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Saputra AND, Rahman MN, Widyasari A. Removal of Complete Spontaneous Migration of an Intrauterine Contraceptive Device to the Bladder by Cystoscopy. Case Rep Obstet Gynecol 2024; 2024:6934178. [PMID: 38770062 PMCID: PMC11105948 DOI: 10.1155/2024/6934178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/22/2024] [Accepted: 05/03/2024] [Indexed: 05/22/2024] Open
Abstract
Intrauterine contraceptive devices (IUCD) are widely used as a reversible method of contraception. Although uterine perforation caused by an IUCD is rare, in some cases, the device may migrate to the pelvic/abdominal cavity or nearby structures. When the IUCD migrate to the bladder, it can lead to various symptoms. These include pain or discomfort in the lower abdomen, difficulties or pain during urination, frequent urinary tract infections, and the development of bladder stones. This article presents a case report of a 24-year-old woman with an intrauterine contraceptive device (IUCD) that had migrated completely into the bladder. She had an IUCD inserted by a midwife four years earlier and became pregnant a year later, unaware of the IUCD's presence. She later presented with lower abdominal pain, hematuria, and dysuria three months before being admitted to our hospital. Imaging confirmed the intravesical location of the IUCD. She underwent successful cystoscopy treatment to remove the migrated IUCD. Prompt diagnosis and appropriate management are crucial in preventing complications and improving patient outcomes. Clinicians should be aware of this potential complication and consider it when patients present with symptoms or complications after IUCD insertion. Regular monitoring and timely intervention can help detect and address IUCD migration effectively.
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Affiliation(s)
- Akbar Novan Dwi Saputra
- Urogynecology and Reconstructive Surgery Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Muhammad Nurhadi Rahman
- Urogynecology and Reconstructive Surgery Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anis Widyasari
- Urogynecology and Reconstructive Surgery Division, Department of Obstetrics and Gynecology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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Do QH, Hoang VT, Chansomphou V, Hoang DT. Endoscopic management of migrated intrauterine device in the stomach. Int J Gynaecol Obstet 2024; 165:830-831. [PMID: 38140800 DOI: 10.1002/ijgo.15327] [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: 11/06/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
SynopsisEctopic intrauterine devices to the gastric wall are extremely rare and they can be managed by upper gastrointestinal endoscopy.
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Affiliation(s)
- Quang Hai Do
- Division of Endoscopy, Department of Radiology, Hai Phong - Vinh Bao International Hospital, Hai Phong, Vietnam
| | - Van Trung Hoang
- Department of Radiology, Thien Hanh Hospital, Buon Ma Thuot, Vietnam
| | - Vichit Chansomphou
- Department of Radiology, Savannakhet Medical-Diagnostic Center, Kaysone Phomvihane, Laos
| | - Duc Thanh Hoang
- Division of Endocrinology, Department of Medicine, Walter Reed National Military Medical Center, Bethesda, USA
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Verstraeten V, Vossaert K, Van den Bosch T. Migration of Intra-Uterine Devices. Open Access J Contracept 2024; 15:41-47. [PMID: 38495451 PMCID: PMC10944303 DOI: 10.2147/oajc.s458156] [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: 01/22/2024] [Accepted: 02/29/2024] [Indexed: 03/19/2024] Open
Abstract
Intrauterine devices (IUDs) are a widely used contraceptive. Possible complications from IUDs include failed insertion, pain, vasovagal reaction, infection, abnormal bleeding, and expulsion. Uterine perforation and migration of the IUD are rare complications occurring in approximately 1-2 per 1000 insertions. We executed a systematic review by reviewing all case reports and case series on IUD migration, published between December 2002 and December 2022. Our review indicates that about half of these patients present with pain and that a third are completely asymptomatic. The most common sites of migration are the intestine, bladder, and omentum. We found that the preferred method for removing the migrated IUD is laparoscopy. Generally, there are no lasting injuries after the removal of the migrated IUD, but occasionally, severe complications have been reported. Healthcare providers should be vigilant about this rare complication, especially in cases of painful insertion or the presence of other risk factors for perforation. When uterine perforation is diagnosed, it is advisable to remove the IUD to prevent severe complications.
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Affiliation(s)
- Victoria Verstraeten
- Obstetrics & Gynaecology - UZ Leuven Gasthuisberg, Leuven, Belgium
- Obstetrics & Gynaecology – AZ Sint- Blasius Dendermonde, Dendermonde, Belgium
| | - Karlien Vossaert
- Obstetrics & Gynaecology – AZ Sint- Blasius Dendermonde, Dendermonde, Belgium
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Gebremichael A, Teka H, Abadi KK, Siferih M, Moges M, Arusi M, Shiferaw A. Missed Diagnosis of Perforation and Intraperitoneal Migration of an Intrauterine Device and Its Management in a Resource-Limited Setting: A Case Report. Int Med Case Rep J 2024; 17:71-76. [PMID: 38293615 PMCID: PMC10826545 DOI: 10.2147/imcrj.s441386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
Background The intrauterine device is a popular and highly effective form of long-acting reversible contraception. Although generally safe, complications could happen. One of the most serious complications of intrauterine device use is uterine perforation. Risk factors for perforation include, but are not limited to, postpartum period, breastfeeding, levels of experience, and excessive force exerted during insertion. This case is significant because it demonstrates risk factors for uterine perforation, how to handle missing strings, and care in places with little resources. Case Presentation We discuss the case of a 27-year-old black Ethiopian woman who presented with chronic pelvic pain and had a perforated intrauterine device discovered in the cul-de-sac. The device had been inserted at six weeks postpartum. The client was unable to feel the strings three months after insertion, and a wrong diagnosis of expulsion was made. After one year of insertion, the intrauterine device was located on a plain abdominal radiograph and removed via laparotomy without complications. Conclusion Although uterine perforation is a rare complication of intrauterine device insertion, special attention should be paid to women with risk factors. In the absence of a witnessed expulsion, assessments and investigations should be carried out before declaring a device expelled. In patients with chronic pelvic pain complaints in the presence of an intrauterine device, perforation and migration outside the uterine cavity should be considered. Abdominal X-rays and laparotomies can be used to find and manage extrauterine migrating devices in environments with limited resources.
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Affiliation(s)
- Akebom Gebremichael
- Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Hale Teka
- Department of Obstetrics and Gynecology, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Kidus Kebede Abadi
- Department of Obstetrics and Gynecology, Riwyet Maternal and Child Health Center, Tigray, Ethiopia
| | - Melkamu Siferih
- Department of Obstetrics and Gynecology, Debre Markos University, Debre Markos, Ethiopia
| | - Menberu Moges
- Department of Obstetrics and Gynecology, Tayo Hospital, Baidoa, Somalia
| | - Muhudin Arusi
- Department of Obstetrics and Gynecology, St. Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Abel Shiferaw
- Department of Obstetrics and Gynecology, Dessie Comprehensive Specialized Hospital, Dessie, Ethiopia
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Aljohani A, Alzarea AA, Alnafee R, Aljadaani KS, Sairafi R, Alzahrani A. Migrated intrauterine device: Case series report. Int J Surg Case Rep 2023; 111:108631. [PMID: 37757734 PMCID: PMC10978329 DOI: 10.1016/j.ijscr.2023.108631] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Implantation of an intrauterine device (IUD) is a common method of contraception in Saudi Arabia. Although rare, IUD migration and colon perforation have been reported. The current report presented three cases of IUD migration into the colon and recto-uterine pouch. METHODS AND OUTCOMES The study included a series of three cases of migrated IUDs. The first case was a 25-year-old female, Gravida 2, Para 2 + 0, at 28 week-gestation, who presented with abdominal pain with a history of IUD placement that had not been removed or imaged before. The patient submitted to the caesarian section (CS), where IUD was found in the sigmoid colon. Elective laparoscopic removal of IUD with resection and primary repair of sigmoid colon was done later. The second case was a 37-year-old female, Gravida 1, Para 1 + 0, non-pregnant hypothyroidism, and a history of IUD placement. The patient got pregnant and gave birth through CS. She was then presented with abdominal pain and requested the removal of the IUD. On colonoscopy, IUD was seen in the pouch of Douglas with no evidence of a fistulous tract. IUD was removed through laparoscopy. The third case was a 47-year-old female, Gravida 14, Para 14 + 0, with a history of previous CS presented with a missing IUD that had been inserted 20 years ago after she had five pregnancies and subsequent deliveries. On colonoscopy, IUD was embedded on the wall of the transverse colon, and through abdominal surgery, IUD was removed by cutting through the colon and primary repair was done. CLINICAL DISCUSSION: the presentation of IUD migration cases was foundto vary according to the site of migration and type of IUD.however the cases are usually present with abdominal pain. An abdominal pelvic imaging with CT in these patients are essential in diagnosis. Retrival of migrating IUDs may be done through colonoscopy, laparoscopy, and in some cases with adhesion laparotomy is the solution. CONCLUSION Abdominal and pelvic CT scan are very important in the diagnosis and the localization of IUD. Elective colonoscopy and laparoscopy are successful management approaches for these cases.
