Management of the malpositioned levonorgestrel-releasing intrauterine system

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• 作者：Amos Ber^a ; Daniel S. Seidman^b ; ^c ; ^{dseidman@tau.ac.il}
• 关键词：Levonorgestrel (LNG)-releasing intrauterine system (IUS) ; Malpositioned IUS ; Sonographic evaluation ; Alligator forceps ; Malpositioned intrauterine device (IUD)
• 刊名：Contraception
• 出版年：2012
• 期刊代码：71_00107824
• 类别：med
• 出版时间：April, 2012
• 卷：85
• 期：4
• 页码：369-373
• 文件大小：419 K

摘要

Background

The management of a malpositioned levonorgestrel (LNG)-releasing intrauterine system (IUS) can present a clinical challenge, complicated by the high cost of replacing it with a new device. We tried to challenge the guidelines and common practice that usually suggest prompt removal of any malpositioned IUS and replacement with a new one.

Study Design

We present our experience with 18 patients in whom the LNG-releasing IUS was found during a routine sonographic evaluation to be displaced towards the cervical canal 2 to 36 months postinsertion. Using an alligator forceps, the device was repositioned in the uterine cavity.

Results

The procedure was deemed successful in 17 (94.4%) of 18 cases. In 3 (17.6%) of the 17 successful procedures, the LNG-releasing IUS was found again to be malpositioned within 2 months. No complications were noted, and no postprocedural infection occurred.

Conclusion

Repositioning of a malpositioned LNG-releasing IUS should be considered, as it is an easy and simple manipulation that can be done in the office with a high success rate and minimal risk of complications.