Advertisement

Ultrasonographically guided intrauterine contraceptive device removal before chorionic villus sampling

      This paper is only available as a PDF. To read, Please Download here.

      Abstract

      OBJECTIVE: Management of a retained intrauterine contraceptive device with no visible string during early pregnancy presents a dilemma. Because these devices are frequently used by multiparous women, it is not unusual that many women with retained devices are also of advanced maternal age. We describe our experience with ultrasonographically guided first-trimester retrieval of an intrauterine contraceptive device in conjunction with chorionic villus sampling.
      STUDY DESIGN: Patients with a first-trimester pregnancy and a retained intrauterine contraceptive device where no string was visible were offered ultrasonographically guided retrieval of the device. If the patient had genetic risks and desired prenatal diagnosis, chorionic villus sampling was offered at the same office visit.
      RESULTS: Six patients underwent intrauterine contraceptive device retrieval, under continuous ultrasonographic guidance, by use of an intrauterine contraceptive device hook. All patients had a posterior or fundal device. One patient had two in situ: a Lippes Loop (Ortho Pharmaceutical Corp., Raritan, N.J.) removed by its string and a Cu-7 (G.D. Searle & Co., Chicago) removed under ultrasonographic guidance. The remaining five patients had a Cu-7. Four of six patientss had chorionic villus sampling performed immediately after the intrauterine contraceptive device removal and one patient had chorionic villus sampling 3 weeks later. There were two losses in our series: one after a lengthy procedure and one before documented viability. All infants were structurally normal and born at term.
      CONCLUSION: First-trimester ultrasonographically guided retrieval of a retained intrauterine contraceptive device may be safely performed in conjunction with chorionic villus sampling.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Obstetrics & Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sivin I
        • Tatum HJ
        Four years of experience with the TCu 380A intrauterine contraceptive device.
        Fertil Steril. 1981; 36: 159-163
        • Foreman H
        • Stadel BV
        • Schlesselman S
        Intrauterine device usage and fetal loss.
        Obstet Gynecol. 1981; 58: 669-677
        • Tatum HJ
        • Schmidt FH
        • Jain AK
        Management and outcome of pregnancies associated with the Copper T intrauterine contraceptive device.
        Am J Obstet Gynecol. 1976; 126: 79-89
        • Berman SM
        • MacKay HT
        • Grimes DA
        • Binkin NJ
        Deaths from spontaneous abortion in the United States.
        JAMA. 1985; 253: 3119-3123
        • Cates W
        • Ory HW
        • Rochat RW
        • Tyler CW
        The intrauterine device and deaths from spontaneous abortion.
        N Engl J Med. 1976; 295: 1155-1159
        • American College of Obstetricians and Gynecologists
        The intrauterine device.
        Technical Bulletin no 164. 1992; (Washington: American College of Obstetricians and Gynecologists)
        • Wagner H
        • Schweppe KW
        • kronholz HL
        • Beller FK
        Moglichkeiten der Extraktion von Intrauterin pessaren bei eingetretener Schwangerschaft.
        Med Welt. 1980; 31: 1317-1320
        • Gustavii B
        • Edvall H
        • Nordenskjold F
        Removal of IUD's in early pregnancy.
        Acta Obstet Gynecol Scand. 1984; 63: 571-572
        • Shalev E
        • Edelstein S
        • Englehard J
        • Weiner E
        • Zuckerman H
        Ultrasonically controlled retrieval of an intrauterine contraceptive device (IUCD) in early pregnancy.
        J Clin Ultrasound. 1987; 15: 525-529
        • Hucke J
        • Campo RL
        • Kozlowski P
        • DeBruyne F
        Erfahrungen mit der hysteroskopischen oder sonographisch gesteuerten Entfernung einer Intrauterinspirale ohne sichtbaren Faden in der Fruschwangerschaft.
        Geburtshilfe Frauenheilkd. 1991; 51: 31-33
        • Stubblefield PG
        • Fuller AF
        • Foster SC
        Ultrasound-guided intrauterine removal of intrauterine contraceptive devices in pregnancy.
        Obstet Gynecol. 1988; 72: 961-964
        • Sachs BP
        • Gregory K
        • McArdle C
        • Pinshaw A
        Removal of retained intrauterine contraceptive devices in pregnancy.
        Am J Perinatol. 1992; 9: 139-141
        • Shalev J
        • Greif M
        • Ben-Rafael Z
        • Itzchak Y
        • Serr DM
        Continuous sonographic monitoring of IUD extraction during pregnancy.
        AJR Am J Roentgenol. 1982; 139: 521-523
        • Vessey MP
        • Johnson B
        • Doll R
        • Peto R
        Outcome of pregnancy in women using an intrauterine device.
        Lancet. 1974; 1: 495-498
        • Steven JD
        • Fraser IS
        The outcome of pregnancy after failure of an intrauterine contraceptive device.
        J Obstet Gynaecol Br Commonw. 1974; 81: 282-284