Removal of a missing intrauterine contraceptive device after location through an ultrasound: a case report within a rural setting and review of literature

Abstract

Background In the last decade, (2000–2019), the modern contraceptive prevalence among married women of reproductive age (14–49 years), has increased by only 2.1%. The slow progress was due to limited access to services and myths surrounding methods held by both users and providers. This case report was identified, diagnosed and managed by a midwife working in rural health center in low resource setting. However, literature is scare on the management of missing Intra-Uterine Contraceptive Device (IUCD) thread removal services of confirmed diagnosis using Vscan or limited ultrasound services in rural health centers. The aim of reporting this case report was developed to enhance easy access to intra-uterine contraceptive method removals, which may address myths associated with difficulties of undergoing the services in rural set-up. A 26 year-old married woman, Gravida 1 and Para 1, attended Mekoy Health Center for IUCD removal service after 7 years of protection and internally referred to limited obstetric ultrasound service room due to non- visualization of IUCD thread with Vaginal Speculum examination. An ultrasonography scan however, showed a centrally located copper-T 380A IUCD in the endometrial cavity. As a result, after dilatation of the cervix, a successful removal of the Copper-T 308A was conducted. The client received followed up care for 2 hours post-procedure and was then discharged. Conclusions This case highlights the importance of availing diagnostic and removal services in rural set ups to mitigate myths in the community. The availability of limited obstetric ultrasound scanning services can improve the diagnoses and management of conditions in clients. The reported case shows that although, the basic infrastructure was limited, ultrasound scanning and Long Acting Reversible Contraception (LARC) trained midwives can ensure the provision of safe IUCD removal services in rural areas.

Spontaneously Expelled Lippes Loop IUD After 40 Years of Use: A Case Report and Review of the Literature

“…Diagnosis of dislocated or migrated IUD requires an abdominopelvic x-ray, computerized tomography (CT) scan or magnetic resonance imaging (MRI). 5,6,10 In our case, the diagnosis was made by speculum examination.…”

“…The pain might result from the embedment of the uterine wall by the device, recurrent pelvic inflammatory disease, and chronic inflammatory response of the endometrium or uterine contraction to expel the device. 1 , 6 , 7 , 10 …”

“…The pain might result from the embedment of the uterine wall by the device, recurrent pelvic inflammatory disease, and chronic inflammatory response of the endometrium or uterine contraction to expel the device. 1,6,7,10 Another possible cause of pelvic pain is uterine contraction, which is aimed at expelling foreign bodies from the uterine cavity. 16 In our case, the intermittent uterine contraction resulted in the expulsion of the IUD to the external cervical os.…”

“…4 Retained IUDs beyond the required time are related to numerous complications. [5][6][7][8][9][10] However, there are cases with no symptoms though kept for many years. 1,5 There are controversies about whether to remove or conservatively managed dislocated or retained IUDs without complaints.…”

Experiences of midwives on Vscan limited obstetric ultrasound use: a qualitative exploratory study

“…In addition, the presence of health system support including assigning personnel, dedicating ultrasound service space, and refilling of essential supplies were the facilitators of the ultrasound service at health center level. Furthermore, the existence of development partners was a facilitator for the limited ultrasound innovation through the donation of the ultrasound machines with seed supplies, and preparation and motivation of service providers at health center level [ 40 ]. The findings were consistent with Swanson et al, (2017) who confer the importance of willingness and commitment of health system management to facilitate ultrasound services in a pilot district in the Democratic Republic of the Congo and Rwanda [ 7 ].…”