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This case presents a cautionary tale demonstrating the importance of skilled ultrasonography for the correct location of an intrauterine device (IUD) lying within the uterine cavity where the threads are 'lost'. Accurate ultrasound examination can ensure the avoidance of unnecessary x-rays or surgery. The case also acts as a reminder that a missing thread of an IUD does not imply that the device is misplaced.
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In a series of 43 healthy women menstrual blood loss was determined before and after insertion of copper IUD (Gravigard). The menstrual blood loss before insertion was compared with the blood loss 1, 2, 3, 4, 5, 6, 7 and 12 months after insertion. An increase amounting to approximately 20 ml per period without significant variations during the study was recorded. No significant influence upon serum iron and TIBC was found in 15 of the subjects selected by random. Compared with plastic IUD's the tested copper IUD causes a less pronounced increase of the menstrual blood loss. The menstrual blood loss in a small group of women with menorrhagia was determined before and up to 5 months after insertion of copper IUD. No aggravation of the menorrhagia was however recorded in this group.
Fourteen uteri, removed for IUD-associated menorrhagia, were studied. Twelve of these IUD-bearing uteri showed pure diffuse myometrial hypertrophy; the other two uteri were enlarged as a result of multiple leiomyomas in one case and extensive deep adenomyosis in the other. The incidence of pure myometrial hypertrophy in the IUD group was far in excess of that observed in a control non-IUD-bearing menorrhagia series, where leiomyomas and/or deep adenomyosis were mostly responsible for the uterine enlargement.
Records of 25 cases of ovarian pregnancy in the period 1965 to 1984 were reviewed. Seventeen cases (68%), had an IUCD in situ, and 15 of these had occurred during the last decade. The ratio of ovarian pregnancy to all ectopic pregnancies was 1:13 in the IUCD group versus 1:78 in the non-IUCD group (p less than 0.025). In contrast to patients with tubal pregnancies, those with ovarian pregnancy very seldom have a history of pelvic inflammatory disease (PID), infertility, or earlier pelvic operations. Subsequent fertility is good compared with patients with tubal pregnancies, for patients both with and without IUCD.
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A case of IUD perforation of the uterus to the rectum is described, the perforation not being recognized for 13 years. A way of handling 'the missing IUD' is outlined.
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Transuterine migration of an IUCD is a rare complication, more spectacular than serious. In general asymptomatic or associated with only minor symptoms, such a perforation usually passes unnoticed. The diagnosis is made when the absence of the string at the cervix is noted at routine examination, and may be proved by radiological examination of the uterine cavity. Treatment consists of removal of the migratory foreign body either by coelioscopy or by laparotomy. Although the no single mechanism for the occurrence of such perforations exists, this study confirmed the high incidence of this complication when the device is inserted in the immediate post-partum period.