Intrauterine Location and Expulsion of Intrauterine Device

Objective To evaluate the misplacement of the IUD in uterine cavity at immediate post insertion, the downward displacement at 6 th and 12 th week after insertion by transvaginal ultrasound and the expulsion rate at 12 th 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 6 th and 12 th 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 6 th week and 4.02% at 12 th 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.