“Fate of the missing IUCD tails” Migration of intrauterine contraceptive device-Factors associated, exploration strategy and management at a tertiary care centre

Abstract

Aim: To analyse the factors associated, clinical presentation, exploration strategy and management in patients with impacted and migrated IUCDs at a tertiary care centre. Materials and Methods: A retrospective study in a tertiary care institutional hospital between January 2016- January 2017 among 5 patients diagnosed with impacted and migrated IUCDs.Results: All patient with impacted IUCD presented with pain abdomen. The incidence of IUCD migration seems to be increased in patients who underwent previous caesarean section as seen in this case series (75%). A weakened myometrium may pose as an antecedent risk for such perforation and migration of IUCDs. All patients underwent 3D TVS pelvis as an investigation of choice in missing IUCD tails. All patients were decided for hysteroscopy with laparoscopic guidance for Cu-T removal and three were converted to laparotomy for failed attempted scopy removal due to complications. Analysing the risk factors associated with these perforations, IUD insertion in the first 0- 3 months of delivery and lactation posed a major risk factor for perforation. Conclusion: A 3D TVS PELVIS served as a valuable tool as a first line cost effective investigation in missing IUCD. The post cesarean IUCD insertion can be delayed upto 6 months of delivery to reduce the risk of uterine perforation and impaction. Patient selection and time of insertion and patient education on self-palpation of IUCD thread is also important after IUCDs insertion. The management strategies included hysteroscopy, laparoscopy and laparotomy when attempted scopy removal fails.