Ultrasound-guided retrieval of lost intrauterine devices using very fine grasping forceps: a case series

Removal of a missing intrauterine contraceptive device after location through an ultrasound: a case report within a rural setting and review of literature

BACKGROUND

In the last decade, (2000-2019), the modern contraceptive prevalence among married women of reproductive age (14-49 years), has increased by only 2.1%. The slow progress was due to limited access to services and myths surrounding methods held by both users and providers. This case report was identified, diagnosed and managed by a midwife working in rural health center in low resource setting. However, literature is scare on the management of missing Intra-Uterine Contraceptive Device (IUCD) thread removal services of confirmed diagnosis using Vscan or limited ultrasound services in rural health centers. The aim of reporting this case report was developed to enhance easy access to intra-uterine contraceptive method removals, which may address myths associated with difficulties of undergoing the services in rural set-up. A 26 year-old married woman, Gravida 1 and Para 1, attended Mekoy Health Center for IUCD removal service after 7 years of protection and internally referred to limited obstetric ultrasound service room due to non- visualization of IUCD thread with Vaginal Speculum examination. An ultrasonography scan however, showed a centrally located copper-T 380A IUCD in the endometrial cavity. As a result, after dilatation of the cervix, a successful removal of the Copper-T 308A was conducted. The client received followed up care for 2 hours post-procedure and was then discharged.

CONCLUSIONS

This case highlights the importance of availing diagnostic and removal services in rural set ups to mitigate myths in the community. The availability of limited obstetric ultrasound scanning services can improve the diagnoses and management of conditions in clients. The reported case shows that although, the basic infrastructure was limited, ultrasound scanning and Long Acting Reversible Contraception (LARC) trained midwives can ensure the provision of safe IUCD removal services in rural areas.

Ultrasound-Guided Extraction of Intrauterine Devices With Nonvisible Threads: 254 Consecutive Cases: An Effective, Noninvasive Technique

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.

Removal of intrauterine contraception with non-visible threads: a case series

OBJECTIVES

(1) To review management of a series of women referred for removal of intrauterine contraception (IUC) with non-visible threads. (2) To establish whether the device was likely to have been placed at the fundus at insertion. (3) To document removal success rates in a community sexual health (CSH) setting.

STUDY DESIGN

A retrospective review of a series of 76 women seen by the author between April 2016 and October 2017 in a specialist CSH clinic for removal of IUC with non-visible threads.

RESULTS

After ultrasound scan (USS) assessment 67 women underwent a removal procedure. Sixty-two devices (92.5%) were successfully removed. Uterine instrumentation beyond the internal os was required in 43 removals, enabling comparison of uterine cavity length with the length of IUC and threads. Such comparison suggested 39/43 (91%) devices were not fundal at insertion and that non-visible threads were likely to have been caused by the device moving to the fundus post-insertion under the influence of uterine contractions, leading to retraction of the threads.

CONCLUSIONS

Removal of IUC with non-visible threads can be successfully done in a CSH setting with ultrasound availability. Non-fundal placement of IUC at insertion is likely to be a significant cause of non-visible threads.