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Affiliation(s)
- Alaa Aljohani
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia
| | | | - Reem Alnafee
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia
| | | | - Rami Sairafi
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia
| | - Ali Alzahrani
- General Surgery Department, Security Force Hospital, Riyadh, Saudi Arabia.
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Almatary A, Alsharif A, Ghabisha S, Ahmed F, Badheeb M. Open surgical retrieval of intra-uterine contraceptive device perforating the ileum: A case report. Int J Surg Case Rep 2023; 109:108635. [PMID: 37552923 PMCID: PMC10425888 DOI: 10.1016/j.ijscr.2023.108635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Intra-uterine contraceptive devices (IUCDs) are globally acknowledged for their high utilization and tolerability as contraceptive techniques. However, the uncommon but critical complication of IUCD perforation and migration into the gastrointestinal (GI) system necessitates careful consideration. CASE PRESENTATION We present a case of IUCD migration culminating in ileal perforation in a 30-year-old female. The patient, with a history of IUCD insertion four years prior, manifested persistent abdominal discomfort lasting for a period of six months. Computed tomography (CT) scans of the abdomen disclosed the presence of an extraneous object perforating the uterine wall and penetrating the ileum. Surgical intervention substantiated the diagnosis, encompassing the removal of the IUCD and subsequent suturing to amend the bowel wall defect. The patient's post-operative recovery proceeded without additional complications. CLINICAL DISCUSSION Migration and GI perforation of the IUCD are uncommon complications, and require immediate attention and proper management. When there is a suspicion of a missing IUCD, obtaining radiologic confirmation and timely removal is crucial. CONCLUSION In females of reproductive age, persistent abdominopelvic pain warrants an evaluation of their IUCD placement history and a thorough examination. If the IUCD string is not visible, further radiological investigation is mandated. Any delay in diagnosis and the ensuing treatment may lead to significant, potentially catastrophic, organ damage.
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Affiliation(s)
- Abdullah Almatary
- Department of General Surgery, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, Yemen
| | - Afaf Alsharif
- Department of Gynaecology, School of Medicine, Jeblah University for Medical and Health Sciences, Ibb, Yemen.
| | - Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen.
| | - Mohamed Badheeb
- Department of Internal Medicine, Faculty of Medicine, Hadhramaut University, Hadhramaut, Yemen
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Zhang M, Sun Z, Yang Y, Zhou J, Ba L. Complete perforated bladder from intrauterine devices: A case series report from a nationwide monitoring system. J Obstet Gynaecol Res 2023. [PMID: 37186345 DOI: 10.1111/jog.15661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
AIM Complete perforation of the bladder caused by an intrauterine device (IUD) is rare. This study examined the characteristics of patients associated with IUD-related bladder perforation and evaluated the relationship between mislocated IUDs and their potential complications. METHODS From October 2005 to December 2021, 13 reports regarding complete perforations to the bladder by IUDs were retrieved from the National Contraceptives Adverse Reaction Monitoring System of China. The clinical features of these cases were analyzed. RESULTS The median patient age was 30 (range, 27-46) years. There were four cases (4/13, 30.8%) with IUDs placed during lactation, one case (1/13, 7.7%) with an IUD placed after medical abortion, and eight cases (8/13, 61.5%) placed after menstruation. Seven cases (7/13, 53.9%) were first-time IUD users. The median duration of IUD placement was 47 (range, 1-145) months. Unexpected pregnancy was reported in five cases (5/13, 38.5%). Six cases (6/13, 46.2%) reported bladder stones with varying degrees of abdominal pain or urinary tract infection. Removal methods included laparotomy (four cases), cystoscopy (four cases), laparoscopy (two cases), laparoscopy combined with cystoscopy (two cases), and laparotomy after cystoscopy (one case). All IUDs were successfully removed. CONCLUSIONS Complete perforation to the bladder by IUDs is a rare adverse event. Regular follow-up is required after the placement of IUDs. The possibility of uterine perforation should be investigated if IUD users encounter persistent lower abdominal pain or urinary tract infection.
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Affiliation(s)
- Min Zhang
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Zhiming Sun
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Yuehua Yang
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Jian Zhou
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
| | - Lei Ba
- Contraceptives Adverse Reaction Surveillance Center of National Health Commission, Nanjing, China
- Jiangsu Health Development Research Center, Nanjing, China
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Amaya SI, Henkel A, Blumenthal PD. Words matter: perforation… or transmural migration? BMJ SEXUAL & REPRODUCTIVE HEALTH 2023; 49:74-75. [PMID: 36564157 DOI: 10.1136/bmjsrh-2022-201738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Stephanie Irene Amaya
- Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Andrea Henkel
- Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
| | - Paul D Blumenthal
- Obstetrics & Gynecology, Stanford University School of Medicine, Palo Alto, California, USA
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Mathew SM, David A. Does Timing of Levonorgestrel Insertion in Women with Abnormal Uterine Bleeding Affect its Expulsion and Bleeding Pattern? A Follow-Up Study. J Obstet Gynaecol India 2023; 73:160-165. [PMID: 37073234 PMCID: PMC10105803 DOI: 10.1007/s13224-022-01714-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/14/2022] [Indexed: 12/15/2022] Open
Abstract
Background Levonorgestrel Intra Uterine System insertion for contraception is preferred in the follicular phase. However, the ideal time of insertion for Abnormal Uterine Bleeding is not stated clearly. The aim of our study is to find out the effect of timing of insertion on expulsion and irregular bleeding pattern post insertion. Methods A follow-up study of patients with LNG-IUS for AUB was conducted. They were grouped into four based on the day of insertion from Last Menstrual Period (LMP). The pattern of irregular bleeding post insertion was compared with odds ratio and the expulsion rate was compared with log rank test. Results The most common indication for the 76 patients was ovulatory dysfunction (39.4%) followed by Adenomyosis (36.84%). Those who had LNG-IUS insertion from day 22-30 had quicker expulsions of 25% of patients by 3 months. By 6 months and later expulsion rate was much higher in the luteal phase than the follicular phase (p < 0.03). The least risk of moderate or heavy bleeding was for the 8-15 day group when compared to the 22-30 day group, the odds ratio being 0.03 [95% CI: (0.01-0.2)]. Conclusion Based on expulsion rate alone, insertion of LNG-IUS at any time in the follicular phase is ideal. Considering both expulsion rate and pattern of bleeding the ideal time would be late follicular phase, that is 8-15th day.
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Affiliation(s)
- Sunitha Mary Mathew
- Department of Obstetrics and Gynecology, Believers Church Medical College Hospital, St Thomas Nagar, Kuttapuzha, Thiruvalla, Kerala 689103 India
| | - Alice David
- Believers Church Medical College Hospital, St Thomas Nagar, Kuttapuzha, Thiruvalla, Kerala 689103 India
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Heaney C, Lee P, Winer A. Robot-Assisted Removal of a Partially Intravesical Intrauterine Device (IUD) and Large Bladder Stone. Case Rep Urol 2023; 2023:8074689. [PMID: 36742352 PMCID: PMC9897916 DOI: 10.1155/2023/8074689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/26/2022] [Accepted: 12/10/2022] [Indexed: 01/29/2023] Open
Abstract
An intrauterine device (IUD) is a highly effective and widely utilized option for long-acting reversible contraception. IUDs are generally well-tolerated with a low rate of serious complications. Perforation of an IUD through the uterine wall and into the urinary bladder is a rare event that may be asymptomatic. The approach for surgical removal primarily depends on the location of the device. We present a case report of a 41-year-old woman who was found to have a partially intravesical IUD and associated 2.4 cm bladder calculus. Removal of the intravesical IUD and stone was achieved with cystoscopy, cystolitholapaxy, and robot-assisted laparoscopic cystotomy.
