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Intrauterine Contraceptive Device, Simple Yet Still A Dilemma

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Citation: 
.
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Introduction
       
          
           

        
       
      
       

         
        

   
       
         

           
 
         
         
 
   
       

            
          

   


       
       
        
         
        

 
 
 


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
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   
         
       
        
       
      
       
          
          
         

  


         


       
          


  
         


Intrauterine Contraceptive Device, Simple Yet Still A
Dilemma
Myat San Yi*, Lim Yee Cherng, Mi Mi Khaing and Rafiae Amin
Faculty of Medicine and Health Sciences, Department of Obstetrics and Gynecology, Malaysia
Received: Published: 
*Corresponding author:
UPINE PUBLISHERS
Open Access
LInterventions in Gynecology and
Women’s Healthcare
Case Report
ISSN: 2637-4544
DOI: 
Int Gyn & Women’s Health Copyrights@ Myat San Yi.
Citation: 
.
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        
           
          


   

       
        
   
          
 
         
          

       
    
      

 


    

 

        
    
           



          

Figure 1.
         
        

         
        
        


       

  
  


         
        


 

Figure 2.
       
       
          
       

 
          


          

  
Int Gyn & Women’s Health Copyrights@ Myat San Yi
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Citation: 
.
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
 
   
          
      

        

         
         

        
  

    

            



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        
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 
      
 

           

 
       

        

  
        

      

        

          
       

         
       
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Article
Objective To evaluate the efficacy of hysteroscopy for diagnosis and treatment of missing intra-uterine devices (IUDs).DesignA retrospective study of 274 patients.SettingShanghai Institute of Planned Parenthood Research, Shanghai Jiading District Gynaecological Endoscopy Centre and Shanghai First Maternity and Infant Health Hospital.Subjects274 patients with missing IUDs, who had previously undergone up to four unsuccessful attempts at IUD removal, were included in our study. Among them, 45 patients had been menopausal for more than 1 year.InterventionsHysteroscopy was used to detect and/or remove the missing IUDs or their broken pieces in all patients.ResultsIn 237 out of 274 patients with missing devices, the IUDs or their broken pieces in the uterine cavity were detected by hysteroscopy. In 236 out of these 237 patients, the IUDs or their broken pieces were removed successfully under hysteroscopic view or after hysteroscopic location. In one case only a small piece of the IUD remained in the uterine wall because of breakage during extraction. The IUDs of the remaining 37 patients were not found in the uterine cavity: in 13 patients there was expulsion of IUDs; in two there were broken pieces embedded in the uterine wall; 14 patients had IUDs removed by laparoscopy, and eight IUDs were removed by laparotomy.Conclusion Our study indicates that hysteroscopy, sometimes with an ultrasound B-scan or laparoscopic guide, is of great value not only for precise locating of the IUD, but also for its removal under direct vision, particularly in the management of patients with broken and/or embedded IUD pieces.
Article
There is limited information about the number of intrauterine device (IUD) users requiring operative intervention for device-related complications. This is an evaluation of cases requiring in-hospital operative intervention for IUD perforations, removals and pregnancy-related complications. Large retrospective case series of patients who received operative management of IUD complications. Charts of patients from 15 hospitals in two health care systems from 2000 to 2007 were reviewed and outcomes of 276 women are reported. There were 95 operative IUD removals for perforations (including 60 levonorgestrel-releasing intrauterine systems), 157 operative procedures for inability to remove an IUD in the office, and 42 pregnancy-related complications that were managed in the operating room. Ectopic pregnancy was the most common diagnosis among pregnant women (23 of 42 pregnant women, 54.8%). The majority of operative procedures were performed for intrauterine IUDs, most of which were appropriately positioned IUDs with missing or short strings. In-office techniques for obtaining analgesia and dilation as well as appropriate devices for removal of T-shaped IUDs should make this practice rare.
Article
Hysterosopic examinations were performed on 22 patients for IUDs suspected of being misplaced or embedded. Devices included 11 Majzlin springs, nine Lippes loops and two other types. Preoperative preparation and hysteroscopic techniques for extraction are described.
Article
Uterine perforation and deep embedding by an intrauterine device (IUD) require exact determination of its location as a necessary step to safe and effective retrieval. Six cases of uterine perforation and four of embedding by an IUD were studied with ultrasonography (US) and hysterography. While US findings suggested the correct diagnosis of perforation in five of the six cases, hysterography yielded more exact diagnostic information. Deep embedding could only be diagnosed with hysterography. A classification of the types of perforation and an algorithm for diagnosing ectopic IUD are presented. Undue reliance on the sonographic appearance of an IUD in the center of the uterine image may lead to hazardous attempts at transvaginal removal of a device that is partly intramural. In this study, hysterography offered the most precise diagnostic information.
Article
UTERINE perforation by an intrauterine contraceptive device (IUD) can be complete or partial. In complete perforation, the ectopic IUD is in the peritoneal cavity, either lying free, often in the posterior cul-de-sac, or adherent to uterus, adnexa, or peritoneum, or frequently enmeshed in omentum. Complete perforation— type 3—is usually diagnosed easily and the IUD is readily removed by laparoscopy, laparotomy, or colpotomy.In partial perforation, the IUD may impinge on the uterus in different areas and in varying degrees. It may be classified according to the compartments involved, considering the uterine cavity as compartment 1, the myometrium as compartment 2, and the peritoneal cavity as compartment 3. Thus, in type 1-2 partial perforation, the IUD is partially in the uterine cavity and partially in the myometrium; in type 2, in the myometrium only; in type 2-3, in the myometrium and peritoneal cavity; and in type 1-2-3, in the uterine cavity,
Article
The incidence of intrauterine device perforation is 0.87 per 1000 insertions. An intrauterine device (IUD) may perforate through the uterine wall into the pelvic or abdominal cavity or into adjacent organs. The accepted treatment for displaced IUDs is surgical removal because of the putative risk of adhesion formation or of damage to the intestine or urinary bladder. The purpose of this article is to present three cases of IUD perforation where surgical removal may not have been necessary. In all three cases, the IUD was removed by laparoscopy. No adhesions were found in any of the patients. Criteria for the surgical removal of a displaced IUD, as a result of uterine perforation, should be re-evaluated. Whilst surgical procedures to remove a misplaced IUD must be performed on symptomatic patients, asymptomatic patients, under certain circumstances, may benefit from conservative management.
Intrauterine contraceptive device (IUD, IUCD). Ministry of Health
  • Katherine Rivlin
  • Carolyn Westhoff
Katherine Rivlin, Carolyn Westhoff (7 th edn.) Family Planning, Comprehensive Gynecology. 13, 237-257. 2. (2018) Intrauterine contraceptive device (IUD, IUCD). Ministry of Health.
Hysteroscopic management of intrauterine devices with lost strings
  • Madhu Shubha Sagar Trivedi
  • Sandhi Goel
  • Jain
Shubha Sagar Trivedi, Madhu Goel, Sandhi Jain (2000) Hysteroscopic management of intrauterine devices with lost strings. 26(4): 229-230.