Removal Of Intrauterine Device Research Articles

Removal of the LNG IUD when strings are not visible: a case series

ObjectivesTo report length of intrauterine device (IUD) and strings as well as technique for extraction when IUD removal occurs without visible strings. Study DesignA prospective case series of 29 women who had IUDs removed in-office when strings were not visible at the external cervical os. ResultsOne third (n=11) were found to have a total length of IUD and strings <7.5 cm. All IUD removals were successfully performed as outpatient procedures. ConclusionRemoval of IUDs without visible strings can be successfully done as an in-office procedure. ImplicationsIn-office removal of IUDs without visible strings is effective, safe and economically sound.

Dimensions of the endometrial cavity and intrauterine device expulsion or removal for displacement: a nested case–control study

To evaluate the effect of the dimensions of the uterine cavity in relation to the expulsion, or removal for displacement, of intrauterine devices (IUDs) MLCu375 and TCu380A. A case-control study nested in a multicentre clinical trial. Eighteen family planning clinics in China. Forty-eight pairs of TCu380A users and 118 pairs of MLCu375 users. The women were classified as cases if IUD expulsion or displacement occurred during the first year of follow-up after insertion. One control was randomly selected for each case matched by IUD model, centre, age, service provider for insertion, and date of insertion. Axial length of the uterine cavity (LUC) and the largest transverse diameter of the coronal section of the uterine cavity (LTD) were measured using abdominal ultrasound. We used multivariate conditional logistic regressions to estimate the adjusted odds ratios (aORs) of expulsions or displacements among women with different sizes of uterine cavity according to the quartile of LUC and LTD, respectively. Among MLCu375 users, women with LTD ≥ 27 mm had a higher risk of expulsion or displacement (aOR 2.40; 95% confidence interval, 95% CI, 1.02-5.63), after adjusting for the volume of menstrual flow, dysmenorrhoea, parity, uterine position, MLCu375 type, and LUC. Among TCu380A users, the association between LTD ≥ 37 mm and expulsion or displacement (aOR 4.98; 95% CI 1.01-22.49) was statistically significant, after adjusting for LUC and potential confounding factors. Our study suggests that LTD should be considered when making the decision of which IUD model to use.

Interest in and experience with IUD self-removal

ObjectivesIn the United States, the popularity of intrauterine devices (IUDs) is low despite many positive attributes such as high effectiveness and ease of use. The requirement that a clinician remove the IUD may limit US women's interest in the method. Our objective was to describe women's experience with self-removal and its effect on attitudes toward the method. Study designWe assessed interest in attempting and success in IUD self-removal among women seeking IUD discontinuation from five US health centers. Women were given the option of attempting self-removal of the IUD. Participants were asked to complete two surveys about their reasons for desiring IUD removal, attitudes toward IUD use and experience with self-removal and/or clinician removal. ResultsThree hundred twenty-six racially diverse women participated (mean age, 28 years; body mass index, 27; duration of IUD use, 3 years); more than half were willing to try self-removal [95% confidence interval (CI): 45–65%], and among those who tried, one in five was successful (95% CI: 14–25%). More than half of participants (54%) reported they were more likely to recommend IUD use to a friend now that they know that it might be possible to remove one's own IUD; 6% reported they were less likely to recommend the IUD to a friend. African American women were particularly interested in the option of IUD self-removal. ConclusionsMany women are interested in the concept of IUD self-removal, although relatively few women currently succeed in removing their own IUD. ImplicationsHealth educators, providers and advocates who inform women of this option potentially increase IUD use, reducing rates of undesired pregnancy.

