile G, Godina C, Cracco F, Mangino FP, Canton M, Romano F, Ricci G. Hysteroscopic removal of intrauterine device in early pregnancy. BMC Womens Health 2022; 22:425. [PMID: 36303205 PMCID: PMC9609195 DOI: 10.1186/s12905-022-02012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022] Open
Abstract
Background Intrauterine devices (IUDs) are commonly used as contraceptives worldwide. However, pregnancies in patients carrying this kind of device may occur. IUD removal when the woman wishes to continue their pregnancy may be very challenging. Only 9 manuscripts in literature reported such similar procedure. Case presentation We report the case of an hysteroscopic removal of IUD in a young woman at 6 weeks of gestation. Discussion The case reported highlights safety and efficacy of operative hysteroscopy as a method of IUD removal in early pregnancy, although other different methods have been reported in literature. In our opinion, maintaining a low infusion pressure during the procedure may help avoiding potential gestational sac damage and IUD displacement for better grasping. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-02012-5.
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Affiliation(s)
- Guglielmo Stabile
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Caterina Godina
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Francesco Cracco
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Francesco Paolo Mangino
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Melania Canton
- grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Federico Romano
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
| | - Giuseppe Ricci
- grid.418712.90000 0004 1760 7415Department of Obstetrics and Gynaecology, Institute for Maternal and Child Health-IRCCS “Burlo Garofolo”, 34137 Trieste, Italy ,grid.5133.40000 0001 1941 4308Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
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Jaber S, Gilad R, Bauman D, Levin G, Voss E. Outpatient hysteroscopic removal of intrauterine devices in early pregnancy: feasibility and outcomes. Fertil Steril 2022; 118:797-803. [PMID: 36075745 DOI: 10.1016/j.fertnstert.2022.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe our experience with outpatient hysteroscopy for removal of intrauterine devices (IUDs) in pregnant patients, along with the pregnancy-related outcomes. DESIGN Retrospectively and prospectively collected data between January 2015 and April 2021. SETTING Hysteroscopic outpatient clinic (See and Treat Clinic) at a university affiliated, tertiary medical center. PATIENT(S) Forty-one patients with an inadvertent but desired pregnancy up to 12 weeks + 6 days gestational age with an IUD in situ, with documented failed attempts of IUD removal. INTERVENTION(S) After ultrasonographic confirmation of IUD location, gestational age, and viability, a small-caliber hysteroscope was introduced via a vaginoscopic approach. The uterus was distended using 0.9% normal saline until a clear view was achieved. On visualization, the IUD was grasped by its strings, tail, or lateral arm using a semirigid hysteroscopic grasper. Oral antibiotic prophylaxis was prescribed in all cases. MAIN OUTCOME MEASURE(S) The primary outcome of interest was term delivery, from 37 weeks of gestation. Secondary outcomes included patient-reported tolerability and satisfaction, and procedure-related and pregnancy related complications. RESULT(S) The procedure was completed successfully in all 41 patients. Thirty-three patients continued their pregnancies, resulting in 32 full-term singleton deliveries and 1 singleton preterm delivery at 33 + 4 weeks. Median gestational age at delivery was 39 weeks, with a median birthweight of 3,450 grams. Eight patients (19.5%) miscarried, 4 of these within a week of the procedure. CONCLUSION(S) In cases of desired pregnancy with an IUD, outpatient hysteroscopic removal of the IUD is a safe and effective management option. Broader uptake of outpatient hysteroscopy and development of hysteroscopic skills will allow more clinicians to offer patients this effective solution.
