Abdominal migration of Intrauterine contraceptive devices
ESC Congress Library. Silvaramalho I. May 10, 2018; 208189; ESC294
Ines Silvaramalho
Ines Silvaramalho
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Objective(s): To review our experience with the clinical presentation and removal of intra-abdominal intrauterine devices (IUD) after uterine perforation. Design and methods: Retrospective analysis of the cases referred to the Department of Gynecology A of Centro Hospitalar e Universitário de Coimbra due to intraabdominal IUD, which underwent its surgical removal between 2000 and September of 2017. Results: A total of 26 cases were analyzed: 13 with a levonorgestrel-releasing intrauterine system (LNG-IUS) - 12 LNG-IUS 52mg e 1 LNG-IUS 13,5mg - and 13 with a copper IUD. The patients were from our department or referred from primary health-care units or other health-care centers with a suspected IUD migration. The location of the intra-abdominal IUDs was ascertained by abdominal X-ray, when it was not possible visualize them inside the uterus by transvaginal ultrasound . Patients median age was 36.0 ± 6.4 years old. They were all parous, 5 of them with previous cesarean sections. At the time of insertion, 6 women had had a delivery in the previous 12 months and 4 were breastfeeding. In 8 cases, they were diagnosed in the first 15 days after insertion; in 5, the diagnosis happened more than 4 months later. Most patients were symptomatic at the time of diagnosis (n=18), citing pelvic (n=16) or abdominal pain (n=4) and abnormal uterine bleeding (n=2). All patients but one underwent laparoscopy (n=25). The IUD was found in the omentum (n=10), Douglas pouch (n=8), embedded in bowel serosa (n=2) and near the adnexa (n=2). There was no correlation between its location and the presence of symptoms .  Mean operation time was 30.00 ± 19.25 minutes, but in some cases other procedures were associated. In 2 cases the postoperative course was complicated by a pelvic abscess. After IUD removal, the contraceptive method of choice was SURGICAL sterilization at the same time for 10 women and oral contraception for 8; 5 chose another IUD.  Conclusions: Uterine perforation by an IUD is an uncommon complication of this contraceptive method. In this study, the number of perforation cases with LNG-IUSs and copper IUDs was equal. Many women are asymptomatic and the diagnosis can only be suspected after a gynecological follow-up exam. An important consequence of a displaced IUD may be the loss of its contraceptive effect. There is no consensus in the need to remove an asymptomatic intra-abdominal IUD. Laparoscopic surgery facilitates this removal process.
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