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Affiliation(s)
- Cassandra Heaney
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Paul Lee
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Andrew Winer
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA
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Koh AS. Neglected Intrauterine Device Migration Complications: Case Reports. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:11-18. [PMID: 36727094 PMCID: PMC9883666 DOI: 10.1089/whr.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 02/03/2023]
Abstract
This series of four cases describes unusual intrauterine device (IUD) migration complications, associated etiologic factors, and their management. Recent increases in sociopolitical and medical forces worldwide contributed to inattention to these patients with subclinical IUD complications. The international movement of patients, delays in gynecologic care due to the COVID-19 pandemic, lack of health care access, shifts away from annual examinations, and patients' lack of medical records or IUD awareness can lead to long durations of neglected IUDs and associated complications. These complications might have been avoided or minimized with regular gynecologic health care. Physicians should consider moving toward routine examinations of all IUD patients, rather than away from annual examinations as has been promulgated by some medical societies. Patient education is needed on the importance of routine monitoring of IUDs and retention of device records. Clinicians should become familiar with IUDs from around the world as well as devices no longer being prescribed, as their appearance, associated complications, and presentations may differ from locally currently available devices.
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Affiliation(s)
- Audrey S. Koh
- Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, San Francisco, California, USA.,Address correspondence to: Audrey S. Koh, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of California, San Francisco, 2100 Webster Street, Suite 518, San Francisco, CA 94115, USA.
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12
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Jing J. Case report: An intrauterine device hugging the musculus rectus abdominis through the center of a cesarean scar. Front Surg 2023; 9:956856. [PMID: 36684317 PMCID: PMC9852525 DOI: 10.3389/fsurg.2022.956856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 10/27/2022] [Indexed: 01/09/2023] Open
Abstract
A 34-year-old woman presented with an abscess of the abdominal wall, with a 10-day history of rupture and discharge. She had a history of cesarean section 17 years ago, intrauterine device (IUD) insertion 5 years ago, and intermittent lumbago and abdominal pain for the past 4 years. A V-shaped IUD was observed via ultrasound between the bladder and abdominal wall, clinging to the musculus rectus abdominis through the center of the cesarean scar. Pelvic computed tomography (CT) revealed a V-shaped metal density at the anterior upper edge of the bladder, one end of which seemed to penetrate the abdominal wall. IUD migration was confirmed by surgery 2 days later. The patient recovered after IUD removal. This case affirms that a migrated IUD can lead to serious complications, even if there are no obvious symptoms for many years. Apart from the fact that the IUD has fallen out of place, a migrated IUD should be removed promptly, regardless of obvious complications. Furthermore, regular ultrasound examination is important for early diagnosis of IUD displacement. Based on the relevant literature, we also hypothesize the possible mechanism of IUD migration between the anterior bladder wall and the abdominal wall. Core tip Uterine perforation and IUD migration to the organs in the abdominopelvic cavity are serious complications of IUD insertion. We present a case of uterine perforation complicated by IUD migration with the application of intraoperative ultrasound localization. This case highlights that ultrasound, especially intraoperative ultrasound, can provide objective information for the diagnosis and localization of IUD migration, with the advantages of point of care, real-time imaging, convenience, low cost, and lack of radiation. Based on this case and on the relevant literature, we hypothesized the possible mechanism of IUD migration between the anterior bladder wall and the abdominal wall. To the best of our knowledge, no previous research has discussed the process of IUD migration beyond the anterior wall of the bladder.
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13
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Roman JD. Uterine Perforation by Levonorgestrel-Releasing Intrauterine Device: A Case Report. Cureus 2022; 14:e31398. [DOI: 10.7759/cureus.31398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/14/2022] Open
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14
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Boushehry R, Al-Taweel T, Bandar A, Hasan M, Atnuos M, Alkhamis A. Rare case of rectal perforation by an intrauterine device: Case report and review of the literature. Int J Surg Case Rep 2022; 99:107610. [PMID: 36116303 PMCID: PMC9568710 DOI: 10.1016/j.ijscr.2022.107610] [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: 08/20/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Intrauterine devices (IUDs) are safe, highly effective and reversible forms of contraception. Reliance on IUD has been increasing and as such, it is the responsibility of the healthcare provider to be aware of the complications associated with it. IUD rectal migration is one of the rare but serious complications that may lead to detrimental sequelae. CASE PRESENTATION A 30-year-old asymptomatic woman presented to the gynaecology clinic two months after a difficult insertion of an IUD. On examination, the device was not localised in utero with transvaginal sonography. Computed tomography scan and colonoscopy revealed the position of the IUD within the rectum. It was successfully retrieved with a combined laparoscopic-colonoscopic approach. Follow-up flexible sigmoidoscopy showed a well-healed rectal wall. CLINICAL DISCUSSION IUD perforation can increase the risk of morbidity and necessitates early surgical intervention even if the patient is asymptomatic. Combined laparoscopic-colonoscopic approach allows for safe retrieval of IUD that has perforated the intraperitoneal rectal segment or is firmly embedded within the mucosa. Recognising the risk factors and adhering to the principles of IUD insertion could significantly lower the risk of perforation. CONCLUSION This case report highlights the importance of a physician's vigilance regarding a perforating IUD in a patient with a history of a difficult insertion. It is imperative to undertake additional steps to rule out such a complication in these cases. Uterine perforation can be avoided with implementation of safe IUD insertion practice.
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Affiliation(s)
| | - Talal Al-Taweel
- Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Kuwait
| | - Asya Bandar
- Obstetrics and Gynaecology Department, Jaber Al-Ahmad Hospital, Kuwait
| | - Maryam Hasan
- Division of Gastroenterology, Department of Internal Medicine, Jaber Al-Ahmad Hospital, Kuwait
| | - Mario Atnuos
- Department of Surgery, Jaber Al-Ahmad Hospital, Kuwait
| | - Ahmed Alkhamis
- Department of Surgery, Jaber Al-Ahmad Hospital, Kuwait; Department of Surgery, Faculty of Medicine, Kuwait University, Kuwait
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Mitranovici MI, Chiorean DM, Sabău AH, Cocuz IG, Tinca AC, Mărginean MC, Popelea MC, Irimia T, Moraru R, Mărginean C, Craina ML, Petre I, Bernad ES, Petre I, Cotoi OS. An Interesting Image of Transmural Migration of a Levonorgestrel-Releasing Intrauterine Device (LNg-IUD). Diagnostics (Basel) 2022; 12:diagnostics12092227. [PMID: 36140629 PMCID: PMC9498182 DOI: 10.3390/diagnostics12092227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 12/03/2022] Open
Abstract
Intrauterine devices (IUDs) are very common as a method of birth control. By adding progesterone (levonorgestrel), a decrease in the risk of complications has been documented, including the risk of perforation. Even though only a few complications have been described, adjacent organs may be involved in the case of migration—a life-threatening situation. A 45-year-old G4P2 woman was seen in our clinic for LNg-IUD removal, according to the medical instructions. Her main complaints were abdominal discomfort, low back pain, and recurrent menorrhagia. A “lost” IUD was initially suspected; the patient confirmed the detection and removal of the control strings, and a subsequent discussion related to delayed transmural migration of the IUD being followed. The ultrasonography revealed the migration of the IUD to the uterine cervix and size-decreased uterine fibroids, confirming the effectiveness of the LNg-IUD. The MRI and ultrasonography being useless, a subsequent X-ray and CT scan were requested, both confirming a myometrium-positioned IUD, adjacent to the serosa and lumbosacral plexus. Even though the IUD is considered a safe device with reversible effect, it can be associated with severe morbidity, with an ultrasound follow-up being required. For more precise detection of the IUD, we strongly recommend an X-ray or CT scan examination, followed by safe removal.