Histological study of hysteroscopy-guided endometrial biopsy from secondary infertile patients after removal of a copper intrauterine contraceptive device

Introduction The intrauterine device (IUD) is a long-acting reversible method of contraception. Copper T380 IUD is a copper-wrapped T-shaped IUD containing no hormones. Although the IUD has been a contraceptive method for about 50 years, the possibility of causing subsequent secondary infertility remains controversial. Aim of the work This work was conducted to study the endometrial structure in patients suffering from secondary infertility after copper IUD removal. Patients and methods Thirty secondary infertile patients aged between 20 and 35 years were classified into two groups: the control group (10 patients), with no past history of IUD insertion, and the IUD group (20 patients), with a history of copper IUD insertion for 6 months to 3 years (subgroup B1) or for more than 3 years (subgroup B2). Preovulatory hysteroscopy-guided endometrial biopsies were obtained and processed for light microscopy and transmission and scanning electron microscopy. Results Specimens from subgroup B1 showed focal loss of surface epithelium, cytoplasmic vacuolation, and small dark nuclei in surface epithelial cells. The stroma showed extravasated red blood cells, wide empty spaces, and cellular infiltration. In addition, the uterine glands of subgroup B2 appeared irregular and dilated with accumulated secretion and cellular debris as well as epithelial stratification. Ultrastructurally, focal loss, distortion and swelling of microvilli, indented nuclei, dilated rough endoplasmic reticulum, swollen mitochondria, and secondary lysosomes were observed in the surface epithelial cells. Scanning electron microscopy showed focal loss of microvilli, irregular surface, and mushroom-like protrusions in subgroup B1. These changes were more prominent in subgroup B2 with the appearance of fissures and corrugation of the surface. Conclusion Copper IUD could induce different degrees of structural changes in the endometrium, which were directly proportional to the duration of IUD insertion. These changes could explain the secondary infertility that may occur in some cases after IUD removal.

English

Intestinal injury following uterine perforation is a serious complication of intrauterine device (IUD) application. It can be in the form of obstruction, perforation or ischemia leading to stricture or fistulae formation. Perforation commonly involves sigmoid colon followed by the small intestine and rectum. Acute complications like peritonitis may occur sometimes leading to death. These complications commonly occur during insertion. Very rarely it may occur during the IUD removal. We are reporting an unusual case of small intestinal (ileum) injury during IUD removal leading to peritonitis. KEY-WORDS: Intrauterine devices, Intestinal injury, Perforation, Peritonitis INTRODUCTION: One of the most serious complications associated with the insertion of intrauterine devices (IUD) is uterine perforation. The reported incidence of uterine perforation ranges from 0.05to 13 per 1,000 insertions, varying according to several factors related to the patient, operator and IUD(1-2)The factors associated with uterine perforation are the type of IUDs, the timing of insertion with respect to the termination of pregnancy, the position i.e. anatomy of the uterus, the insertion technique, and the experience of the person inserting the IUD.(3) Uterine perforation can be iatrogenic, during the insertion, by the applied mechanical force (primary perforation) or spontaneously afterward (secondary perforation). Fifteen percent of uterine perforations involve adjacent organs, usually the small or large intestines.(2) IUD-related complications involving the intestines include obstruction, perforation, ischemia, mesenteric injury, stricture and fistulae.(3) Although intestinal injuries occur during insertion, it is unusual during removal of IUD. We are reporting a case of small intestinal perforation during removal of a copper T380A IUD. THE CASE: A 27-year-old, para 1 female was admitted in our hospital with history of severe pain abdomen, fever and abdominal distension for 4 days. She had history of an IUD (copper T380A) insertion one year back in an outside hospital immediately after her first delivery. Her menstrual periods were regular with heavy bleeding and pain for which she wanted to remove the IUD. Last menstrual period was 15 days back. The IUD was removed 4 days back in the same outside hospital. She experienced some difficulty during the process of removal. It was manipulated with instruments and she had severe pain and minimal vaginal bleeding during the process. Next day she had severe pain abdomen for which she again visited the same hospital. She was prescribed analgesic and advised to take rest. However, since the pain, fever and abdominal distension persisted in spite of medication, she visited our hospital

Comparing the effect of mefenamic Acid and vitex agnus on intrauterine device induced bleeding.

