The application of hysteroscopy in diagnosis and treatment of missing intra‐uterine devices

Abstract

Objective To evaluate the efficacy of hysteroscopy for diagnosis and treatment of missing intra‐uterine devices (IUDs). Design A retrospective study of 274 patients. Setting Shanghai Institute of Planned Parenthood Research, Shanghai Jiading District Gynaecological Endoscopy Centre and Shanghai First Maternity and Infant Health Hospital. Subjects 274 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. Interventions Hysteroscopy was used to detect and/or remove the missing IUDs or their broken pieces in all patients. Results In 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.

Intrauterine Contraceptive Device, Simple Yet Still A Dilemma

“…There were studies recommending usage of hysteroscopy for embedded or displaced IUCD. A study by Zuan Chong Feng et al mentioned that hysteroscopy with an ultrasound B-scan is of great value not only for precise location but also for its removal under direct vision, particularly in the management of patients with broken and/or embedded IUCD pieces [3]. A study by Dwyer and James revealed that the incidence of difficulties associated with IUCD removal may occur in up to 9% of follow-up visits of women who have been fitted with IUCD [4].…”