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Ultrasound-guided retrieval of lost intrauterine devices using very fine grasping forceps: a case series
  1. Francesca Moro1,
  2. Jure Knez1,
  3. Katie Pateman1,
  4. Grigorios Derdelis1,
  5. Xulin Foo1,
  6. Davor Jurkovic2
  1. 1Clinical Research Fellow, Institute of Women's Health, University College London, London, UK
  2. 2Consultant Gynaecologist, Institute of Women's Health, University College London, London, UK
  1. Correspondence to Dr Davor Jurkovic, Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Road, London NW1 2BU, UK; davor.jurkovic{at}nhs.net

Abstract

Aim To assess the efficacy of a novel ultrasound-guided procedure for the retrieval of intrauterine contraceptive devices (IUDs) when the threads are not visible at the external cervical os (‘lost threads’).

Methods This was a prospective cohort study of consecutive women referred for ultrasound examination because of lost IUD threads. The procedures were performed under local anaesthesia in the outpatient setting. After injection of local anaesthetic, the anterior cervical lip was grasped with a vulsellum forceps. A 5Fr hysteroscopy grasping forceps was introduced transcervically into the uterine cavity under continuous transabdominal ultrasound guidance. The IUD was then grasped and removed from the uterus. Patients’ demographic data, gynaecological history, ultrasound findings, duration of procedure, success rate and pain score were recorded.

Results Twenty-three consecutive women were included in the study. Ultrasound examination showed an IUD correctly sited in the centre of the uterine cavity in 20/23 (87%), in 2/23 (9%) it was partially embedded in the myometrium and in 1/23 (4%) the IUD was partially sited in the cervical canal. In 8/23 (35%) women the IUD threads were not visible on ultrasound scan. Removal of the IUD was successful in 22/23 (96%) cases with a median operating time of 3 (interquartile range 1.25–4.75) minutes. 15/23 (65%) women experienced no or minimal pain (pain score ≤3), 4/23 (17%) reported moderate pain (pain score 4–6) and 4/23 (17%) described the pain as severe (pain score 7–10). No complications were recorded during or immediately after the procedure.

Conclusions Ultrasound-guided retrieval of lost IUDs using fine hysteroscopy grasping forceps is a highly successful technique and is well tolerated by women.

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