Abstract
Background: Misplacement is one of the complications reported with intrauterine contraceptive devices (IUCDs) as a form of contraception. Objective: To study the methods of diagnosis and the mode of management of misplaced IUCDs at the Federal Teaching Hospital, Ido-Ekiti. Methods: This was a retrospective review of records of all clients who presented with complaints of missing IUCD over a 5 year period, from 1st January 2011 to 31st December 2015. Results: A total of 527 clients were seen at the family planning unit within the period under review. Three hundred and one (301) clients used IUCD, giving a prevalence of 57.1% of total contraceptive use. Of these, 12 IUCDs were reported misplaced, giving the incidence of misplaced IUCDs as 4%. The peak age of the clients reporting misplaced IUCD was 31-40 years. IUCDs insertion during puerperium was seen in 33.4% while most (41.6%) had their IUCD insertion more than 12 months following last childbirth. When considering IUCD insertion in relation to abortion and menses, most (50%) had insertion during menstrual period, 25% had insertion just before the onset of the next menses, postabortal insertion was seen in 16.7% while one (8.3%) could not ascertained the event that preceded the insertion of IUCD. Inability to feel the thread was the commonest presenting complaint in 6 (50%). Most of the clients with misplaced IUCD had the device inserted at the primary health centre (41.6%) and private hospitals (33.4%). Pelvic examination with uterine sound and abdominal ultrasound were the diagnostic methods commonly used. Most clients (83.3%) missed their IUCDs within the first twelve months of use. Retrieval hook was used for removal in 91.7% of the cases. One (8.3%) had exploratory laparotomy to recover the missing IUCD. Conclusion: Intrauterine devices should be inserted after proper case selection by properly trained medical personnel in both primary and tertiary centres in order to reduce reported cases of missing IUCDs.
Highlights
Intrauterine contraceptive device is a long acting reversible contraceptive
[2] In Nigeria, the level of acceptance ranges from 39.7%- 64% [3] with a failure rate of 1-2% each year has been reported worldwide. [2, 4] The intrauterine contraceptive devices (IUCDs) produce both morphological and biochemical changes in the reproductive tract by inducing inflammatory response in the endometrium, with associated increase in the levels of macrophages, and other inflammatory agents in the uterine and the tubal fluids. [5, 6]
[14] The different diagnostic methods used in detecting missing IUCDs include pelvic examination with uterine sound, abdomino-pelvic ultrasound alone, abdominopelvic ultrasound complimented with hysterosalpingography (HSG), plain abdominal x-ray, HSG, laparoscopy, minilaparotomy and laparotomy
Summary
Intrauterine contraceptive device is a long acting reversible contraceptive. It is an acceptable, common convenient, effective and relatively safe method of contraception with an estimated 127 million users of IUCDs worldwide. The major risks reported in association with use of IUCDs include ectopic pregnancy, spontaneous abortion, uterine perforation and expulsion. [2, 5] Missing or misplaced IUCD is one of the setbacks associated with the use of the device. Methods: This was a retrospective review of records of all clients who presented with complaints of missing IUCD over a 5 year period, from 1st January 2011 to 31st December 2015. Most of the clients with misplaced IUCD had the device inserted at the primary health centre (41.6%) and private hospitals (33.4%).
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