Colposcopy in the localization of missing intrauterine devices

Abstract

The use of colposcopy as an office procedure is shown to be an effective method in localizing the IUD's string deep in the cervical canal, and for following those patients who wish to continue with IUD, thus avoiding replacement of the device. In 24 patients with missing string, colposcopy was used, and was found to be an effective procedure which obviates the use of unnecessary x-ray exposure, invasive procedures and expensive ultrasonography.

PIP: Since curling and retraction of the filament into the uterine cavity is 1 of the main causes of nonvisualized string, a noninvasive office procedure, colposcopy, was adopted for the investigation of missing IUD in an attempt to identify the string in the cervical canal. During the past 2 years 24 patients with the diagnosis of "missing IUD string" were examined by colposcopy. These patients were previously investigated in an outpatient department which failed to locate the IUD string at the external cervical os. The essential target of colposcopic examination was the endocervical canal. In the majority of the patients the IUD was located in utero by colposcopic visualization of the string deep in the cervical canal, embedded between the cervical ridges. In 2 patients, the string was not located on colposcopy; these patients were examined by ultrasound and only in 1 was the IUD in utero. The other was diagnosed as "unnoticed expulsion." The correct summary of paired data for comparing 2 proportions was used as a statistical method for comparing the usual clinical methods of localizing IUD strings in the cervical canal (which failed to locate the strings in these patients) and the colposcopy method. The difference between the 2 methods was statistically significant. The IUD was left in utero in 17 patients who were followed for an average period of 16 months in the outpatient department by routine colposcopic examination. In 5 patients the IUD was removed at the request of the patient using a long straight clamp and without any discomfort to the patient. It seems that using colposcopy in the initial localization of intrauterine contraceptive devices with missing tails can prevent unnecessary ionizing radiation, patient discomfort by sounding, or the introduction of an intrauterine hook to locate the IUD, and the use of anesthesia or cervical block to permit hysteroscopy. It can also reduce the necessity for ultrasonographic investigation, which is an expensive procedure.