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Affiliation(s)
- Melinda-Ildiko Mitranovici
- Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
- Correspondence:
| | - Diana Maria Chiorean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Adrian-Horațiu Sabău
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Iuliu-Gabriel Cocuz
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Andreea Cătălina Tinca
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Mihaela Cornelia Mărginean
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
| | - Maria Cătălina Popelea
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
| | - Traian Irimia
- School of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Raluca Moraru
- Faculty of Medicine, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Claudiu Mărginean
- Department of Obstetrics and Gynecology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
| | - Marius Lucian Craina
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Izabella Petre
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Elena Silvia Bernad
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Ion Petre
- Department of Medical Informatics and Biostatistics, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Sq, 300041 Timisoara, Romania
| | - Ovidiu Simion Cotoi
- Department of Pathology, County Clinical Hospital of Targu Mures, 540072 Targu Mures, Romania
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 38 Gheorghe Marinescu Street, 540142 Targu Mures, Romania
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Tarafdari A, Malek M, Pahlevan Falahy E, Hadizadeh A. IUD perforation and embedment within omentum: A rare and perplexing incidence. Clin Case Rep 2022; 10:e05732. [PMID: 35441023 PMCID: PMC9010853 DOI: 10.1002/ccr3.5732] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Revised: 03/09/2022] [Accepted: 03/28/2022] [Indexed: 01/22/2023] Open
Abstract
Intrauterine devices rarely fail, which results in pregnancy. Meanwhile, these devices can perforate uterine and migrate through abdomen. Our case experienced IUD failure and perforation simultaneously, and the device was embedded in omentum and shifted rapidly, which made it hard to localize and could only be removed using ultrasonography guidance.
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Affiliation(s)
- Azadeh Tarafdari
- Department of Obstetrics and Gynecology Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Mahrooz Malek
- Department of Radiology Medical Imaging Center Advanced Diagnostic and Interventional Radiology Tehran Iran
| | - Elaheh Pahlevan Falahy
- Department of Obstetrics and Gynecology Imam Khomeini Hospital Complex Tehran University of Medical Sciences Tehran Iran
| | - Alireza Hadizadeh
- School of Medicine Tehran University of Medical Sciences Tehran Iran
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Thomas S, Hindman N. Case series demonstrating in vivo MR safety of stainless steel (Chinese/Ring) IUDs. BJR Case Rep 2022; 8:20210165. [PMID: 36101733 PMCID: PMC9461733 DOI: 10.1259/bjrcr.20210165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/21/2021] [Accepted: 12/24/2021] [Indexed: 11/05/2022] Open
Abstract
Intrauterine devices (IUDs) are one of the most common forms of long-term contraception used by patients around the world. Many studies have been performed over the past few decades demonstrating the safety of many common hormonal and metallic intrauterine devices in Magnetic Resonance (MR) imaging; however, the stainless steel ring IUD (often termed the “Chinese” IUD) is still considered MR Unsafe. This device was used in the 1980s and 1990s in China, where as many as 60 million women in China were using an IUD by 1988, and approximately 90% of those were stainless steel ring IUDs. In a major metropolitan area hospital such as ours with a large immigrant population, we encounter females with this ring IUD several times a year. As this population ages, the need for medical care (and concomitantly, MR imaging) is projected to increase. The purpose of this case review is to examine the imaging and clinical course of patients with stainless-steel ring intrauterine devices who safely received 1.5T Brain MR scans at our institution for clinically necessary diagnostic imaging.
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Affiliation(s)
- Shailin Thomas
- Department of Radiology, NYU School of Medicine, New York, USA
| | - Nicole Hindman
- Department of Radiology, NYU School of Medicine, New York, USA
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Wan L, Wang Y, Xiao C, Li X, Cao J, Wang S, Wei X, Liu X. Four cases of heterotopia of an intrauterine device embedded in the bladder muscular layer causing cystolithiasis: case report and review of the literature. J Int Med Res 2021; 49:300060520979444. [PMID: 33472467 PMCID: PMC7829606 DOI: 10.1177/0300060520979444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Family planning is a basic national policy in China. An intrauterine device (IUD)
is an important method of achieving family planning owing to its high safety,
low cost, and convenient use. The indwelling birth control ring has no obvious
adverse effects on the sexual life of women after the operation, and the process
is reversible. This ring can be removed for women who want to have children
again. There are approximately 100 million women with IUDs worldwide, with
approximately 80 million in China. This finding accounts for approximately 40%
of women of childbearing age in China. Although an IUD is safe, the invasive
operation inevitably leads to complications, such as pelvic infection, abnormal
menstruation, and damage to adjacent organs. Among them, ectopic bladder stone
formation is a rare complication, but several related cases have been reported.
We report four cases of heterotopia of an IUD and cystolithiasis, with diagnosis
based on the medical history, clinical manifestations, imaging, and cystoscopic
findings. The four patients with ectopic IUDs were treated with cystoscopy
combined with laparoscopy (or hysteroscopy). We describe the process of
diagnosis and treatment of our patients, and the related literature on an
ectopic IUD is reviewed.
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Affiliation(s)
- Li Wan
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Yong Wang
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Chuan Xiao
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xin Li
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Jingzhao Cao
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Shubin Wang
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xupan Wei
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
| | - Xiangyu Liu
- Department of Urology, Pangang Group General Hospital, Pan Zhihua, China
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Duncan J, Fay K, Sanders J, Cappiello B, Saviers-Steiger J, Turok DK. Ex-vivo forces associated with intrauterine device placement and perforation: a biomechanical evaluation of hysterectomy specimens. BMC WOMENS HEALTH 2021; 21:141. [PMID: 33827522 PMCID: PMC8028834 DOI: 10.1186/s12905-021-01285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 03/28/2021] [Indexed: 11/10/2022]
Abstract
Background This biomechanical analysis of hysterectomy specimens assesses the forces associated with intrauterine device placement. These include compressive forces required to cause uterine perforation with two commonly available commercial intrauterine device placement instruments and a metal uterine sound. Methods We obtained hysterectomy specimens at a single academic center. All specimens resulted from excision for benign conditions in premenopausal women by any operative method. Within one hour of excision, we stabilized uterine specimens in an apparatus specifically designed for this analysis. A single, experienced clinician performed all experimental maneuvers and measured forces with a Wagner FDIX-25 force gauge. The investigator applied traction on a tenaculum to approximate force used during an intrauterine device placement. The maximum compressive force to the uterine fundus was determined by using manufacturers’ placement instruments for two commercially available products and a metal sound. Results Sixteen individuals provided hysterectomy specimens. No complete perforations occurred while using loaded intrauterine devices; in a single observation the LNG IUS entered the myometrium. The plastic intrauterine device placement rod bowed in all attempts and did not perforate the uterine serosa at the fundus. A metal uterine sound created a complete perforation in all specimens (p < .001). The lowest mean maximum force generated occurred with the levonorgestrel intrauterine system placement instrument 12.3 N (SD ± 3.8 N), followed by the copper T380A intrauterine device placement instrument 14.1 N (SD ± 4.0 N), and highest for the metal sound 17.9 N (SD ± 7.6 N) (p < 0.01). Conclusions In this ex-vivo model, metal uterine sounds caused complete perforation and intrauterine device placement instruments did not. This study received Institutional Review Board (IRB0059096) approval.
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Affiliation(s)
- Jane Duncan
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Kathryn Fay
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA.
| | - Jessica Sanders
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | | | - Jane Saviers-Steiger
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - David K Turok
- Department of Obstetrics and Gynecology, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
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20
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Rasyid N, Nainggolan HJ, Jonardi PA, Raharja PAR, Wiweko B, Atmoko W, Birowo P. Early-onset complete spontaneous migration of contraceptive intrauterine device to the bladder in a post C-section patient: A case report. Int J Surg Case Rep 2021; 82:105850. [PMID: 33838481 PMCID: PMC8056411 DOI: 10.1016/j.ijscr.2021.105850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/24/2021] [Accepted: 03/28/2021] [Indexed: 11/16/2022] Open
Abstract
Migration of a contraceptive intrauterine device (IUD) rarely occurs. Computed tomography is the preferred radiological examination. Waiting for the complete migration of IUD is beneficial for its easy removal. Periodical evaluation may prevent complications in patients with contraceptive IUD.
