Approach Towards Misplaced or Malposition IUCD: Lessons Learned QC01-QC04
Dr. Neha Varun,
A-2A/35, West Janakpuri, New Delhi-58, India.
Introduction: Intrauterine Contraceptive Devices (IUCDâ€™s) are the effective, economical, long-acting and reversible type of contraceptive method used worldwide. But, it is associated with complications like increased bleeding, perforation and rarely transmigration of IUCD to adjacent organs. Dislocated IUCD is the terminology used to define the IUCD with an abnormal position within the uterus (malposition) or a transmigrated IUCD with an extra-uterine location (misplaced).
Aim: This study was conducted with the aim to find out the incidence of dislocated IUCD requiring operative interventions, to study the various clinical presentations of this condition, investigations needed to localise the IUCD and the preferred surgical intervention for its retrieval.
Materials and Methods: This study was a cross-sectional retrospective study conducted in a medical college over a period of two years from Juneâ€™ 2016 to Juneâ€™ 2018. Records from the medical record department and family planning department of the hospital were reviewed to identify the patients with the diagnosis of dislocated IUCD, who underwent operative interventions for its retrieval. A total of 20 such patients have been included in the study.
Results: Total number of IUCD inserted during study period in the institute was 482 and surgical intervention for dislocated IUCD was required in only 4.1% (20/482) patients. Out of these 20 patients, in 16 patients minimally invasive approach and in four patients long artery forceps under anaesthesia was utilised for the retrieval of dislocated IUCD. Mean age (range) was 27.5 (22-35) years and parity was 3 (1-3). Most common presenting complaint was missing thread (65%). A 3.52% (17/482) of the patients had an IUCD within the uterine cavity (partial perforations or IUCD embedded in the uterine wall) and 0.6% (3/482) had misplaced IUCD (transmigrated IUCD). Among the study group, in 80% (16/20) patients IUCDâ€™s were inserted in the postpartum phase and in 20% (4/20) as an interval IUCD. Among the misplaced IUCD group, all patients had an operative laparoscopy and none required a laparotomy. Among the malpositioned IUCD, 76.47% (13/17) had an operative hysteroscopy for the removal of IUCD and in 23.5% (4/17) patients IUCD was removed using long artery forceps under anaesthesia. No surgery-related intra-operative or post-operative complications were observed.
Conclusion: Minimally invasive approach proved to be the preferred diagnostic and the therapeutic modality for the dislocated IUCD. Dislocated IUCD requiring operative interventions is a very rare complication of this long acting contraceptive method. Thus, this condition should not be a reason to deny IUCD insertion and every attempt should be made to lower down its failure and complication rates.