Ease of removal of malpositioned intrauterine devices: A retrospective cohort study.

Autor: Frisse AC; Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States. Electronic address: ann.frisse@mssm.edu., Louik JB; Albert Einstein College of Medicine, Bronx, NY, United States., Kachwala IA; Albert Einstein College of Medicine, Bronx, NY, United States., Wu H; Department of Environmental Health Sciences, Mailman School of Public Health at Columbia University, New York, NY, United States., Felix N; Albert Einstein College of Medicine, Bronx, NY, United States., Vorawandthanachai T; Albert Einstein College of Medicine, Bronx, NY, United States., Avila K; Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States., Benfield NC; Department of Obstetrics, Gynecology, and Women's Health, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, United States.
Jazyk: angličtina
Zdroj: Contraception [Contraception] 2024 Sep; Vol. 137, pp. 110504. Date of Electronic Publication: 2024 Jun 05.
DOI: 10.1016/j.contraception.2024.110504
Abstrakt: Objective: This study aimed to compare removal timing, techniques, and success of malpositioned intrauterine device (IUDs) to nonmalpositioned IUDs.
Study Design: We performed a retrospective cohort study of IUD users with ultrasound performed between July 2014 and July 2017 within one medical system. We used Fisher exact and Wilcoxon rank-sum tests to compare clinical characteristics and IUD removal details between patients with malpositioned and nonmalpositioned IUDs.
Results: Of 1759 ultrasounds reporting the presence of an IUD, 436 described IUD malposition. Of these, 150 described the IUD as embedded and 16 as partially perforated. IUDs were more likely to be removed and removed sooner for patients with malpositioned compared with nonmalpositioned IUDs (281/436 vs 545/1323, p < 0.001 and median 17 days vs 236 days from the index ultrasound, p < 0.001). Most IUDs, malpositioned and nonmalpositioned, were removed on the first attempt (82%, 85%), by a generalist obstetrician and gynecologist (75%, 70%), using a ring forceps (73%, 65%). Most embedded and partially perforated IUDs were removed (68%, 69%), using a ring forceps (59%, 67%), on the first attempt (84%, 91%).
Conclusions: Malpositioned IUDs were more likely to be removed and removed sooner than nonmalpositioned IUDs. Most IUDs, even IUDs labeled as partially perforated or embedded, were removed by a generalist obstetrician and gynecologist, using ring forceps, on first attempt.
Implications: Ultrasound findings of IUD malposition are not associated with difficult IUD removal.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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