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Migration of an Intrauterine System
IMAGE OF THE MONTH
Migration of an Intrauterine System Stéphanie Parent, MD, Audrey Binette, MD, FRCSC, Yves-André Bureau, MD, FRCSC Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke QC
A
26-year-old woman had a levonorgestrel-releasing intrauterine system (LNG-IUS) inserted for contraceptive purposes two months after an elective, low transverse primary Caesarean section. Nine months later, she was evaluated because of menorrhagia and pelvic pain. A 3-D endovaginal ultrasound showed the LNG-IUS arms had migrated a short distance into the myometrium. In a subsequent diagnostic hysteroscopy, only the device threads were visible in the right anterior endocervical canal. The uterine cavity was normal. Pulling on the threads failed to dislodge the device. Subsequent ultrasound examinations showed that the LNG-IUS had migrated to the right cornual position, and it was partly subserous (Figure 1, arrow). A laparoscopy confirmed the position of the device and allowed for its surgical removal by means of monop-
olar resection and traction (Figure 2). At postoperative follow-up, the patient reported a complete resolution of her symptoms. We believe that the LNG-IUS was at least partially inserted over the Caesarean scar, a weakened area of the myometrium, which facilitated migration. The patient consented to publication of these images. J Obstet Gynaecol Can 2016;-(-):1-1 Copyright ª 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jogc.2016.08.011
Figure 2. Figure 1.
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Migration of an Intrauterine System Stéphanie Parent, MD, Audrey Binette, MD, FRCSC, Yves-André Bureau, MD, FRCSC Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke QC
A
26-year-old woman had a levonorgestrel-releasing intrauterine system (LNG-IUS) inserted for contraceptive purposes two months after an elective, low transverse primary Caesarean section. Nine months later, she was evaluated because of menorrhagia and pelvic pain. A 3-D endovaginal ultrasound showed the LNG-IUS arms had migrated a short distance into the myometrium. In a subsequent diagnostic hysteroscopy, only the device threads were visible in the right anterior endocervical canal. The uterine cavity was normal. Pulling on the threads failed to dislodge the device. Subsequent ultrasound examinations showed that the LNG-IUS had migrated to the right cornual position, and it was partly subserous (Figure 1, arrow). A laparoscopy confirmed the position of the device and allowed for its surgical removal by means of monop-
olar resection and traction (Figure 2). At postoperative follow-up, the patient reported a complete resolution of her symptoms. We believe that the LNG-IUS was at least partially inserted over the Caesarean scar, a weakened area of the myometrium, which facilitated migration. The patient consented to publication of these images. J Obstet Gynaecol Can 2016;-(-):1-1 Copyright ª 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.jogc.2016.08.011
Figure 2. Figure 1.
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