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One intrauterine device lost, two found
One intrauterine device lost, two found Avi Tsafrir, M.D., and Vladimir Plotkin, M.D. Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Jerusalem, Israel
During a search for a recently inserted, lost intrauterine device (IUD), a pelvic x-ray found two devices. One of the IUDs had been inserted 9 years earlier and was thought expelled. (Fertil Steril 2008;90:185. 2008 by American Society for Reproductive Medicine.) Key Words: Intrauterine device, perforation, spontaneous, embedding
A 41-year-old woman had an intrauterine device (IUD) (Mirena, Schering Oy, Turku, Finland) inserted during withdrawal bleeding from oral contraception. She had two normal pregnancies and two vaginal deliveries at term. Transvaginal ultrasound performed immediately after the procedure confirmed that the IUD was situated within the uterus. Six weeks later, the patient was well, reporting only mild spotting. On examination, no IUD threads were seen protruding from the external os. A repeat sonogram could not visualize the IUD. However, a plain abdominal x-ray surprisingly demonstrated two IUDs in the pelvis (Fig. 1).
FIGURE 1 A plain abdominal x-ray performed as part of the work-up of a recently inserted lost intrauterine device. Two intrauterine devices are demonstrated in the pelvis.
Apparently, the patient had had an IUD inserted 8 years earlier but had asked to have it removed several months later. At that time, the IUD was not found in the uterus, and the clinical diagnosis was spontaneous expulsion. The patient had since been using oral contraception. During laparoscopy, both IUDs were found to be in the pelvis, one covered with adhesions. No uterine anomaly was noted during the work-up. Spontaneous uterine perforation is a rare complication. In 0.8 per 1000 IUD insertions, IUD embedding may occur within the uterine wall, which probably occurred in this case, followed later by complete perforation (1). Uterine perforation should always be ruled out whenever an IUD cannot be demonstrated within the uterine cavity.
Tsafrir. One IUD lost, two found. Fertil Steril 2008.
REFERENCE 1. Harrison-Woolrych M, Ashton J, Coulter D. Uterine perforation on intrauterine device insertion: is the incidence higher than previously reported? Contraception 2003;67:53–6.
Received June 16, 2007; revised and accepted September 21, 2007. Reprint requests: Avi Tsafrir, M.D., Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Jerusalem, Israel (FAX: þ9722-6666211; E-mail: [email protected]).
0015-0282/08/$34.00 doi:10.1016/j.fertnstert.2007.09.065
Fertility and Sterility Vol. 90, No. 1, July 2008 Copyright ª2008 American Society for Reproductive Medicine, Published by Elsevier Inc.
185
During a search for a recently inserted, lost intrauterine device (IUD), a pelvic x-ray found two devices. One of the IUDs had been inserted 9 years earlier and was thought expelled. (Fertil Steril 2008;90:185. 2008 by American Society for Reproductive Medicine.) Key Words: Intrauterine device, perforation, spontaneous, embedding
A 41-year-old woman had an intrauterine device (IUD) (Mirena, Schering Oy, Turku, Finland) inserted during withdrawal bleeding from oral contraception. She had two normal pregnancies and two vaginal deliveries at term. Transvaginal ultrasound performed immediately after the procedure confirmed that the IUD was situated within the uterus. Six weeks later, the patient was well, reporting only mild spotting. On examination, no IUD threads were seen protruding from the external os. A repeat sonogram could not visualize the IUD. However, a plain abdominal x-ray surprisingly demonstrated two IUDs in the pelvis (Fig. 1).
FIGURE 1 A plain abdominal x-ray performed as part of the work-up of a recently inserted lost intrauterine device. Two intrauterine devices are demonstrated in the pelvis.
Apparently, the patient had had an IUD inserted 8 years earlier but had asked to have it removed several months later. At that time, the IUD was not found in the uterus, and the clinical diagnosis was spontaneous expulsion. The patient had since been using oral contraception. During laparoscopy, both IUDs were found to be in the pelvis, one covered with adhesions. No uterine anomaly was noted during the work-up. Spontaneous uterine perforation is a rare complication. In 0.8 per 1000 IUD insertions, IUD embedding may occur within the uterine wall, which probably occurred in this case, followed later by complete perforation (1). Uterine perforation should always be ruled out whenever an IUD cannot be demonstrated within the uterine cavity.
Tsafrir. One IUD lost, two found. Fertil Steril 2008.
REFERENCE 1. Harrison-Woolrych M, Ashton J, Coulter D. Uterine perforation on intrauterine device insertion: is the incidence higher than previously reported? Contraception 2003;67:53–6.
Received June 16, 2007; revised and accepted September 21, 2007. Reprint requests: Avi Tsafrir, M.D., Department of Obstetrics and Gynecology, Shaare-Zedek Medical Center, Jerusalem, Israel (FAX: þ9722-6666211; E-mail: [email protected]).
0015-0282/08/$34.00 doi:10.1016/j.fertnstert.2007.09.065
Fertility and Sterility Vol. 90, No. 1, July 2008 Copyright ª2008 American Society for Reproductive Medicine, Published by Elsevier Inc.
185