Introduction and importance Spontaneous migration of a contraceptive intrauterine device (IUD) to the bladder is very rare. It usually takes years for the IUD to migrate completely from the uterine cavity to the bladder. We report a case of early-onset complete spontaneous migration of contraceptive IUD to the bladder in a post C-section patient. Case presentation A 30-year-old woman presented with suprapubic pain and dysuria three weeks prior to hospitalization. She had C-section three months prior and underwent copper IUD insertion two months after the surgery. One week after IUD insertion, radiography showed that the IUD remained in the uterus, but the patient felt suprapubic pain and dysuria. Computed tomography (CT) three weeks after IUD insertions showed IUD migration to the bladder with its tips embedded in the uterine wall. Cystoscopy was performed one week later and the IUD was completely inside the bladder. By then, the IUD was removed completely via forceps with no complication. Clinical discussion The exact pathophysiology of spontaneous IUD migration is unknown, but migration always starts with uterine perforation. In our case, uterine perforation was probably caused by immediate traumatic perforation. CT is the preferred radiological examination. IUD removal was performed one month after IUD insertion showing complete migration of the IUD, though CT one week prior suggested that the tips of the IUD remained embedded. Conclusion In cases of early-onset complete spontaneous migration of contraceptive IUD to the bladder, CT is the preferred radiological examination, and delaying removal procedure may be beneficial.
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Affiliation(s)
- Nur Rasyid
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia.
| | - Hoshea Jefferson Nainggolan
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Prinnisa Almanda Jonardi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Putu Angga Risky Raharja
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Budi Wiweko
- Division of Reproductive Endocrinology and Infertility, Department of Obstetric and Gynecology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Widi Atmoko
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
| | - Ponco Birowo
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jalan Diponegoro No. 71, Jakarta 10430, Indonesia
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21
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Holyoak GR, Lyman CC, Wang S, Germaine SS, Anderson CO, Baldrighi JM, Vemula N, Rezabek GB, Kane AJ. Efficacy of a Y‐Design Silastic Elastomer Intrauterine Device as a Horse Contraceptive. J Wildl Manage 2021. [DOI: 10.1002/jwmg.22027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G. Reed Holyoak
- College of Veterinary Medicine Oklahoma State University Stillwater OK 74078 USA
| | - Candace C. Lyman
- College of Veterinary Medicine Auburn University Auburn AL 36849 USA
| | - Shuodao Wang
- School of Mechanical & Aerospace Engineering Oklahoma State University Stillwater OK 74078 USA
| | | | - Cory O. Anderson
- College of Veterinary Medicine Oklahoma State University Stillwater OK 74078 USA
| | - Julia M. Baldrighi
- College of Veterinary Medicine Oklahoma State University Stillwater OK 74078 USA
| | - Neha Vemula
- School of Mechanical & Aerospace Engineering Oklahoma State University Stillwater OK 74078 USA
| | - Grant B. Rezabek
- College of Veterinary Medicine Oklahoma State University Stillwater OK 74078 USA
| | - Albert J. Kane
- U.S. Department of Agriculture Animal and Plant Health Inspection Service Fort Collins CO 80526 USA
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Tabatabaei F, Masoumzadeh M. Dislocated intrauterine devices: clinical presentations, diagnosis and management. EUR J CONTRACEP REPR 2021; 26:160-166. [PMID: 33555216 DOI: 10.1080/13625187.2021.1874337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Intrauterine devices (IUDs) are globally one of the most popular methods of contraception. Uterine perforation is one of the most significant complications of IUD use and commonly occurs at the time of IUD insertion rather than presenting as delayed migration. This paper reports a series of 13 cases of displaced IUDs requiring retrieval by laparoscopy or laparotomy. All the IUDs were copper bearing and most perforations occurred immediately after IUD insertion. CASES In two patients with sigmoid colon injury and IUD penetration of the appendix, laparoscopic management had failed and laparotomy was necessary owing to severe obliteration of the pelvic cavity. In one patient laparotomy was the preferred surgical approach owing to acute bowel perforation. In the remaining patients, the displaced devices were successfully removed by laparoscopy. CONCLUSION Uterine perforation and IUD migration to the organs in the abdominopelvic cavity are serious complications of IUD insertion and can be successfully managed by laparoscopy, or by laparotomy in the presence of severe pelvic adhesions or unexpected complications.
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Affiliation(s)
- Fatemeh Tabatabaei
- Department of Obstetrics and Gynaecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Gynaecologic Laparoscopic Surgeries, Al-Zahra Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdiyeh Masoumzadeh
- Department of Obstetrics and Gynaecology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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23
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Sarver J, Cregan M, Cain D. Fractured copper intrauterine device (IUD) retained in the uterine wall leading to hysterectomy: A case report. Case Rep Womens Health 2021; 29:e00287. [PMID: 33552933 PMCID: PMC7851793 DOI: 10.1016/j.crwh.2021.e00287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/18/2022] Open
Abstract
Several types of contraception methods exist, and among these are hormonal and non-hormonal intrauterine devices (IUDs). Cases have been reported of fractured IUD pieces and retention of copper fragments upon attempted removal in office. These findings suggest the importance of careful removal of an IUD by providers. A 38-year-old Caucasian woman, gravida 2, para 2, presented for a colposcopy and endometrial biopsy (EMB). She had had a copper IUD (ParaGard) placed 10 years prior. She now requested to have it removed. After completion of the colposcopy and EMB, the provider located the IUD strings for removal. During careful removal of the IUD, a piece was broken off and remained in the uterine cavity. Upon visual inspection of the removed IUD, the right wing was missing and presumed to be still in the patient. Transabdominal and transvaginal ultrasound (TVUS) confirmed presence of a portion of the IUD in the uterine wall near the cervix. The patient was scheduled for surgical removal of the IUD by robot-assisted total laparoscopic hysterectomy with bilateral salpingectomy. This case highlights the importance of thorough evaluation of an IUD upon removal. Practitioners who work with IUD insertion and removal should remain informed about this rare complication. Risk of fracture during IUD removal should be better communicated between physicians and patients. This case study underlines the importance of careful IUD planning, from insertion to removal. Further research considering improved stepwise removal should be considered. Fracture of an intrauterine device (IUD) upon removal is a very rare complication, with a prevalence rate of 1–2%. Risk of fracture during IUD removal should be better communicated between physicians and patients. Our patient's IUD fracture prompted a hysterectomy to safely remove the device. Malposition of an IUD may interfere with effectiveness and complicate removal.
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Affiliation(s)
- Jordan Sarver
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, United States of America
| | - Melissa Cregan
- Ohio University Heritage College of Osteopathic Medicine, Athens, OH 45701, United States of America
| | - Daniel Cain
- Twins Springs Gynecology, Massillon, OH 44646, United States of America
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Retroperitoneal Ectopic Location of an Intrauterine Device Revealed by Renal Colic: An Exceptional Case. Case Rep Urol 2020; 2020:8893750. [PMID: 32908776 PMCID: PMC7458883 DOI: 10.1155/2020/8893750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022] Open
Abstract
The intrauterine device (IUD) is one of the most effective contraceptive methods. Its Pearl Index is less than 1 per 100 women. It is the most used method around the world: about 100 million users. However, its insertion can cause certain complications, such as infection, expulsion, or perforation essentially when the rules of use are poorly applied. Perforation remains exceptional but one of the most serious complications. Indeed, after a perforation, the IUD could be located in different neighboring organs. We report a new case of IUD ectopic location in the peritoneal cavity, which was diagnosed 7 years after the insertion and as part of the renal colic assessment. The surgery was performed to remove the IUD which was embedded in the peritoneum and compresses the ureter and causes dilation upstream. To our knowledge, this is the first case reported in the literature of an ectopic location in the retroperitoneal space of an intrauterine device.
