In-Office Histeroscopic Removal of Intrauterine Device (IUD) during Early Pregnacy. Step By Step

Abstract

<h3>Study Objective</h3> This video aims to demonstrate the step-by-step removal of an intrauterine device during early pregnancy using office hysteroscopy. <h3>Design</h3> Step by step video explaining removal of IUD in office hysteroscopy settings. <h3>Setting</h3> Advanced gynecology laparoscopic and pelvic pain unit. <h3>Patients or Participants</h3> We present a case of a 23-year-old G2P1 with malpositioned Cu-IUD and 9.5 weeks of gestation. <h3>Interventions</h3> We present an intrauterine copper device retrieval in an office hysteroscopy setting. First, we performed transvaginal ultrasound identifying pregnancy location, viability, and exact IUD position. Detailed informed consent assessed risks, benefits, and potential procedure complications. Using Bettocchi-type office hysteroscopy equipment through a vaginoscopy approach and under real ultrasound guidance we got into uterine cavity and visualized the gestational sac. Saline as distention media allowed for the hysteroscope to navigate safely around the gestational sac and provided space for atraumatic IUD removal. Post procedure ultrasound confirmed embryo viability. No tocolytics or antibiotics were prescribed. <h3>Measurements and Main Results</h3> Successful uncomplicated intrauterine device removal in early pregnancy in office hysteroscopic settings. <h3>Conclusion</h3> In situ Intrauterine device during pregnancy represents a risk of abortion and preterm delivery. IUD removal during pregnancy is a safe and feasible procedure when performed by trained and experienced personnel. Office hysteroscopic IUD removal can be performed without anesthesia and with low risks of maternal and fetal complications.