Abstract

PIP: Migration of IUD from the corpus uteri occurs in approximately 1/2500 applications. Primary migration of the IUD is associated with perforation of the uterine wall. Secondary migration of a properly inserted IUD is caused by uterine contraction. Diagnosis of IUD migration can be made following pelvic x-ray examination (hysterography, cystography), irrigoscopy, echography, and finally, laparoscopy. Difficulties encountered during diagnosis of IUD migration are illustrated by a case history of a 24-year old woman. After the birth of her 2nd child, the patient received application of the Lippes IUD; the patient experienced pain during application and for the next 10 days. The patient was seen 14 months after IUD insertion with a 2-month history of amenorrhea. A pregnancy of 7-weeks gestation was diagnosed. During termination of pregnancy, the IUD could not be detected. Subsequent examination of an extremely wide and long cervical canal revealed the limbs of the device in the posterior fornix of the cervix uteri, approximately 7-8 mm above the wide uterine ligament. Conventional posterior-anterior x-ray examination of the lesser pelvis showed the presence of the IUD. These findings were confirmed at hysterography and cystography. The patient underwent exploratory laparotomy, and the IUD was removed. It was concluded that difficulties with insertion of the IUD were associated with anatomical abnormalities of the cervix uteri. It was emphasized that women with abnormal size of the vagina have a risk of asymptomatic extraperitoneal migration of the IUD.