5 - Hysteroscopic Removal of Intrauterine Devices in Pregnancy

Abstract

Objective To introduce and demonstrate an approach to the hysteroscopic removal of retained intrauterine devices (IUDs) in pregnancy. Pregnancy risks associated with retained IUDs are also discussed, specifically spontaneous abortion and preterm labor. Design A step-by-step explanation of the procedure with surgical video footage. Setting Academic medical center. Patient(s) We present four patients undergoing hysteroscopic removal of IUDs in pregnancy. All patients have imaging documenting an IUD in utero, desire pregnancy continuation, and undergo a physical examination where the IUD strings are not retrievable from the cervical os. Intervention(s) Before the procedure, informed consent is obtained, imaging is reviewed, viability is confirmed, and preoperative antibiotics are administered. Hysteroscopy is then performed with the use of a stepwise approach: 1) vaginoscopic hysteroscopy; 2) IUD localization with or without ultrasound guidance; and 3) IUD removal with the use of a hysteroscopic grasper. Technical tips include using a small-caliber hysteroscope and infusion of small volumes of isotonic distension media. Main Outcome Measure(s) Uncomplicated removal of the IUD with postoperative confirmation of viability. Result(s) Hysteroscopic IUD removal was successfully performed in all four cases presented. After the procedure, all four patients delivered live births at term. Conclusion(s) The surgical approach presented in this video allows for the successful removal of IUDs in early pregnancy. This technique has a low complication rate and is associated with a >90% ongoing pregnancy rate. Patients with retained IUDs in pregnancy should be offered IUD removal in pregnancy, and referred to physicians experienced in advanced hysteroscopy for consideration of this procedure.