Abstract

PIP: Suggestions on how to manage a missing IUD for current practitioners in the U.S., who may not have any IUD experience, are recommended. It is important to realize that IUDs do not perforate the uterus on their own: they do so at insertion. No one who inserts enough IUDs will never perforate a uterus: the average perforation rate is 3 per 1000. Ultrasound cannot find a lost IUD without reference to some structure, especially if the IUD is free-floating. The best way to ensure that the IUD is not in the uterus use hysteroscopy. Any cystoscope can be converted to a hysteroscope by attaching a glass adaptor, and no distension medium is necessary. If the IUD is not found in the uterus, it can be located in the abdominal cavity by x-ray of the abdomen, including a lateral views. An anterior-posterior view of the pelvis may suggest that the IUD is in the uterus when it is not. If the IUD is in the abdominal cavity, the safest, and most acceptable way to remove it is by laparoscopy. Most lawsuits concerning perforated IUDs were prompted by laparotomy or colpotomy. IUDs in the abdomen, especially copper IUDs, will develop adhesions, any may bear bacteria from the insertion process. Perforated copper IUDs should be removed as soon as possible.