Ultrasound-Guided Hysteroscopic Removal of IUD with Missing Tails in a 15-Weeks’ Pregnant Woman

Mustafa Albayrak, MD, Ahmet Karatas, MD, Ismail Biyik, MD, Fatih Keskin, MD

Department of Obstetrics and Gynecology, Duzce University School of Medicine, Duzce, Turkey (Drs Albayrak, Keskin). Department of Obstetrics and Gynecology, Abant Izzet Baysal University, Bolu, Turkey (Dr Karatas). Department of Obstetrics and Gynecology, Karacabey State Hospital, Karacabey, Bursa, Turkey (Dr Biyik).

ABSTRACT

Unexpected pregnancy with an intrauterine device (IUD) in situ is not an uncommon finding in daily practice. It is generally agreed that an IUD should be removed in the first trimester when its tail is visible vaginally. However, because of limited experience and data in the literature, uncertainty exists about the management and technique of IUD removal during pregnancy when the tails are inaccessible on examination, especially in the second trimester. The IUD may be left in situ or removed using a grasping tool under ultrasonographic guidance or by hysteroscopy. Here, we report a case of ultrasound-guided hysteroscopic removal of an IUD with retracted tail in a woman at 15 weeks’ gestation. We believe when the decision is made to remove an IUD, ultrasound-guided hysteroscopy may be a safer option in experienced hands compared with an ultrasound-guided grasping tool, especially during the second trimester.

Key Words: IUD, Hysteroscopy, Contraception, Endoscopy, Pregnancy.

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