The management of the malposition of intrauterine devices at the tertiary center

Abstract

Aims: The malposition of intrauterine devices (IUD) is a major problem in contraception and this study aims to evaluate the surgical procedures used in the management of these cases. Methods: Patients who were operated on for malposition of copper T IUD between 2018-2021 were evaluated retrospectively. The cases were analyzed in 4 groups as followed; instrumental removal, hysteroscopic (H/S), laparoscopic (L/S), and laparotomic (LPT) procedure. The groups were compared in age, obstetric history, IUD insertion time, and intraoperative outcomes. Results: There were a total of 39 cases and the groups consisted of instrumental removal (n=8), H/S (n=24), L/S (n=6), and LPT (n=1) procedure. In the H/S group, mean age (44 ±10) and duration of IUD use (10.1 ±7.5 years) were found to be significantly higher than the other groups (p=0.03 and p=0.001 ). Six cases (25%) in the H/S group IUD was in the uterine cavity while in 5 (20.8%) it was embedded in the endometrium and myometrium. In the L/S group, the duration of IUD use was shorter (1.3 ± 0.8 years) and the mean age (29±10) was lower and all cases were managed laparoscopically except in one case that was extracted after conversion to laparotomy. Conclusion: Advanced age and prolonged IUD use are risk factors for embedded of the IUD in the uterine cavity in the hysteroscopy group, however, IUDs that reach the abdomen by ruptured uterus are detected at younger ages and earlier in IUD use, and minimally invasive methods are eligible surgical procedures for these cases.