Technical report: Fluoroscopically controlled retrieval of intra-uterine contraceptive devices

Abstract

In a 1-year period in Reading England 4 women 23-53 years old were referred to the radiology department at Royal Berkshire Hospital for removal of IUDs with missing threads. Prior to the referral an experienced gynecologist had used forceps and retrieval hooks to try to retrieve the IUDs in all 4 cases. There were no pregnancies. Ultrasound confirmed that the IUD was in utero in all 4 cases. Sterile rectal biopsy forceps were inserted through the non-dilated cervical canal. Under-couch uniplanar fluoroscopy was used to guide the forceps onto the IUDs arm. The arm was grasped and the IUD gently pulled out through the cervical canal. IUD retrieval was successful in all 4 cases. The 4 women were discharged right after IUD retrieval with instructions to take 100 mg doxycycline once a day for 4 days. For 3 of the 4 women the fluoroscope screening time ranged from 14 to 183 seconds. For 1 woman 388 seconds were required for screening due to inexperience and the IUDs being embedded in the uterus. About 40 women annually undergo IUD removal under general anesthesia at the Royal Berkshire Hospital. The authors recommend fluoroscopically-guided retrieval of IUDs with missing threads when blind techniques have failed and as an alternative to techniques using general anesthesia.