Management of the malpositioned levonorgestrel-releasing intrauterine system

Ber, Amos; Seidman, Daniel S.

doi:10.1016/j.contraception.2011.09.002

Cited by 7 publications

(11 citation statements)

References 4 publications

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“…Nevertheless, no other IUD repositioning studies have presented expulsion data after 6 months of the procedure 9,15 . Our expulsion rate within 6 months was 17.6% (9/51), similar to that reported in the study of Ber and Seidman 9 , in which IUD repositioning was performed without ultrasound guidance (3/17; 17.6%). Long‐term studies are needed to assess the expulsion rate of repositioned IUDs more than 6 months after the procedure.…”

Section: Discussionsupporting

confidence: 84%

“…Data on IUD expulsion beyond 6 months of the procedure were not available. Nevertheless, no other IUD repositioning studies have presented expulsion data after 6 months of the procedure 9,15 . Our expulsion rate within 6 months was 17.6% (9/51), similar to that reported in the study of Ber and Seidman 9 , in which IUD repositioning was performed without ultrasound guidance (3/17; 17.6%).…”

Section: Discussionmentioning

confidence: 99%

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Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Yamaguti

Reis

Martins³

et al. 2023

Ultrasound in Obstet & Gyne

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Objective To describe the feasibility of an ultrasound‐guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation. Methods This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6‐month follow‐up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications. Results We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound‐guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow‐up. No uterine perforation or infection‐related complications occurred within 6 months of the procedure. Conclusion The ultrasound‐guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Yamaguti

Reis

Martins³

et al. 2023

Ultrasound in Obstet & Gyne

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“…Ber and Seidman 9 used alligator pliers to restore the LNG‐IUS position in 18 women who experienced downward movement of the device, confirmed using ultrasound. Placement restoration was successful immediately in 17 of the 18 cases.…”

Section: Discussionmentioning

confidence: 85%

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Hong¹,

Wang²,

Fu³

et al. 2021

J of Obstet and Gynaecol

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Aim: The levonorgestrel-releasing intrauterine (LNG-IUS) system is an effective primary treatment for adenomyosis; however, it has high expulsion rates. We aimed to modify the system-allowing affixion to the myometrium-and evaluate the expulsion rate, effectiveness, and side effects in patients with adenomyosis and heavy menstrual bleeding. Methods: This study included patients with adenomyosis and heavy menstrual bleeding who underwent implantation of: a modified LNG-IUS (experimental group, n = 47); and the original system after gonadotropin-releasing hormone agonist treatment (control group, n = 47), between January 2014 and April 2016. Results: In the experimental group, two device expulsions occurred 12-18 months postimplantation. In the remaining 45 patients, the system was safely removed after the 60-month validity period, and no extrauterine device movement or infection occurred. In the control group, downward displacement and expulsion of the device occurred in eight (17%) patients within 60 months. The 5-year total expulsion rates were 4.3% and 17.0% in the experimental and control groups, respectively (p = 0.045). There were significant changes in the pretreatment severity of dysmenorrhea, menstrual volume, uterine volume (cm 3 ), and hemoglobin level in each group compared with after 1 year (p < 0.01 in all groups). The severity of dysmenorrhea, menstrual volume, uterine volume, and hemoglobin level after 1 year were similar between the two groups (p > 0.05 in all groups). Conclusions: Use of the modified LNG-IUS is a safe, cost-effective, and simple method for reducing the downward movement and expulsion rate in patients with adenomyosis and heavy menstrual bleeding.

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“…As an alternative to replacing the incidentally found low-lying IUD, Ber et al 17 reported on a case series of 18 patients who were asymptomatic but found to have a low-lying LNG-IUS. Alligator forceps were used to grasp the device in the cervical canal and push it up towards the fundus.…”

Section: Resultsmentioning

confidence: 99%

“…Ultimately, whilst it may be that the IUD and IUS still provide contraceptive effect when displaced from their optimal position at the fundus, there is no definitive evidence that this is the case. To be sure of providing the best contraceptive effect, it may remain best practice to replace an incidentally-found low-lying device, although an attempt may be made to correct the position of an IUS 17. This is particularly relevant for younger women, who have higher fertility 19…”

Section: Discussionmentioning

confidence: 99%

Low-lying or malpositioned intrauterine devices and systems

Golightly

Gebbie

2014

J Fam Plann Reprod Health Care

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IntroductionThe intrauterine device (IUD) and intrauterine system (IUS) are widely used forms of long-acting reversible contraception. Occasionally, IUD/IUS users have an ultrasound scan that shows a low-lying IUD/IUS or an IUD/ IUS is found incidentally on scan to be low-lying within the uterus. No formal guidelines exist on the clinical implications of this scenario or the most appropriate management. We report here on a systematic review of the literature. Methods A search of the online database PubMed was performed to identify articles relating to low-lying or malpositioned IUD/IUS. Results A total of 1101 articles was identified, and 15 were determined to be relevant to the research question. Discussion There is little published evidence to determine the nature and extent of the clinical relevance of a low-lying IUD. We recommend individualised management of these women, with particular caution in younger women and those with a history of previous IUD/IUS expulsion. Consideration may be given to attempting to readjust the IUD/IUS position, but if removal is performed, immediate replacement is essential if provision of alternative effective contraception has not been established.

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Management of the malpositioned levonorgestrel-releasing intrauterine system

Cited by 7 publications

References 4 publications

Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Ultrasound‐guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Effect of modified levonorgestrel‐releasing intrauterine system in human adenomyosis with heavy menstrual bleeding

Low-lying or malpositioned intrauterine devices and systems

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