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25
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Uterine dimensions and intrauterine device malposition: can ultrasound predict displacement or expulsion before it happens? Arch Gynecol Obstet 2020; 302:1181-1187. [PMID: 32748051 DOI: 10.1007/s00404-020-05713-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Intrauterine devices (IUDs) are the most commonly used method of long-acting reversible contraception. IUD malpositions are described as expulsion, embedding, displacement, and perforation, which may cause contraception failure, organ injury, hemorrhage, and infection. The aim of the study was to evaluate the relationship between displacement and IUD positioning in the uterus, and uterine dimensions as measured using transvaginal ultrasonography. MATERIALS AND METHODS Three-hundred and eighty-four patients who had TCu380A devices inserted at a tertiary hospital were evaluated at insertion and at 1 month, 3 months, and 6 months after insertion. At the insertion visit, demographic characteristics, history of menorrhagia, dysmenorrhea, previous IUD displacement, and obstetric history were recorded. Transvaginal ultrasonographic measurement of the uterine cavity, uterine length, uterine width, cervix length, cervix width, transverse diameter of the uterine cavity, the distance between the tip of the IUD and the fundus, and endometrium were measured to evaluate IUD displacement. RESULTS Sixteen of 384 patients had displacement. There were significant differences in times between last pregnancy outcomes and IUD insertion and dysmenorrhea history (p = 0.004 and p = 0.028, respectively). Among TCu380A users, women with 7.5 mm IUD endometrium distances had a higher risk for displacement with a sensitivity of 81% and specificity of 37.5% (AUC: 0.607, 95% CI 0.51-0.70). Women with uterus width less than 41.5 mm were more likely to have displacement with a sensitivity of 53.8% and a specificity of 75% (AUC: 0.673, 95% CI 0.60-0.75). CONCLUSION IUD endometrium distance and uterus width are important parameters for displacement for TCu380A.
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Sharma R, Suneja A. Incarcerated and Transmigrated Intrauterine Contraceptive Devices Managed at a Tertiary Care Teaching Hospital of East Delhi: A 5-Year Retrospective Analysis. J Obstet Gynaecol India 2019; 69:272-278. [PMID: 31178644 DOI: 10.1007/s13224-018-1159-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/14/2018] [Indexed: 02/07/2023] Open
Abstract
Purpose of the Study Intrauterine contraceptive devices (IUCDs) are highly effective form of long-acting reversible contraception having least number of complications. We aimed to find the incidence, risk factors and the management done for incarcerated and transmigrated intrauterine contraceptive devices at a Tertiary Care Teaching Hospital during past 5 years. Methods A cross-sectional retrospective analysis of 5 years (January 2013-December 2017) was done, and the case records from Medical Record Department and Family Planning Unit of our institution were analysed. Results Total number of IUCD insertions done in last 5 years (from January 2013 to December 2017) in our institution was 4557. Misplaced IUCDs requiring surgical interventions were 71 (1.6%) out of which 63 (88.7%) were incomplete perforations or embedded and 8 (11.3%) were complete perforations or transmigrated IUCDs. Transmigration sites were omentum, uterovesical fold, mesentery and bladder. Laparotomy was needed in 4 (5.6%), and 2 (2.8%) needed each laparoscopy and cystoscopy. Main risk factors identified were postpartum previous on or two caesarean sections, low parity, grade of operator and IUCD and uterocervical length discrepancy. Conclusion The risk of perforation should not be a reason to defer IUCD insertion and every effort should be made to bring down its failure and complication rates.
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Affiliation(s)
- Richa Sharma
- Department of Obstetrics and Gynecology, Guru Teg Bahadur Hospital, University College of Medical Sciences, Delhi, 110095 India
| | - Amita Suneja
- Department of Obstetrics and Gynecology, Guru Teg Bahadur Hospital, University College of Medical Sciences, Delhi, 110095 India
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Shinichiro S, Wakimoto Y, Kamei H, Fukui A, Shibahara H. Removal of a Retroperitoneal Foreign Body by Laparoscopic Surgery. Gynecol Minim Invasive Ther 2019; 8:86-88. [PMID: 31143631 PMCID: PMC6515751 DOI: 10.4103/gmit.gmit_84_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/19/2018] [Accepted: 11/26/2018] [Indexed: 01/16/2023] Open
Abstract
Migration of intrauterine devices (IUDs) into the abdominal cavity is rare. In this report, we describe a patient in whom a levonorgestrel intrauterine system (LNG-IUS) device was initially misplaced outside of the uterus, likely due to stenosis of the cervix following a conization procedure for carcinoma in situ. The patient presented with persistent abdominal pain and vaginal bleeding. The LNG-IUS was not visible on physical examination and ultrasound imaging, requiring intraoperative abdominal radiography and postoperative computed tomography for localization. Once localized, we proceeded with the removal of the foreign body in the retroperitoneal space by laparoscopy. Misplacement of an IUD such as LNG-IUS outside of the uterus after a conization procedure should be suspected in women with persisting symptoms, and this possibility should be diligently assessed.
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Affiliation(s)
- Saeki Shinichiro
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yu Wakimoto
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hidetake Kamei
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Atsushi Fukui
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroaki Shibahara
- Department of Obstetrics and Gynecology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Abstract
To reduce the rate of unintended pregnancies, patients should select a contraceptive option that fits their needs and lifestyle. Long-acting reversible contraceptives (LARCs) are a relatively safe and effective option. This article outlines the characteristics of available LARCs and identifies the appropriate method for specific patient populations.
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Goldstuck ND, Le HP. Delivery of progestins via the subdermal versus the intrauterine route: comparison of the pharmacology and clinical outcomes. Expert Opin Drug Deliv 2018; 15:717-727. [DOI: 10.1080/17425247.2018.1498080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Norman D. Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, University of Stellenbosch, Bellville, Western Cape, South Africa
| | - Hung P. Le
- Department of Physical Sciences, MacEwan University, Edmonton, Alberta, Canada
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Goldstuck ND. Dimensional analysis of the endometrial cavity: how many dimensions should the ideal intrauterine device or system have? Int J Womens Health 2018; 10:165-168. [PMID: 29692635 PMCID: PMC5901129 DOI: 10.2147/ijwh.s158281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The geometrical shape of the human uterus most closely approximates that of a prolate ellipsoid. The endometrial cavity itself is more likely to also have the shape of a prolate ellipsoid especially when the extension of the cervix is omitted. Using this information and known endometrial cavity volumes and lateral and vertical dimensions, it is possible to calculate the anteroposterior (AP) dimensions and get a complete evaluation of all possible dimensions of the endometrial cavity. These are singular observations and not part of any other study. Methods The AP dimensions of the endometrial cavity of the uterus were calculated using the formula for the volume of the prolate ellipsoid to complete a three-dimensional picture of the endometrial cavity. Results Calculations confirm ultrasound imaging which shows large variations in cavity size and shape. Known cavity volumes and length and breadth measurements indicate that the AP diameter may vary from 6.29 to 38.2 mm. These measurements confirm the difficulty of getting a fixed-frame intrauterine device (IUD) to accommodate to a space of highly variable dimensions. This is especially true of three-dimension IUDs. A one-dimensional frameless IUD is most likely to be able to conform to this highly variable space and shape. Conclusion The endometrial cavity may assume many varied prolate ellipsoid configurations where one or more measurements may be too small to accommodate standard IUDs. A one-dimensional device is most likely to be able to be accommodated by most uterine cavities as compared to two- and three-dimensional devices.
