Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient Care

Boortz, Hillary E.; Margolis, Daniel; Ragavendra, Nagesh; Patel, Maitraya; Kadell, Barbara

doi:10.1148/rg.322115068

Cited by 118 publications

(112 citation statements)

References 37 publications

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“…A simple abdominal X-ray can easily discern expulsion from migration. An ultrasound, CT scan or MRI of the abdomen and pelvis can then map the exact location of the migrating IUD and identify any associated visceral complication [12].…”

Section: Discussionmentioning

confidence: 99%

Tubal Migration of Intrauterine Device: A Report of a Rare Case of Trauma-Induced Migration Leading to Acute Abdomen

Badr¹,

Cheikh²,

Hassan³

et al. 2017

J Clin Gynecol Obstet

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Intrauterine devices (IUDs) are the most commonly used reversible contraceptive methods. They are a highly effective and safe tool of contraception but might carry some uncommon complications including device migration. Trauma-induced trans-tubal migration has not been reported before. We encountered a 26-year-old woman who presented to the emergency department (ED) with left iliac fossa pain, 1 day following a fall-down trauma. She had a history of uneventful IUD insertion 3 months prior to presentation. In the ED, a standing KUB showed an extra-uterine intra-abdominal IUD. At laparoscopy, the IUD was found protruding through the isthmic part of the fallopian tube. Trauma to patients wearing IUDs should prompt fellow gynecologists to check the location of the device within 24 -48 h. Recognition of this rare yet serious complication can be of benefit in the differential diagnosis of patients presenting to the ED with acute abdomen.

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Section: Discussionmentioning

confidence: 99%

Tubal Migration of Intrauterine Device: A Report of a Rare Case of Trauma-Induced Migration Leading to Acute Abdomen

Badr¹,

Cheikh²,

Hassan³

et al. 2017

J Clin Gynecol Obstet

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“…If vaginal US is unavailable, X-ray makes it possible to differentiate between a perforation and an expulsion when threads are not found and uterine perforation is suspected. In hospital settings, CT or magnetic resonance imaging is good alternative for further preoperative examination if suspicion of visceral complication arises (Boortz et al, 2012).…”

Section: Discussionmentioning

confidence: 99%

Uterine perforation caused by intrauterine devices: clinical course and treatment

Kaislasuo

Suhonen²,

Gissler

et al. 2013

Human Reproduction

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summary answer: Symptoms are mostly mild and 30% of women are asymptomatic. Surgical findings are mainly minimal; no visceral complications were found in this study. However, adhesions as well as pregnancies seem to be more common among women using Cu-IUDs. what is known already: Prior studies and case reports have suggested that uterine perforation by modern IUDs/IUSs is rarely serious. main results and the role of chance: The majority of patients (n ¼ 53; 71%) had mild symptoms of abnormal bleeding or abdominal pain or both, in combination with missing IUD/IUS threads. Asymptomatic patients (n ¼ 22; 29%) were examined because of missing threads or pregnancy. Failure to remove the IUD/IUS by pulling visible threads was the reason for referral in seven women (9%) requesting removal of the device. Eleven women (15%) were pregnant. Misplaced IUDs/IUSs were localized by a combination of vaginal ultrasonography (US) and X-ray, hysteroscopy or curettage. Only after this were patients treated by means of laparoscopy. The majority (n ¼ 44; 65%) of the 68 intra-abdominal devices were located in the omentum, the remaining 24 (35%) around the uterus. Partial perforation or myometrial embedding was diagnosed in all seven cases (9%) with visible threads, but unsuccessful removal by pulling. During laparoscopy, filmy adhesions were found in 21 patients (30%). Pregnancy (33 versus 7%, P ¼ 0.009) and intra-abdominal adhesions (58 versus 20%, P ¼ 0.002) were significantly more common in the Cu-IUD group. Infections were rare; one non-specific acute abdominal infection, later found to be unrelated to the IUD, led to laparoscopy and in four cases the IUD was surrounded by pus, but there were no symptoms of infection.limitations, reasons for caution: The study setting revealed only surgically treated symptomatic patients and asymptomatic women attending regular follow-up. Women not treated, but only followed or not attending follow-up, were not identified, excluding the possibility to analyse missed undiagnosed perforations, or conservative follow-up as a treatment option.wider implications of the findings: As surgical findings are minimal, asymptomatic women may need no treatment at all.An alternative form of contraception is, however, important as pregnancies do occur. If a woman plans a pregnancy, a misplaced LNG-IUS should be removed, as it may act as a contraceptive. study funding/competing interest(s): Helsinki University Central Hospital research funds. O.H. has lectured and designed educational events with Bayer AG and MSD, and serves occasionally on scientific advisory boards for these companies. S.S. has

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“…Studies [2,7,8,12] have been done in the past to identify the misplaced IUCDs by different imaging modalities irrespective of the time and method of insertion, but there is no study in the literature, describing the correct position of the IUCDs in terms of the ultrasonographic parameters in the immediate postpartum period. This study was done to identify the malpositioned IUCDs by sonography done within 24 h of the insertion of the IUCD and explore its association with the side effects observed after 6 months of follow up.…”

Section: Discussionmentioning

confidence: 99%

“…In case of the nonvisibility of the IUCD strings, imaging modalities like ultrasonography, X-rays, MRI, and CT-scan are quiet helpful [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Association of the Position of the Copper T 380A as Determined by the Ultrasonography Following its Insertion in the Immediate Postpartum Period with the Subsequent Complications: An Observational Study

Gupta

Malik

Sinha

et al. 2014

J Obstet Gynecol India

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Purpose Incorrectly placed copper T 380A leads to increased contraception failure. This study aimed to find an association between the ultrasonographic position of the copper T 380A in the immediate postpartum period and the adverse effects observed during the period of 6 months after its insertion. Methods This descriptive study was carried out in the Department of Obstetrics & Gynaecology of a tertiary-carecenter of India from September 2011 to February 2013. The women eligible for immediate postpartum copper T 380A insertion with previous regular menstrual cycles for at least 6 months before the current pregnancy, and those who were willing for follow-up visits and had easy accessibility to the hospital, were recruited. A clinical evaluation and ultrasonographic assessment of Intra-Uterine-Contraceptive-Device (IUCD) after insertion was carried out after enrolment. The complications (expulsions, vaginal discharge, menstrual irregularity, and lower abdominal pain) were subsequently assessed during a 6-month follow-up period. The primary objective was the ultrasonographic assessment of the placement of IUCD immediately after insertion. The incidence of complications and their association with the presence of malposition was also studied. Results Hundred patients were evaluated during the study period. Forty-four (44 %) women were found to have malpositioned IUCDs on ultrasonographic evaluation done following insertion. The complications among the IUCD users included menstrual irregularity (27.17 %), pain in lower abdomen (20.65 %), vaginal discharge (7.6 %), and expulsions (9.7 %). The IUCD expulsions, menstrual irregularities, and pain were significantly more in patients with malpositions (p \ 0.05). Conclusions Malpositioning of IUCD is common immediately following insertion and is significantly associated with more complications during the follow-up.

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Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient Care

Cited by 118 publications

References 37 publications

Tubal Migration of Intrauterine Device: A Report of a Rare Case of Trauma-Induced Migration Leading to Acute Abdomen

Tubal Migration of Intrauterine Device: A Report of a Rare Case of Trauma-Induced Migration Leading to Acute Abdomen

Uterine perforation caused by intrauterine devices: clinical course and treatment

Association of the Position of the Copper T 380A as Determined by the Ultrasonography Following its Insertion in the Immediate Postpartum Period with the Subsequent Complications: An Observational Study

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