Increased bleeding is the most common cause of intrauterine device (IUD) removal. The use of alternative therapies to treat bleeding has increased due to the complications of medications. But most alternative therapies are not accepted by women. Therefore, conducting studies to find the right treatment with fewer complications and being acceptable is necessary. This study aimed to compare the effect of mefenamic acid and vitex agnus castus on IUD induced bleeding. This was a double blinded randomized controlled clinical trial. It was conducted on 84 women with random allocation in to two groups of 42 treated with mefenamic acid and vitex agnus capsules taking three times a day during menstruation for four months. Data were collected by demographic questionnaire and Higham 5 stage chart (1 month before the treatment and 4 months during the treatment)., Paired t-test, independent t-test, chi-square test, analysis of variance (ANOVA) with repeated measurements, and SPSS software were used to determine the results. Mefenamic acid and vitex agnus significantly decreased bleeding. This decrease in month 4 was 52% in the mefenamic acid group and 47.6% in the vitex agnus group. The mean bleeding score changes was statistically significant between the two groups in the first three months and before the intervention. In the mefenamic acid group, the decreased bleeding was significantly more than the vitex agnus group. However, during the 4(th) month, the mean change was not statistically significant. Mefenamic acid and vitex agnus were both effective on IUD induced bleeding; however, mefenamic acid was more effective.

Actinomycose secondaire du psoas : une complication du dispositif intra-utérin

Genital-pelvic actinomycosis is an uncommon disease which often arises on women with long term use of intrauterine device. Its diagnostic remains difficult. Even if different clinical locations has been reported, location to the psoas muscle is exceptional. We report such a case, diagnosed on a 53 years old woman. Both a tumoral and a severe infectious syndrome appeared three months after an intra-uterine device removal. The septic syndrome led to a laparotomic approach. Unusual clinical presentation, delay between device removal and septic syndrome and lack of genital infection explain the issues to reach the final diagnosis.

The use of interventional ultrasound in early pregnancy complications.

Background: The use of ultrasound to establish pregnancy location, viability and gestational age in the first trimester is well established. In addition to the conventional uses of ultrasound in early pregnancy, interventional ultrasound may also be used to guide clinicians during surgical procedures for the management of early pregnancy complications (i.e. treatment of ectopic pregnancy, caesarean section scar pregnancy, molar pregnancy, retained products of conception, and removal of intra‐uterine devices in early pregnancy). Aims: This review discusses the role of interventional ultrasound as it pertains to the management of first trimester complications, particularly with regard to the use of ultrasound in conjunction with surgical modalities. Materials and Methods: This review was based on recently published research, as cited in the PubMed database, regarding the use of either transvaginal or transabdominal ultrasound to assist with the management of early pregnancy complications. Conclusions: In addition to the diagnostic capabilities of ultrasound in early pregnancy, interventional ultrasound plays an important role in the management of various first trimester pregnancy complications. With the advent of more conservative approaches to early pregnancy complications, interventional ultrasound is a viable option which is not only safe in experienced hands but also enables fertility preservation.

Long Term Follow Up of Women Using Reversible Contraceptive Methods-Conclusions from Combining Data of 3 Different Audits

Objective: The matter of the choice of the available contraceptive methods has increased in the last few years. Physicians have a wide range of contraceptive methods to choose but in the same time are in a big concern about the appropriate type of contraception they should select for their patient and the effects in woman’s health and couple’s wellbeing. We present the outcome of 3 different audits in a large population of Northern Greece and we discuss the outcome of their results. Method: Three different audits studied medical data from 14.880 women, of different ages, which presented to the outpatient family planning clinic of our hospital. They were all interviewed using a standardized questionnaire, from which we got important information about behavior, the use, effects and reactions of contraceptive methods. The only exclusion criterion from the study was the use of the pill for less than three months, removal of IUD in less than three months, failure to attend for follow up and women who had moved away from the geographical area. The data of our analysis were retrospectively selected from the case files of 11.129 women between 15 to 40 years old, who used reversible contraception between the years 1984-2011. Results: In the first audit, 2120 women participated, users of any type of oral contraceptive pills? They gave information about the satisfaction, the side-effects and the main reasons of discontinuing the use of the pill. In the second audit 9009 women chose different types of Intrauterine Devices (IUD) as a contraceptive method. All of them have been examined in outpatient department and they have been checked for the safety of their IUD in correlation with unexpected pregnancy. Data about outcome, side effects and unexpected pregnancies were recorded. The third audit refers to the concerns about the use of oral sex steroids in relationship with cervical cancer and pathology in smear test. In the IUD group, we had more often results of inflammatory changes, negative for malignancy, in comparison with the contraceptive pill group. There was not statistically significant difference between the two groups regarding low and high grade squamous intraepithelial lesions (LGSIL/HGSIL). Conclusions: By studying the results of all these audits, we can get some important information about the behavior, the side-effects and ways of improving the usage of all types of reversible contraception. These results can be used as a baseline from which to monitor trends in the use of contraception in correlation to similar studies.