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Affiliation(s)
- Sireen Jaber
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem; Department of Obstetrics and Gynecology, Hadassah Mount Scopus-Hebrew University Medical Center, Jerusalem, Israel.
| | - Ronit Gilad
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem; Department of Obstetrics and Gynecology, Hadassah Mount Scopus-Hebrew University Medical Center, Jerusalem, Israel
| | - Dvora Bauman
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem; Department of Obstetrics and Gynecology, Hadassah Ein Kerem-Hebrew University Medical Center, Jerusalem, Israel
| | - Gabriel Levin
- The Department of Gynecologic Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Ernst Voss
- Faculty of Medicine, Hebrew University of Jerusalem, Israel; Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Jerusalem; Department of Obstetrics and Gynecology, Hadassah Mount Scopus-Hebrew University Medical Center, Jerusalem, Israel
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Kottmann C, Troncoso M, Valenzuela I, Ugarte C, Diaz P, Monckeberg M, Illanes SE. Ultrasound-Guided Extraction of Intrauterine Devices With Nonvisible Threads: 254 Consecutive Cases: An Effective, Noninvasive Technique. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:3073-3077. [PMID: 30887558 DOI: 10.1002/jum.14986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 01/31/2019] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
Intrauterine devices (IUDs) are among the most efficient and widely used contraceptive methods available. Removal is recommended after a certain time or in some cases when adverse effects are observed. A considerable number of patients have nonvisible guides or "lost threads" on speculum examinations, hindering the extraction. In this article, we report a consecutive series of 254 nonpregnant patients referred to our center after 1 or more failed attempts at IUD removal. We describe a novel ultrasound-guided approach, using a laparoscopic forceps to safely and effectively remove IUDs in nonpregnant patients.
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Affiliation(s)
- Cristian Kottmann
- Department of Obstetrics and Gynecology, Faculty of Medicine, Los Andes University, Santiago, Chile
- Department of Obstetrics and Gynecology, Clinica Davila, Santiago, Chile
| | - Maite Troncoso
- Department of Obstetrics and Gynecology, Faculty of Medicine, Los Andes University, Santiago, Chile
- Department of Obstetrics and Gynecology, Clinica Davila, Santiago, Chile
| | - Ignacio Valenzuela
- Department of Obstetrics and Gynecology, Faculty of Medicine, Los Andes University, Santiago, Chile
- Department of Obstetrics and Gynecology, Clinica Davila, Santiago, Chile
| | - Carolina Ugarte
- Department of Obstetrics and Gynecology, Faculty of Medicine, Los Andes University, Santiago, Chile
| | - Pilar Diaz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Los Andes University, Santiago, Chile
| | - Max Monckeberg
- Department of Obstetrics and Gynecology, Faculty of Medicine, Los Andes University, Santiago, Chile
| | - Sebastian E Illanes
- Department of Obstetrics and Gynecology, Faculty of Medicine, Los Andes University, Santiago, Chile
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Zhao CY, Ye F. Live birth after hysteroscopy performed inadvertently during early pregnancy: A case report and review of literature. World J Clin Cases 2018; 6:559-563. [PMID: 30397614 PMCID: PMC6212613 DOI: 10.12998/wjcc.v6.i12.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/21/2018] [Accepted: 08/28/2018] [Indexed: 02/05/2023] Open
Abstract
Generally, hysteroscopy is not appropriate for pregnant women without an indication. What if a patient undergoes hysteroscopy accidentally during the early gestational period? We here report a rare case of a woman who continued pregnancy after a diagnostic hysteroscopy was performed in early pregnancy and delivered a healthy baby. The patient had a history of infertility and oligomenorrhea, probably due to a previous induced abortion. A hysteroscopy was performed after the end of her “menstruation” for assessment of her uterine cavity. Early pregnancy, instead of the expected intrauterine adhesions, was suspected, and the procedure was immediately ceased. Subsequent tests confirmed the diagnosis of pregnancy. She had a full-term delivery by elective caesarean section. The success of this case was attributed to the use of vaginoscopic techniques in hysteroscopy and correct judgment and decision-making during the procedure. This case report provides some useful methods and experience that might be helpful when a similar situation occurs in clinical practice.
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Affiliation(s)
- Chong-Yi Zhao
- Department of Gynecology, First People’s Hospital of Yunnan Province, Kunming 650000, Yunnan Province, China
| | - Feng Ye
- Department of Neurosurgery, People’s Hospital of Deyang City, Deyang 618000, Sichuan Province, China
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