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Affiliation(s)
- Norman D Goldstuck
- Department of Obstetrics and Gynecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Bellville, Western Cape, South Africa
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Relationship between copper IUD complications and ultrasonographic findings. Arch Gynecol Obstet 2018; 297:989-996. [DOI: 10.1007/s00404-018-4711-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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Sun X, Xue M, Deng X, Lin Y, Tan Y, Wei X. Clinical characteristic and intraoperative findings of uterine perforation patients in using of intrauterine devices (IUDs). ACTA ACUST UNITED AC 2018; 15:3. [PMID: 29386988 PMCID: PMC5770510 DOI: 10.1186/s10397-017-1032-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023]
Abstract
Background Intrauterine devices (IUDs) are the most popular form of contraception used worldwide; however, IUD is not risk-free. IUD migrations, especially uterine perforations, were frequently occurred in patients. The aim of this study was to investigate the clinical characteristics and intraoperative findings in patients with migrated IUDs. Results 29 cases of uterine perforation associated with migrated IUDs and 69 control patients were followed between January 2008 to March 2015. Patients who used IUDs within first 6 months from the last delivery experienced a characteristically high rate of the perforation of the uterine wall. A significantly larger number of IUD insertion associated with uterine perforation were performed in rural hospitals or operated at a lower level health care system. There was no clear difference in the age and presented symptoms in patients between two groups. Majority of contraceptive intrauterine devices was the copper-releasing IUDs. Furthermore, patients who used V-shaped IUD showed significantly higher incidence of pelvic adhesions when compared with the users of O-shaped IUDs. Conclusions Unique clinical characteristics of IUD migration were identified in patients with uterine perforation. Hysteroscopy and/or laparoscopy were the effective approaches to remove the migrated IUDs. Improving operating skills is required at the lower level of health care system.
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Affiliation(s)
- Xin Sun
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Min Xue
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Xinliang Deng
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Yun Lin
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Ying Tan
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
| | - Xueli Wei
- Department of Obstetrics and Gynecology, The 3rd Xiangya Hospital of Central South University, 138 Tongzipo Rd, Changsha, Hunan 410013 China
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Goldstuck ND, Steyn PS. Insertion of intrauterine devices after cesarean section: a systematic review update. Int J Womens Health 2017; 9:205-212. [PMID: 28458581 PMCID: PMC5402906 DOI: 10.2147/ijwh.s132391] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Women who undergo a cesarean section (CS) are in a unique position to receive the intrauterine contraceptive device (IUD). They may also want to use the IUD as a long-acting reversible contraceptive method provided the IUD is safe and effective in the presence of a CS scar. Search strategy We researched and reviewed the MEDLINE, POPLINE, Google Scholar, and ClinicalTrials.gov databases from January 1968 to June 2015. Selection criteria Eligible studies reported event rates or practical problems relating to IUD usage in post-placental or interval insertion (>90 days) after CS. Studies with ≥20 subjects were included. Data collection and analysis Analysis of eligible data collected from the search followed the PRISMA guidelines. Main results Twelve eligible studies of post-placental IUD insertion after CS included four randomized controlled trials of post-placental versus delayed insertion. Women randomized to delayed insertion were less likely to receive a device. Six studies examined the problem of missing IUD threads at follow-up with only 30%–60% presence of strings observed. Conclusion The IUD is a long-acting reversible contraceptive method that is suitable for use in all women undergoing CS. The problems of device expulsion, missing threads at follow-up, and the tendency of increased puerperal bleeding need to be solved. Solutions are proposed.
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Affiliation(s)
- Norman D Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Western Cape
| | - Petrus S Steyn
- Department of Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa
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Wildemeersch D, Andrade A, Goldstuck ND, Hasskamp T, Jackers G. Intrauterine levonorgestrel delivery with frameless fibrous delivery system: review of clinical experience. Int J Womens Health 2017; 9:49-58. [PMID: 28176932 PMCID: PMC5268329 DOI: 10.2147/ijwh.s122579] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The concept of using a frameless intrauterine device (IUD) instead of the conventional plastic framed IUD is not new. Frameless copper IUDs have been available since the late 1990s. They rely on an anchoring system to retain in the uterine cavity. The clinical experience with these IUDs suggests that frameless IUDs fit better as they are thin and, therefore, do not disturb or irritate the uterus. High tolerance and continuation rates have been achieved as complaints of pain are virtually nonexistent and the impact on menstrual blood loss is minimal. Conventional levonorgestrel-releasing intrauterine systems (LNG-IUSs) are very popular as they significantly reduce menstrual bleeding and provide highly effective contraception. However, continuation of use remains problematic, particularly in young users. Total or partial expulsion and displacement of the LNG-IUS also occur too often due to spatial incompatibility within a small uterine cavity, as strong uterine contractions originate, attempting to get rid of the bothersome IUD/IUS. If not expelled, embedment ensues, often leading to chronic pain and early removal of the IUD/IUS. Several studies conducted recently have requested attention to the relationship between the LNG-IUS and the endometrial cavity. Some authors have proposed to measure the cavity width prior to inserting an IUD, as many uterine cavities are much smaller than the currently existing LNG-IUSs. A frameless fibrous drug delivery system fits, in principle, in all uterine cavities and may therefore be preferable to framed drug delivery systems. This review examines the clinical performance, acceptability, and potential of the frameless LNG-IUS (FibroPlant®) when used for contraception, treatment of heavy menstrual bleeding, dysmenorrhea, and endometrial suppression in women using estrogen replacement therapy, endometrial hyperplasia, and other gynecological conditions. The review concludes that FibroPlant LNG-IUS offers unique advantages in reducing side effects.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Amaury Andrade
- Centro de Biologia da Reprodução, Universidade Federal Juiz de Fora, Juiz de Fora, Brazil
| | - Norman D Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
| | - Thomas Hasskamp
- Klinik für Operativen Gynäkologie, GynMünster, Münster, Germany
| | - Geert Jackers
- Applied Controlled Release, Technology Park, Ghent (Zwijnaarde), Belgium
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A multicenter study assessing uterine cavity width in over 400 nulliparous women seeking IUD insertion using 2D and 3D sonography. Eur J Obstet Gynecol Reprod Biol 2016; 206:232-238. [DOI: 10.1016/j.ejogrb.2016.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/28/2016] [Accepted: 09/13/2016] [Indexed: 11/22/2022]
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Tale of the Tails, the Missing Postpartum IUCD Strings. J Obstet Gynaecol India 2016; 67:202-207. [PMID: 28546668 DOI: 10.1007/s13224-016-0940-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 09/01/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Using an intrauterine device (IUD) is many times safer than pregnancy and more effective in preventing pregnancy than oral contraceptives, condoms, spermicidal, any barrier method, or natural family planning. Benefits of healthy timing and spacing of pregnancy are many. Postpartum contraception is becoming popular after introduction of PPIUCD services. OBJECTIVE To study the incidence, management, clinical outcome of missing strings cases in post-placental and intra-cesarean IUCD. MATERIALS AND METHODS This study was a retrospective observational study, carried out in the district of Balangir, Odisha, India. Status of women who had post-placental and intra-cesarean IUCD insertion in various institutions between January 2010 and December 2012 having follow-up as per the protocol was taken for the study. All the complications were recorded and studied. Incidence, clinical outcome, and management of missing strings were analyzed. RESULTS Records of 1343 clients were studied. Six hundred and seventeen cases had failed to report for follow-up as per the study design. Seven hundred and twenty-six cases had follow-up as per the protocol. Of them, 36 had expulsion, and rest 690 cases were taken for the study. There were 209 missing strings at 3 months. At the end of the study, there was spontaneous descend in 138 cases. More than 50 % cases were asymptomatic. Ultrasonography was the method of diagnosis, and simple sounding of the uterus alone could also establish IUD in uterine cavity. Removal rate was higher in missing strings group, Continuation rate is higher in String visible group. CONCLUSION Post-placental intra-cesarean Copper T 380A insertion is a safe and effective method of reversible contraception; missing string is emerging as a potential distracter of its use. It is important that every user must be followed up and the providers must be competent in managing complication. Better after care in form of effective follow-up and complication management is needed to maintain popularity. Introduction of compensation scheme will also help improving the acceptance.
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Rowlands S, Oloto E, Horwell DH. Intrauterine devices and risk of uterine perforation: current perspectives. Open Access J Contracept 2016; 7:19-32. [PMID: 29386934 PMCID: PMC5683155 DOI: 10.2147/oajc.s85546] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Uterine perforation is an uncommon complication of intrauterine device insertion, with an incidence of one in 1,000 insertions. Perforation may be complete, with the device totally in the abdominal cavity, or partial, with the device to varying degrees within the uterine wall. Some studies show a positive association between lactation and perforation, but a causal relationship has not been established. Very rarely, a device may perforate into bowel or the urinary tract. Perforated intrauterine devices can generally be removed successfully at laparoscopy.