Current approaches to pelvic inflammatory disease

Pelvic inflammatory disease (PID) is an inflammatory process of infectious nature that can affect structures and organs of the upper genital tract. Considering this disease’s epidemiological relevance and severe complications, this article provides an update and proposes a systematic approach to PID. The main etiological agents are Neisseria gonorrhoeae, Chlamydia trachomatis and other etiological agents of urethritis, cervicitis, vulvovaginitis and vaginoses. These are generally of polymicrobial origin, which determines the treatment basis for pelvic inflammatory diseases. Women must be checked for PID when experiencing abdominal discomfort, backache, dyspareunia, or presenting with stains during gynecological examination and prior to transcervical procedures. The clinical and laparoscopic classification of PID can be divided into: a) stage I (endometritis/salpingitis without peritonitis), stage II (acute salpingitis with peritonitis), stage III (acute salpingitis with tubal occlusion or tube-ovarian abscess), and stage IV (tubeovarian abscess rupture). Defining the stage guides procedures and treatment, given that in mild forms (stage I) the treatment and follow-up can be performed in the ambulatory environment while moderate to severe cases require hospitalization so that intravenous treatment and treatment outcome monitoring can be started. Supportive treatment, removal of intrauterine device (IUD), sexual abstinence and rest are also indicated, as well as counseling on the implications of the disease and partner approach.

Fertility in older women following removal of long-term intrauterine devices in the wake of a natural disaster

BackgroundIn order to evaluate the effect of long-term intrauterine device (IUD) use on female fertility, we interviewed 2301 women who lost children in the 2008 Wenchuan earthquake in China, which prompted IUD removal. Study DesignA clinical retrospective survey. ResultFive hundred and twenty-four women were lost to follow-up, and data from the remaining 1770 women were analyzed. The completed questionnaires revealed that 80.11% (1418/1770) became pregnant following IUD removal and about 88% (1256) of whom conceived within 1 year. Among women with different durations of IUD use, pregnancy rates and miscarriage rates were as follows: <5 years, 89.77% and 4.27%; 6–10 years, 81.10% and 10.19%; and >10 years, 75.20% and 12.98%, respectively. Age, duration of IUD use, a history of a previous miscarriage and abnormal menstruation before the earthquake were independently associated with reduced fertility, but a higher gravidity pre-earthquake was associated with a higher conception rate. ConclusionLong-term IUD use in older women had a high rate of pregnancy after removal of IUD, but with an increased risk of fertility problems.

Controversies in family planning: desired pregnancy, IUD in situ and no strings visible

We recently saw a 29-year-old G2P1001 who is 8 weeks pregnant with her copper 380A intrauterine device (IUD) embedded in her cervix. The IUD was placed 7 years ago at an outside facility. On transvaginal ultrasound, the IUD is at least partially in the cervical stroma, not in the canal itself, and appears to be at an angle with one arm in the left portion of the cervix and the remainder in the anterior stroma. This is a desired pregnancy. She has had three attempts at IUD removal, including one with us which was extensive and unsuccessful.

