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    IUD Issues: Zero in with ultrasound

     

    Guided insertion, removal

    IUDs can typically be inserted and removed in straightforward office procedures. At times, however, ultrasound can be uniquely advantageous in assisting both insertion and removal of the devices. If a patient’s uterus is severely anteverted or retroverted, direct sonographic visualization can offer some reassurance to a clinician that the IUD is being appropriately placed within the uterus (Video). Similar difficulties may be encountered when an IUD is removed. At times the string may not be visible if it has retracted into the uterus or the IUD is partially embedded. In those cases, removal under direct ultrasound guidance may offer great benefit, avoiding the need to do the procedure in the operating room20 (Video).

     

    References

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    2. Lethaby A, Munawar H, Rishworth JR, Rees MC. Progesterone or progestogen-releasing intrauterine systems for heavy menstrual bleeding. (Review) The Cochrane Collaboration. 2015.

    3. Long-acting reversible contraception: implants and intrauterine devices. American College of Obstetricians and Gynecologists. Practice Bulletin Number 121, July 2011, Reaffirmed 2013.

    4. Benacerraf BR, Shipp TD, Bromley B. Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound Obstet Gynecol. 2009;34:110–115.

    5. Benacerraf BR, Abuhamad AZ, Bromley B. et al. Consider ultrasound first for imaging the female pelvis. Am J Obstet Gynecol. 2015;212:450–455.

    6. Sakhel K, Benson CB, Platt LD, et al. Begin with the basics. Role of 3-dimensional sonography as a first-line imaging technique in the cost-effective evaluation of gynecologic pelvic disease. J Ultrasound Med. 2013;32:381–388.

    7. Shipp TD, Bromley B, Benacerraf BR. The width of the uterine cavity is narrower in patients with an embedded intrauterine device (IUD) compared to a normally positioned IUD. J Ultrasound Med. 2010;29:1453–1456.

    8. Moschos E, Twickler DM. Does the type of intrauterine device affect conspicuity on 2D and 3D ultrasound? AJR. 2011;196:1439–1443.

    9. Chen XY, Guo QY, Wang W, Huang LL. Three-dimensional ultrasonography versus two-dimensional ultrasonography for the diagnosis of intrauterine device malposition. Int J Gyn Obstet. 2015;128:157–159.

    10. Nowitzki KM, Hoimes ML, Chen B, Zheng LZ, Kim YH. Ultrasonography of intrauterine devices. Ultrasonography 2015;34:183-194.

    11. Agacayak E, Tunc SY, Icen MS, Oguz A, Ozler A, Turgut A, Basaranoglu S. Evaluation of predisposing factors, diagnostic and treatment methods in patients with translocation of intrauterine devices. Obstet Gynaecol Res. 2015;41:735–741.

    12. Abuhamad AZ, Singleton S, Zhao Y, Bocca S. The Z Technique: An easy approach to the display of the midcoronal plane of the uterus in volume sonography. J Ultrasound Med. 2016;25:607–612.

    13. Valsky DV, Cohen SM, Hochner-Celnikier D. et al. The Shadow of the Intrauterine Device. J Ultrasound Med. 2006;25:613–616.

    14. Asch E, Levine D, Brook OR. Fractured intrauterine device copper sheath with an intact Polyethylene Core. J Ultrasound Med. 2013;32:1877–1878.

    15. Braaten KP, Benson CB, Maurer R, Goldberg AB. Malpositioned intrauterine contraceptive devices; risk factors, outcomes, and future pregnancies. Obstet Gynecol. 2011;118:1014–1020.

    16. Anteby E, Revel A, Ben-Chetrit A et al. Intrauterine device failure: relation to its location within the uterine cavity. Obstet Gynecol. 1993;81:112–114.

    17. Liang H, Li L, Yuan W, Zou Y, Gao E-S, Duffy JMN, Wu S-C. Dimensions of the endometrial cavity and intrauterine device expulsion or removal for displacement: a nested case-control study. BJOG. 2014;121:997–1004.

    18. Levi EE, Stuart GS, Zerden ML, Garrett JM, Bryant AG. Intrauterine device placement during Cesarean delivery and continued use 6 months postpartum. Obstet Gynecol. 2015;126:5–11.

    19. Dias T, Abeykoon S, Kumarasiri S, Gunawardena C, Padeniya T, D’Antonio F. Use of ultrasound in predicting success of intrauterine contraceptive device insertion immediately after delivery. Ultrasound Obstet Gynecol. 2015;46:104–108.

    20. Verma U, Astudillo-Dávalos FE, Gerkowicz SA. Safe and cost-effective ultrasound guided removal of retained intrauterine device: our experience. Contraception. 2015;92:77–80.

    Thomas D Shipp, MD, RDMS
    Dr Shipp is a Vice President with Diagnostic Ultrasound Associates, PC, Brookline, Massachusetts, and a Sonologist and Associate ...
    Bryann Bromley, MD
    Dr Bromley is a Vice President at Diagnostic Ultrasound Associates, PC, Brookline, Massachusetts, and a Sonologist and Professor of ...

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