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Affiliation(s)
- Sam Rowlands
- Centre of Postgraduate Medical Research and Education, Faculty of Health and Social Sciences, Bournemouth University, Dorset, UK
| | - Emeka Oloto
- Staffordshire and Stoke on Trent Partnership NHS Trust, Leicester, UK
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Abstract
INTRODUCTION Intrauterine devices (IUD) are viewed as important contraceptive methodologies to prevent unintended pregnancy. AREAS COVERED This expert opinion examines the place of frameless devices for use in young women in order to minimize side effect, improve patient comfort and maximize continuation of use to help reduce unintended pregnancies. EXPERT OPINION Frameless designed IUDs have the ability to be used in both small and large uterine cavities of varied shapes and can significantly reduce abnormal bleeding, pain, embedment and expulsion and likely account for higher continuation rates than that seen with framed IUDs.
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Affiliation(s)
- Dirk Wildemeersch
- a Gynecological Outpatient Clinic and IUD Training Center , Ghent , Belgium
| | - Norman D Goldstuck
- b Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences , Stellenbosch University and Tygerberg Hospital , Western Cape , South Africa
| | - Thomas Hasskamp
- c Klinik für Operativen Gynäkologie, GynMünster , Münster , Germany
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Ferguson CA, Costescu D, Jamieson MA, Jong L. Transmural migration and perforation of a levonorgestrel intrauterine system: a case report and review of the literature. Contraception 2015; 93:81-6. [PMID: 26386445 DOI: 10.1016/j.contraception.2015.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Uterine perforation is an uncommon yet well-known complication of copper intrauterine devices and the levonorgestrel intrauterine system (IUS). While initial extrauterine placement at the time of insertion is felt to be the cause of perforation in most cases, some hypothesize that delayed transmural migration and subsequent perforation can occur with slightly malpositioned or even properly placed devices. CASE A 46-year-old female had a 52-mg levonorgestrel IUS inserted for menstrual management and contraception. We arranged a follow-up ultrasound as the uterus was enlarged on bimanual examination and the cavity sounded to 11cm. This ultrasound was completed 6days after insertion and reported the IUS to be in the "upper uterine cavity". Over time, transmural displacement and perforation of the horizontal arms of the device occurred. Computed tomography scans performed over 2years for nongynecologic indications document this gradual migration. A retrospective review of initial ultrasound images showed no evidence of uterine defect, embedment or perforation but the cavity length did appear to be less than 11cm. CONCLUSIONS While initial extrauterine placement at the time of insertion is the most common mechanism of perforation, delayed transmural migration is another mechanism that can occur.
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Affiliation(s)
- Carrie Anne Ferguson
- Contraception Advice Research and Education Fellowship, Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada K7L 3N6.
| | - Dustin Costescu
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton, ON, Canada L8S 4L8
| | - Mary Anne Jamieson
- Department of Obstetrics and Gynaecology, Queen's University, Kingston, ON, Canada K7L 3N6
| | - Lisa Jong
- Department of Radiology, Queen's University, Kingston, ON, Canada K7L 3N6
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Wildemeersch D, Goldstuck ND. Expulsion and continuation rates after postabortion insertion of framed IUDs versus frameless IUDs - review of the literature. Open Access J Contracept 2015; 6:87-94. [PMID: 29386926 PMCID: PMC5683144 DOI: 10.2147/oajc.s87607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early intrauterine device (IUD) discontinuation after insertion immediately following aspiration abortion or after early medical abortion occurs as a consequence of expulsion of the IUD or removal due to side effects. These are often the consequence of the uterine forces impacting on the IUD due to spatial discrepancy with the uterine cavity causing pain, abnormal bleeding, and eventually, removal of the IUD. These women are candidates for repeat pregnancy as they often select less-effective methods or no contraception at all. Repeat abortion could be reduced by giving attention to these factors. STUDY DESIGN In order to have an indication on the magnitude of the problem of IUD expulsion or discontinuation, we searched the MEDLINE database for clinical trials, randomized controlled trials, and prospective observational studies related to immediate postaspiration termination of pregnancy (TOP) and early medical abortion IUD insertion studies that reported IUD expulsion and IUD continuation rates. RESULTS The search identified 17 clinical trials that were suitable based on the data they presented. The majority concerned T-shape IUDs, inserted immediately following surgical (aspiration) pregnancy termination. Two studies were conducted after medical TOP, and four studies were conducted with the frameless IUD inserted after surgical (vacuum aspiration) TOP. The results showed expulsion rates between 0.8% and 17.3% at 8 weeks, up to 5 years after insertion, respectively. In four studies with the frameless IUD, totaling 553 insertions, the expulsion rate was 0.0% in three of them. Follow-up in the latter studies varied between 5 weeks and 54 months. Reported continuation rates with conventional (framed) IUDs were between 33.8% and 80% at 1 year for studies providing 1 year rates and between 68% and 94.1% for studies reporting continuation rates at 6 months. Studies utilizing frameless IUDs reported 1 year continuation rate over 95%. CONCLUSION Frameless IUDs, due to their attachment to the uterine fundus, appear to be better retained by the postabortal uterus when compared with conventional framed IUDs. The absence of a frame ensures compatibility with uterine cavity anatomical dimensions, and may therefore result in improved acceptability and continuation rates in comparison with framed IUDs. Both these characteristics of the frameless IUD could help reduce the number of repeat unwanted pregnancies and subsequent abortions in some cases.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Norman D Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Western Cape, South Africa
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Wildemeersch D, Goldstuck N, Hasskamp T, Jandi S, Pett A. Intrauterine device quo vadis? Why intrauterine device use should be revisited particularly in nulliparous women? Open Access J Contracept 2015; 6:1-12. [PMID: 29386919 PMCID: PMC5683133 DOI: 10.2147/oajc.s72687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Long-acting reversible contraceptive (LARC) methods, including intrauterine devices (IUDs) and the contraceptive implant, are considered the best methods for preventing unintended pregnancies, rapid repeat pregnancy, and abortion in young women. An opinion paper of 2012 by the American College of Obstetricians and Gynecologists recommends Mirena and Paragard for use in nulliparous and adolescent women. However, these IUDs are not designed for young women and are not optimal as they often lead to early discontinuation. Objective This article was written with the objective to respond to the urgent need to improve intrauterine contraception as it is likely that the objectives of LARC will not be met without significant improvement of IUD design. Anatomical variations in size and shape of the uterus are not sufficiently considered, producing harm and suffering, which often lead to early removal of the IUD. Proposed problem solving The article describes why IUDs should be revisited to meet the challenge of LARC and proposes how to solve these problems. The opinion statement presented here may be considered provocative but is based on hundreds of women with IUD problems who consult or are referred to the practices of the authors of this article due to the disproportion between the IUD and their small uterine cavity. The solution is simple but requires a revision of the current design of IUDs. One-dimensional (longitudinal) IUDs are likely to be the first option. Framed devices with shortened transverse arm and IUDs which adapt to the width of the given uterus are viewed as second best. Conclusion One of the reasons of the high unintended pregnancy rate in the USA may be the paucity of suitable IUDs. Also, the legal climate in the USA seems to be a problem for developers as many lawsuits have recently been reported. Clinical studies conducted in young nulliparous and adolescent women suggest that IUDs that fit well in the uterine cavity, like a shoe, result in better tolerance, less side effects, and last but not least, higher use continuation rates.
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Affiliation(s)
- Dirk Wildemeersch
- Gynecological Outpatient Clinic and IUD Training Center, Ghent, Belgium
| | - Norman Goldstuck
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Western Cape, South Africa
| | | | - Sohela Jandi
- Gynecological Outpatient Clinic, Berlin, Germany
| | - Ansgar Pett
- Gynecological Outpatient Clinic, Berlin, Germany
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Intrauterine devices that do not fit well cause side effects, become embedded, or are expelled and can even perforate the uterine wall. J Minim Invasive Gynecol 2014; 22:309-10. [PMID: 25283708 DOI: 10.1016/j.jmig.2014.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 09/27/2014] [Indexed: 02/06/2023]
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