Reasons for intrauterine device removal: a comparison of adults and adolescents

Reasons for intrauterine device removal: a comparison of adults and adolescents

Endoscopic removal of intrauterine device penetrated through the rectal wall

Following sterilization, intrauterine devices (IUDs) are the most widely used contraceptives in the world, especially in developing countries (1). Nowadays, IUDs are made of plastic, metal (mainly copper) and a small string. Uterine perforation is found in 1/350-1/2.500 inserts. It leads to the migration of the IUD, usually to adjacent organs to the uterus such as the rectum. Also there are reports of devices in the peritoneum, omentum, appendix and colon (2,3). We report a case of partial migration of an IUD into the lumen of the rectum, which was diagnosed and successfully removed by colonoscopy.

Diagnostic et prise en charge des perforations utérines par dispositif intra-utérin : à partir de 11 cas

ObjectiveIntrauterine device insertion is common. It is however not harmless and uterine perforation can be serious. Patients and methodsEleven cases of uterine perforation after intrauterine device insertion were listed at Tourcoing hospital between 2005 and 2009. They were analyzed to identify risk factors of uterine perforation and specify management. ResultsThe main symptom was pelvic pain (4 cases), pregnancy occurrence (3 cases) or unability to remove the IUD (2 cases). The intrauterine device was set during the first 9 months of post-partum in 7 cases, 2 patients were still breastfeeding. Seven patients underwent laparoscopy, 2 needed switch for laparotomy, one was treated by laparotomy only and one was lost of follow-up. Discussion and conclusionIncidence of uterine perforation after IUD insertion ranges from 0,1 to 3/1000. Pelvic pain is the most revealing symptom. Fifteen percent of perforations complicate with adjacent organ lesion. Perforation incidence seems greater if the intrauterine device is set during the 6 first weeks of post-partum and breastfeeding, but non influenced by operator practical experience. Ultrasound follow-up of patients carrying intrauterine device is controversial. Facing a suspicion of ectopic intrauterine device, pelvic ultrasound examination is the first step imaging modality and using 3D could be useful. If it fails to localize the intrauterine device, an abdominal X-ray must be performed. Ectopic intrauterine device removal is recommended.

A novel medical device for removal of intrauterine devices under direct vision

BackgroundEvaluation of the efficacy of a novel medical device for removal of retained intrauterine devices (IUDs) under direct vision without uterine distention is reported. CasesThe five cases presented used the novel medical device to remove the IUDs. One woman had an incarcerated IUD, two women had fractured IUDs and two women had IUDs with lost threads. All IUDs were removed completely with use of direct vision without uterine distention. ConclusionsThe device is effective for the removal of incarceration IUDs under direct vision without uterine distention.

Retrospective Review of Intrauterine Device in Adolescent and Young Women

Study ObjectiveTo examine our experience with intrauterine device (IUD) use in adolescents and young women. DesignRetrospective descriptive study evaluating outcomes after IUD insertion for patients 21 years or less over an 8-year period. SettingThree sites including a Pediatric and Adolescent gynecology private practice, a Title X clinic, and community based, grant funded clinic serving a high risk teen population. ParticipantsFemales from menarche to age 21. Main Outcomes MeasuredThe probability of IUD retention, differences in IUD retention probabilities between two age groups, and risk factors for IUD removal, expulsion, and infection were evaluated. Results233 records showed 50% of the <18-year-old age group and 71.5% of the 18–21-year-old group had their IUD in place at 5 years. Age was found to be a significant factor for removal (P < 0.001), with under 18-year-olds at greater risk of removal/expulsion (hazard ratio (HR) = 2.85). Parity (RR = 5.6 for nulliparous vs multiparous patients, P < 0.001) and prior STI (RR = 5.5, P < 0.001) were significant risk factors for infection. Nulliparous patients were at higher risk of expulsion (P = 0.045), though age was not a statistically significant risk factor. ConclusionsThe rate of continuation was lower in adolescents under 18 compared to18–21-year-olds, but was still higher than for other hormonal contraceptives. Despite this groups' high risk for STI the IUD did not increase the risk of infection and may offer some degree of protection. IUDs appear to be a safe option in young adolescents (<18 years old) and nulliparous women.

