The strange disappearance of a copper intrauterine device: a case report
DOI:
https://doi.org/10.32385/rpmgf.v38i4.13317Keywords:
Copper intrauterine device, Adverse effects, Case reportAbstract
Introduction: This case report describes one of the possible adverse effects of Intrauterine devices (IUD) and explores the correct procedure in the primary health care setting.
Case description: In October 2019, the patient chose a Copper intrauterine device (Cu-IUD) and a pre-procedure ultrasound was performed (no changes detected). In February 2020, the Cu-IUD was introduced without complications and an ultrasound was required to confirm its correct positioning. Due to the COVID-19 pandemic, the patient didn’t do it and kept condom use. In March 2021, after a new request, the ultrasound performed did not identify the device. The patient denied having expelled the device or any other symptoms. At our observation, the wires were not visible. An abdominal X-ray was performed, showing the device “in the middle area of the pelvic excavation, in an oblique position”. A new ultrasound then revealed the “presence of IUD in the pelvic cup, in extrauterine topography, lateralized to the left side of the uterus”. The patient was sent to an urgent gynecology appointment and the Health Products Surveillance Unit of INFARMED was notified. In June 2021, she was enrolled for laparoscopy for Cu-IUD removal and bilateral salpingectomy for definitive contraception.
Comment: This case highlights the importance of ultrasound evaluation after placement of intrauterine devices, confirming their location and guaranteeing the effectiveness of the method and the rapid detection of complications. It was intended to review the correct procedure: physical examination, complementary diagnostic tests, participation to the competent authorities, and early referral to gynecology for rapid resolution of the incident.
Downloads
References
Searle ES. The intrauterine device and the intrauterine system. Best Pract Res Clin Obstet Gynaecol. 2014;28(6):807-24.
Çintesun FN, Çintesun E, Esenkaya Ü, Gϋnenc O. Uterine dimensions and intrauterine malposition: can ultrasound predict displacement or expulsion before it happens? Arch Gynecol Obstet. 2020;302(5):1181-7.
Jatlaoui TC, Riley HE, Curtis KM. The safety of intrauterine devices among young women: a systematic review. Contraception. 2017;95(1):17-39.
Argaw MD, Abawollo HS, Desta BK, Tsegaye ZT, Belete DM, Abebe MG. Removal of a missing intrauterine contraceptive device after location through an ultrasound: a case report within a rural setting and review of literature. Contracept Reprod Med. 2020;5(1):23.
Kho KA, Chamsy DJ. Perforated intraperitoneal intrauterine contraceptive devices: diagnosis, management, and clinical outcomes. J Minim Invasive Gynecol. 2014;21(4):596-601.
Cheung ML, Rezai S, Jackman JM, Patel ND, Bernaba BZ, Hakimian O, et al. Retained intrauterine device (IUD): triple case report and review of the literature. Case Rep Obstet Gynecol. 2018;2018:9362962.
Berry-Bibee EN, Tepper NK, Jatlaoui TC, Whiteman MK, Jamieson DJ, Curtis KM. The safety of intrauterine devices in breastfeeding women: a systematic review. Contraception. 2016;94(6):725-38.
Thapa S, Dangal G, Karki A, Pradhan HK, Shrestha R, Bhattachan K, et al. Missing intrauterine device copper-T: case series. J Nepal Health Res Counc. 2018;16(3):354-6.
Mona Lisa®. Cu 375/375 short-loop dispositivo intrauterino. Bruxelas: Mona Lisa; 2015.
Heinemann K, Reed S, Moehner S, Minh TD. Comparative contraceptive effectiveness of levonorgestrel-releasing and copper intrauterine devices: the European Active Surveillance Study for Intrauterine Devices. Contraception. 2015;91(4):280-3.
Heinemann K, Reed S, Moehner S, Minh TD. Risk of uterine perforation with levonorgestrel-releasing and copper intrauterine devices in the European Active Surveillance Study on Intrauterine Devices. Contraception. 2015;91(4):274-9.
Kaislasuo J, Suhonen S, Gissler M, Lähteenmäki P, Heikinheimo O. Intrauterine contraception: incidence and factors associated with uterine perforation: a population-based study. Hum Reprod. 2012;27(9):2658-63.
Barnett C, Moehner S, Minh TD, Heinemann K. Perforation risk and intra-uterine devices: results of the EURAS-IUD 5-year extension study. Eur J Contracept Reprod Health Care. 2017;22(6):424-8.
Sowmya K, Shruthi D, Manoli N. A case report of successful retrieval of missing copper T by laparoscopic approach. J Med Sci Health. 2016;2(1):37-9.
Ibitoye BO, Aremu AA, Onuwaje MA, Ayoola OO. What is the fate of the missing intrauterine contraceptive device? Trop Doct. 2009;39(4):221-3.
Elahi N, Koukab H. Diagnosis and management of lost intrauterine contraceptive device. J Pak Med Assoc. 2002;52(1):18-20.
Downloads
Published
Issue
Section
License
Copyright (c) 2022 Portuguese Journal of Family Medicine and General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
