Removal of retained intrauterine contraceptive devices in pregnancy

Abstract

Using real-time ultrasound and clinical expertise gained from chorionic villus sampling, we describe a technique for ultrasound-guided intrauterine device removal in those cases in which the string is not visible. Utilizing a stone clamp for intrauterine manipulation, we were easily able to extract the device without interrupting the pregnancy. We concur with recent recommendations advocating all intrauterine devices can be removed if pregnancy termination is declined.

PIP: Physicians at leading hospitals in Boston, Massachusetts were able to remove a retained IUD from 3 women who were in their 1st trimester of pregnancy. They took cervical cultures to test for chlamydia, beta-hemolytic Streptococcus, and gonococcus before attempting to remove the IUD. They used a 3.5 MHz transducer from an Acuson 128 machine to perform a transabdominal ultrasound scan. The physicians used a transcervically introduced stone clamp to retrieve the IUD. The technique was like that used for transcervical chorionic villus sampling. The 1st case was a 36-year old gravida 3 with a copper-7 IUD whose string had disappeared from sight. She was 8 weeks' gestation. The IUD was laying below the gestational sac. She delivered a full-term healthy infant weighing 3348 gm. The 2nd patient was a 27-year old Chinese woman who had been pregnant before, but had no living children. She was 9 weeks' gestation and had a stringless metal ring IUD. It was in the lower uterus. She experienced some bleeding afterwards. She did not experience any difficulties during the rest of her pregnancy and delivered a full-term infant (2665 gm). The 3rd case was also a Chinese woman with a metal ring IUD. She was gravida 2 para 1 at 10 weeks' gestation. Like the other Chinese woman, the IUD was in the lower uterus. She experienced bleeding throughout the 1st trimester. Nevertheless, at 40 weeks' gestation, she had a healthy 2665 gm infant. This method is best accomplished by someone skilled in in utero manipulation as is done with chorionic villus sampling. The physicians recommend that other physicians should try to remove a retained IUD using this technique no matter its location, type, or the presence of a visible string or not, if the patient indeed wants to continue the pregnancy.