Adolescent experience with intrauterine device insertion and use: a retrospective cohort study

BackgroundAdolescents contribute disproportionately to the epidemic level of unintended pregnancy in the USA. Intrauterine devices (IUDs) are highly effective but underutilized in this age group. Study DesignWe searched our electronic clinic database to identify females ≤19 years old who underwent attempted IUD insertion between January 2007 and June 2009. This retrospective cohort study primarily compared the insertion and postinsertion experiences between nulliparous and parous teens. ResultsOf the 307 charts reviewed, the majority of subjects were white (73.4%) and nulliparous (77.5%), with a median age of 18 years (range 15–19). The vast majority (96.4%, 296/307) had a successful IUD insertion upon first attempt; all of the 11 unsuccessful IUD insertion attempts were among nulliparous teens.Follow-up was available for 56% (172/307). During the first 12 months of use, there were 2.9% (5/172) IUD expulsions and 24.4% (42/172) removals, with no differences between nulliparous and parous teens. IUD continuation at 6 months was 83.3%. Pelvic inflammatory disease was diagnosed in 4.6% (8/172) of post-IUD insertions. There were no pregnancies reported in those teens with IUD continuation, while six were reported in subjects who underwent IUD removal. Independent predictors of IUD discontinuation were a history of chronic pelvic pain or dysmenorrhea, and bleeding and/or pain complaints at any post-IUD visit. ConclusionsOverall, adolescents experience minimal complications with IUD use, with similar rates of successful insertion as adults. IUD discontinuation rates were not significantly different between nulliparous and parous teens. While discontinuation was higher than reported in adults, it was lower than reported among teens using other forms of contraception.

Complications among adolescents using copper intrauterine contraceptive devices

Objective To evaluate the rate and pattern of complications associated with use of the Copper T 380A intrauterine device (IUD) among adolescents. Methods A prospective comparative study of women eligible for IUD insertion who attended the family planning clinic of Sohag University Hospital, Egypt, between July 1, 2008 and December 31, 2010. The participants were categorized as adolescents or adults. The Copper T 380A IUD was inserted in all participants and follow-up visits were scheduled at 1, 3, and 6 months. Odds ratio and χ 2 square tests were used to compare the rates of complications at each visit. Results Of 1512 patients eligible for IUD insertion, 852 met the inclusion criteria: 281 adolescents and 571 adults. The rates of pain, bleeding, displacement, expulsion, and removal of IUDs were significantly higher in adolescents ( P < 0.05). The rates of these complications were high in adolescents younger than 16 years; the rates then decreased with age and became comparable with the adult rates at 18 years of age. Conclusions IUD-associated complications were high in adolescents up to the age of 17 years. Our data suggest that adolescents younger than 18 years of age should be counseled carefully before IUD insertion, and examined more frequently to detect displacement or expulsion of the device.

Minimally invasive approach to cases of lost intra-uterine device: a 7-year experience

ObjectivesTo evaluate the effectiveness of hysteroscopy and laparoscopy for diagnosis and treatment in women with lost intra-uterine devices (IUDs), and to elucidate the most common extra-uterine locations of lost IUDs. Study designRetrospective clinical study at Atatürk University Hospital, Erzurum, Turkey. Women with lost IUDs presenting in the last 7 years were referred to the obstetrics and gynaecology clinics. Women whose lost IUDs were removed using a Novak curette were excluded from the study. ResultsOf the 55 cases studied, 29 (52.7%) lost IUDs were located inside the uterine cavity, 23 (41.8%) were located outside the uterine cavity, and three (5.5%) were embedded in the myometrium. The most common extra-uterine location of lost IUDs was around the uterosacral ligaments (n=8, 34.7%). Considerable association was found between the position of the uterus and the extra-uterine location of lost IUDs. In all eight cases where the lost IUD was located around the uterosacral ligaments, the uterine position was anteverted and perforation was found on the posterior side of the uterus. IUD removal was performed successfully in 46 women (83.6%) by either hysteroscopy or laparoscopy. ConclusionsLost IUDs inside or outside the uterine cavity can be managed by minimally invasive approaches. If an anteverted uterus is seen on laparoscopy, the initial exploration for the lost IUD should be made around the uterosacral ligaments.