Ultrasonography of intrauterine devices

Abstract

The intrauterine device (IUD) is gaining popularity as a reversible form of contraception. Ultrasonography serves as first-line imaging for the evaluation of IUD position in patients with pelvic pain, abnormal bleeding, or absent retrieval strings. This review highlights the imaging of both properly positioned and malpositioned IUDs. The problems associated with malpositioned IUDs include expulsion, displacement, embedment, and perforation. Management considerations depend on the severity of the malposition and the presence or absence of symptoms. Three-dimensional ultrasonography has proven to be more sensitive in the evaluation of more subtle findings of malposition, particularly side-arm embedment. Familiarity with the ultrasonographic features of properly positioned and malpositioned IUDs is essential.

Perforation of the appendix and the sigmoid colon by an ectopic IUD

“…8 When mechanical complications such as uterine perforations by IUDs or infectious complications such are suspected, a computed tomography (CT) or magnetic resonance imaging (MRI) is a useful and life-saving additional diagnostic modality. 5 In our case, bowel injury was not suspected and abdominal tomographic imaging was not requested due to a low suspicion for bowel involvement.…”

“…4 Factors such as insertion in the puerperal insertion, a retroverted uterus and technical know how of medical personnel can be attributed as risk factors for IUD perforation. 5 Early presentations are most often symptomatic and most frequently include complaints of abdominal and pelvic pain, while late presentations are usually assymptomatic with complaints of missing IUD strings on selfexamination or pregnancy. 1,6,7 According to Balci et al the diagnosis of ectopic Intrauterine device can often made with ultrasonography as first line and pelvic radiography should be recommended when ultrasonography fails to locate the missing device.…”

The influence of the levonorgestrel‐releasing intrauterine system position on bleeding patterns in reproductive age women

“…Fundal placement was defined as LNG‐IUS location less than 0.5 cm from the uterine fundus with both arms extended and parallel to the axis of the uterine cornua, with the upper end of the vertical arm of the intrauterine device (IUD) pointing directly and centrally into the uterine cavity . Non‐fundal LNG‐IUS placement was defined as device location greater than 0.5 cm from the uterine fundus, and/or the device's inferior portion was positioned within the internal os, with partial or total device displacement into the cervical canal . All women received a chart in which they were requested to record their bleeding patterns and any possible side‐ effects of the contraceptive.…”

“…The device is considered to be correctly positioned in the uterine cavity when it rests above the internal cervical os with its two arms unfolded in the direction of the respective uterine horns. Malposition of the device can result in device expulsion through the external cervical os, perforation of the uterine serosa, or partial deposition of the device in the uterine myometrium (sparing the serosa) as a result of device malposition in the cervical canal …”

Ultrasonography: a diagnostic choice to localise intra uterine contraceptive devices

“…4 For localisation of intrauterine contraceptive device, four important ultrasonographic features have been recognized which are:- Type-specific morphology  Posterior acoustic shadowing  Entrance-exit reflection  Anechoic halo around the IUCD…”