Intrauterine Location and Expulsion of Intrauterine Device

Abstract

Objective To evaluate the misplacement of the IUD in uterine cavity at immediate post insertion,
the downward displacement at 6thand 12thweek after insertion by transvaginal ultrasound and
the expulsion rate at 12th week.
Design Prospective descriptive study.
Setting Family Planning Unit, Department of Obstetrics and Gynaecology, Faculty of
Medicine, Ramathibodi Hospital, Mahidol University.
Materials and Methods A total of 110 women who had Tcu 380 A IUD inserted from May, 2001 to
December, 2001 were recruited. Prior to IUD insertion, history taking, bimanual pelvic
examination and uterine length measurement with uterine sound were performed. A
transvaginal ultrasound scan was performed immediately after insertion to measure the
distance from the superior edge of the IUD to the internal uterine wall (D). History taking,
pelvic exam and transvaginal ultrasound were repeated at 6th and 12th week. The IUD that
protruded visibly through the external cervical os or lay completely in the cervical canal were
removed and the women were offered the option of a re-insertion or other contraceptive
methods.
Results Misplaced IUD (D>3 mm.) were identified in 59 of 110 women (53.6%). The median
distance between the superior edge of the IUD to the internal uterine wall was 3.00 mm.(range
0.2-30.0 mm.). Four cases had expulsion of IUD and the distance “D” were 1.3, 3.1, 25, and
30 mm. The cumulative expulsion rate at 12 th week was 2.67%. The cumulative downward
displacement (>5 mm.) rate were 3.31% at 6th week and 4.02% at 12th week.
Conclusion The distance between the internal uterine wall and the superior edge of the IUD at
immediate post insertion and downward displacement may have influence on IUD expulsion.