Intrauterine Contraceptive Device Removal

Published on 30/05/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 1226 times

Chapter 247 Intrauterine Contraceptive Device Removal

DESCRIPTION

Removal of an intrauterine contraceptive device (IUCD).

INDICATIONS

Elective, desiring a return to fertility or to replace a device after its approved lifespan. IUCDs should also be removed in the face of active pelvic inflammatory disease, unrelenting side effects, or an intrauterine pregnancy (if possible). The IUCD does not have to be removed from an asymptomatic patient in whom actinomycosis is found on cervical cytology.

CONTRAINDICATIONS

Unstable or uncooperative patient or those in whom the presence of an IUCD cannot be confirmed.

REQUIRED EQUIPMENT

• Skin (vaginal) preparation materials (iodine-based antibacterial solution [e.g., Betadine] or other suitable cleansing agents)
• Vaginal speculum
• Tenaculum
• Nonsterile examination gloves
• Uterine packing forceps or other long forceps
• IUD or “crochet” hook (optional)
• Cervical cytology brush (Cytobrush or similar) (optional)

TECHNIQUE

The discomfort of an IUCD removal may be decreased by premedicating with a single oral dose of a nonsteroidal anti-inflammatory agent given in doses usually used to treat dysmenorrhea or through the use of 2% intracervical lignocaine gel. Before beginning the procedure, the size, shape, and location of the uterus should be determined. The cervix should be visualized with the aid of a speculum. The cervix should be disinfected if reinsertion of a new device if planned.

When the IUCD string(s) are visible at the cervical os, gentle traction with uterine packing forceps or other suitable grasping device will result in the delivery of the IUCD. When the string is not apparent, gentle probing of the outer portion of the cervical canal with the forceps or a sterile crochet hook may locate the strings. A Cytobrush may also be placed in the endocervix and gently swept downward to locate strings. These maneuvers will often yield the string that may then be grasped as described earlier. If these maneuvers are unsuccessful in retrieving the IUCD, the cervix should be disinfected prior to any further attempts. Ultrasonography should be considered to ensure an intrauterine location of the IUCD. The possibility of an ongoing pregnancy must also be considered (if not already assessed).

An IUCD (“crochet”) hook may be used under sterile conditions in the outpatient setting, or the IUCD may be removed in the operating room or ambulatory surgery setting, where hysteroscopic guidance is available. In most cases, if a hook is to be used a tenaculum to stabilize the cervix will be needed. In use, the hook is passed through the cervix to the level of the uterine fundus. As the hook is advanced, the device should be carefully monitored for vibrations, sounds, or the “feel” that the tip has encountered the IUCD. Once the hook has reached the fundus (or the IUCD, if felt), the hook is slowly rotated through 180 to 360 degrees and withdrawn. Moderate resistance to withdrawal is associated with capture of the IUCD, and persistent traction will often deliver the device. Even when no resistance is felt, removal of the hook will often deliver the string(s), allowing removal of the IUCD by conventional traction. If neither the IUCD nor its string has been retrieved in several attempts, the effort should be abandoned until the presence of the IUCD in the body has been confirmed and removal via hysteroscopy or laparoscopy has been entertained.

COMPLICATIONS

Vasovagal reaction, pain, uterine perforation (when a hook is used), infection (uterine or pelvic), bleeding.

FOLLOW-UP

Based on contraceptive plans and the indications for the removal.

CPT CODE(S)

58301 Removal of intrauterine device (IUD)

image

REFERENCES

Level I

Bounds W, Hutt S, Kubba A, et al. Randomised comparative study in 217 women of three disposable plastic IUCD thread retrievers. Br J Obstet Gynaecol. 1992;99:915.

Level II

Andersson K, Batar I, Rybo G. Return to fertility after removal of a levonorgestrel-releasing intrauterine device and Nova-T. Contraception. 1992;46:575.

Hov GG, Skjeldestad FE, Hilstad T. Use of IUD and subsequent fertility—Follow-up after participation in a randomized clinical trial. Contraception. 2007;75:88. Epub 2006 Nov 14

Hubacher D, Lara-Ricalde R, Taylor DJ, et al. Use of copper intrauterine devices and the risk of tubal infertility among nulligravid women. N Engl J Med. 2001;345:561.

Ranzini AC, Wapner RJ, Davis GH. Ultrasonographically guided intrauterine contraceptive device removal before chorionic villus sampling. Am J Obstet Gynecol. 1995;173:603.

Skjeldestad FE, Bratt H. Return of fertility after use of IUDs (Nova-T, MLCu250 and MLCu375). Adv Contracept. 1987;3:139.

Stanback J, Grimes D. Can intrauterine device removals for bleeding or pain be predicted at a one-month follow-up visit? A multivariate analysis. Contraception. 1998;58:357.

Zhang J. Factors associated with copper T IUD removal for bleeding/pain: a multivariate analysis. Contraception. 1993;48:13.

Level III

American College of Obstetricians and Gynecologists. Intrauterine device. ACOG Practice Bulletin 59. Obstet Gynecol. 2005;105:223.

Assaf A, Gohar M, Saad S, et al. Removal of intrauterine devices with missing tails during early pregnancy. Contraception. 1992;45:541.

Ben-Rafael Z, Bider D. A new procedure for removal of a “lost” intrauterine device. Obstet Gynecol. 1996;87:785.

Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet. 2000;356:1013.

Johnson BA. Insertion and removal of intrauterine devices. Am Fam Physician. 2005;71:95.

Mishell DRJr. Family planning. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, editors. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby/Elsevier; 2007:306.

Sachs BP, Gregory K, McArdle C, Pinshaw A. Removal of retained intrauterine contraceptive devices in pregnancy. Am J Perinatol. 1992;9:139.

World Health Organization. Mechanism of action, safety and efficacy of intrauterine devices. Geneva: WHO, 1997.

Wyatt S, Gallen IW, Nicholls A. A potential hazard of prolonged insertion of an intrauterine device. N Engl J Med. 1994;330:1395.

Related posts:

Cervical Incompetence Pessary Fitting Eating Disorders: Anorexia Nervosa and Bulimia Bartholin’s Gland: Abscess/Infection Pre-Eclampsia and Eclampsia (Toxemia of Pregnancy) Breast: Galactocele