Removal of intrauterine devices with missing tails during early pregnancy

Abstract

During a 70-month period, CO2 hysteroscopy was carried out on 52 pregnant women wearing IUDs with retracted tails. Ultrasonography was done prior to hysteroscopy to determine the size of the gestational sac and the site of the device. Successful removal of the device occurred in 46 cases. The technique, the findings of the study, and the limitations of the procedure are described.

PIP: IUDs were successfully removed from 46 of 52 pregnant women bearing IUDs with retracted tails, from December 1985 to November 1991, at the Department of Gynecology and Obstetrics, Benha University Hospital, Egypt. The presence and location of the IUD was confirmed with ultrasonography, excluding 3 patients who did not have retracted IUD tails, and 8 who were 12 weeks' gestation. After paracervical block or short-acting IV anesthesia, the 7 mm Storz hysteroscope was introduced, using cervical dilatation only if needed. CO2 gas, up to 200 ml, was injected into the internal os with a Hysteroflator (Wiest, Berlin). The IUD was carefully removed with a grasping forceps. The women received the antiprostaglandin endomethasin (sic) by suppository the night before, and after the procedure. Patients were observed for 5 days, and ultrasound was repeated 2 weeks later to confirm fetal viability. There were 6 failures to remove an IUD, 2 involving disturbance of the gestational sac, and 2 where the IUD lay beneath the sac. 2 spontaneous abortions resulted in the series. 24 Lippes Loops, 12 Copper Ts, 8 Copper 7s, and 6 Nova T devices were removed. It is recommended that the operator gain experience on women having their pregnancy terminated before attempting to remove an IUD from a pregnant woman wishing to continue her pregnancy.