Intrauterine contraception - do sub optimally placed devices migrate to the uterine fundus?
ESC Congress Library. Dwivedi T. May 10, 2018; 208228; ESC26
Dr. Tina Dwivedi
Dr. Tina Dwivedi
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Abstract
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Background: Many women present to community sexual health clinics for review following insertion of intrauterine contraception and on speculum examination, the threads of the device are not visible. The authors propose that these women reflect that suboptimal placement of intrauterine contraceptive devices is common place and that in the vast majority of cases, the devices quickly migrate upwards to the uterine fundus, taking the threads into the cervical canal or endometrial cavity. Insertion of intrauterine contraception for most fitters is a blind process. Objective: To assess whether intrauterine contraceptive devices, identified immediately post insertion to be suboptimally placed, migrate to the uterine fundus. Design and Method: Women with a suboptimally placed intrauterine device were identified as a result of a transvaginal ultrasound scan immediately following insertion. These women were offered a review appointment for follow up transvaginal ultrasound four to six weeks following insertion. Twenty-four women were identified. two were not eligible for inclusion as the intrauterine device had to be removed at the initial visit. Six women failed to attend for follow up ultrasound. This left sixteen women eligible for inclusion in the case series. Out of these sixteen women, thirteen had Mirena® and three had Levosert® fitted. A spread sheet was created containing demographics and ultrasound findings. Results: In seven of the women, the IUS was 1cm or less from the uterine fundus, whereas in nine women the IUS was located more than 1 cm from the fundus. At follow up ultrasound scan (four-six weeks following insertion) in 100% of the women (all 16), the device had migrated to the fundus. Conclusion: It is likely that intrauterine contraception located within 1-2 cm of the uterine fundus will migrate to the fundus following insertion. In many of these women the threads will not be visible on speculum examination at follow up.
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