Ultrasound-guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

E M M Yamaguti; E T Sontag Dos Reis; W P Martins; M N Nadai; N F Soares; F da Silva Costa; C S Vieira

doi:10.1002/uog.26023

Ultrasound-guided repositioning technique for partially expelled intrauterine device: descriptive feasibility study

Ultrasound Obstet Gynecol. 2023 Jan;61(1):109-113. doi: 10.1002/uog.26023.

Authors

E M M Yamaguti¹, E T Sontag Dos Reis¹, W P Martins², M N Nadai¹, N F Soares¹, F da Silva Costa^{1

3

4}, C S Vieira¹

Affiliations

¹ Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
² SEMEAR Fertilidade, Reproductive Medicine, Ribeirão Preto, Brazil.
³ Maternal-Fetal Medicine Unit, Gold Coast University Hospital, Southport, Queensland, Australia.
⁴ School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.

PMID: 35793228
DOI: 10.1002/uog.26023

Abstract

Objective: To describe the feasibility of an ultrasound-guided repositioning technique for partially expelled intrauterine devices (IUDs) without use of sedation.

Methods: This was a descriptive feasibility study of patients with a partially expelled IUD managed in our outpatient clinic from January 2016 to February 2020. The partially expelled IUDs (vertical arm extending partially or entirely through the cervical canal) were repositioned at the uterine fundus using Hartmann alligator forceps under ultrasound guidance. Paracervical or intracervical anesthesia and prophylactic antibiotics were not used. Data related to the procedure and 6-month follow-up were extracted from patient medical records. The primary outcome was the success rate of the repositioning procedure, defined as ultrasound confirmation of the entire IUD located above the internal os. Secondary outcomes included the retention and expulsion rates of the repositioned IUD at 6 months after the procedure and description of complications.

Results: We included data from 55 women with a partially expelled IUD (35 levonorgestrel IUDs and 20 copper IUDs) referred for repositioning. Ultrasound-guided repositioning of the IUD was successful in 51 (92.7%) cases, while the procedure was not completed in four patients due to pain. Of the 55 procedures, 48 (87.3%) were performed by obstetrics and gynecology trainees under the supervision of a senior specialist. Among the 51 successfully repositioned IUDs, nine (17.6%) were expelled within 6 months after the procedure and six patients were lost to follow-up. No uterine perforation or infection-related complications occurred within 6 months of the procedure.

Conclusion: The ultrasound-guided repositioning technique appears to be a safe and feasible approach for partially expelled IUDs. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Keywords: alligator forceps; displaced IUD; intrauterine device; partially expelled IUD; ultrasound.

MeSH terms

Feasibility Studies
Female
Humans
Intrauterine Devices*
Pregnancy
Ultrasonography, Interventional
Uterus / diagnostic imaging