Uterine structural abnormality and intrauterine device malposition: analysis of ultrasonographic and demographic variables of 517 patients

Gerkowicz, Sabrina A.; Fiorentino, Desiree G.; Kovacs, Andrew; Arheart, Kristopher L.; Verma, Usha

doi:10.1016/j.ajog.2018.11.122

Cited by 29 publications

(34 citation statements)

References 15 publications

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“…The risk factors for perforation are: insertion in the early postpartum period (<6 months of delivery) or during lactation; developmental uterine anomalies; small uterine size (women of low parity), and technical inexperience. Malposition and expulsion of the inserted devices are significantly associated with the retroflexed position of the uterus, uterine anomalies, and the presence of fibroids [3].…”

Section: Discussionmentioning

confidence: 99%

Silent perforation and migration of IUCD: A diagnostic challenge in patients with pain abdomen: A case report

Srirambhatla¹,

Narayanam²,

Kannepalli³

2021

Indian J Case Reports

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Secondary perforations of intrauterine contraceptive devices (IUCD) may be clinically silent. The patient may not report the missing threads due to a lack of acute symptoms or under the impression that the device could have been expelled. We present a case of a 42-year-old lady treated for renal cell carcinoma and presenting with recurrent right lower quadrant abdominal pain for 2 years. Ultrasound scans did not reveal any abnormality. A plain computed tomography (CT) revealed a migrated IUCD embedded in the omentum with adjacent inflammation. Although CT is not the modality of choice in the diagnosis of migrated IUCD, it proved helpful in diagnosing this case as history was not forthcoming. This case highlights the diagnostic dilemma faced in cases of silent IUCD migration presenting with pain abdomen. It is important to counsel the patient at the time of IUCD insertion for the early recognition of missing devices and prompt diagnosis of complications.

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Section: Discussionmentioning

confidence: 99%

Silent perforation and migration of IUCD: A diagnostic challenge in patients with pain abdomen: A case report

Srirambhatla¹,

Narayanam²,

Kannepalli³

2021

Indian J Case Reports

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“…[ 13 ] Risk factors that impact the occurrence of uterine perforation include breastfeeding and postpartum state, experience of the inserting doctor and uterine anatomy. [ 5 , 14 – 16 ] Women who were breastfeeding at the time of insertion have a 6-fold higher perforation risk than women who were not breastfeeding. [ 5 ] Malpositioned IUDs may lead to a high rate of pregnancy due to the possible reduced efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Studies showed that the type of IUD did not affect the risk of uterine perforation, although stainless steel IUDs were less effective for contraception and easier to expulse. [ 5 , 14 ] As the incidence of IUD malposition is increased in patients with uterine structure abnormality, [ 16 ] it was not clear whether the partial septate uterus in this patient contributed to the IUD translocation.…”

Section: Discussionmentioning

confidence: 99%

Intrauterine device found in an ovarian tumor

Liu²,

Fan³

et al. 2020

Medicine

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Rationale: Intrauterine devices (IUDs) are one of the most common and effective methods of contraception worldwide. Migration of an IUD to an extrauterine site is a rare complication. The aim of this study was to report an extremely rare case in which an IUD was found in an ovarian tumor. Patient concerns: A 63-year-old Chinese woman presented with vaginal bleeding and lower abdominal pain during hospitalization due to pneumonia. Preoperative imaging showed bilateral cystic masses in the adnexal region, and ring hyperdensity was found in the right ovarian mass. Endometrial thickening and multiple uterine leiomyomas were found on ultrasonography. Hysteroscopy showed partial septate uterus and a small endometrial polyp. Diagnosis: Bilateral ovarian cystadenomas with perforation of the IUD into the right ovarian tumor were considered based on preoperative imaging and the patient's medical history. Furthermore, early endometrial carcinoma was suspected. Interventions: The patient underwent hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. A stainless steel ring IUD was confirmed within the right ovarian tumor during the operation. Outcomes: The pathology results demonstrated bilateral ovarian serous cystadenofibromas with focal epithelial proliferation and endometrial atypical hyperplasia with malignant transformation. The patient has been followed up for 7 months, and there has been no recurrence at present. Lessons: The presence of an IUD within an ovarian tumor is extremely rare. This is the second reported case in the English literature describing an extrauterine IUD within an ovarian tumor. The correlation between ovarian cancer tumorigenesis and IUD translocation is unclear and requires further investigation.

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“…A known but rare complication of IUD placement includes uterine perforation and migration to adjacent organs like bladder, lower urinary tract, and rectum [2][3][4][5][6] ; however, penetration of the gastric wall and symptoms resembling a peptic ulcer have not yet been reported. The incidence of uterine perforation in lactat- ing women within 36 weeks after delivery of 4.8/10 0 0 is approximately 4-fold higher than the overall perforation risk [7] , which may be related to low estrogen levels during the lactation period [8] .…”

Section: Commentmentioning

confidence: 99%

“…The total incidence of uterine penetration caused by IUDs is 1.1/10 0 0 [1] . In rare cases, IUDs can perforate the uterine wall into the abdominal cavity or even penetrate adjacent organs, causing symptoms similar to lesions of the lower digestive tract, urinary tract, or pelvic floor [2][3][4][5][6] . Here, we present a novel case of an IUD penetrating the gastric wall with symptoms resembling a peptic ulcer, requiring a laparoscopic partial gastric resection.…”

Section: Introductionmentioning

confidence: 99%