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Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding

  1. B. R. Benacerraf1,2,3,4,5,*,
  2. T. D. Shipp2,4,5,
  3. B. Bromley2,4,5

Article first published online: 29 JUN 2009

DOI: 10.1002/uog.6421

Issue

Ultrasound in Obstetrics & Gynecology

Ultrasound in Obstetrics & Gynecology

Volume 34, Issue 1, pages 110–115, July 2009

Additional Information

How to Cite

Benacerraf, B. R., Shipp, T. D. and Bromley, B. (2009), Three-dimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding. Ultrasound in Obstetrics & Gynecology, 34: 110–115. doi: 10.1002/uog.6421

Author Information

  1. 1

    Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA

  2. 2

    Department of OB GYN, Brigham and Women's Hospital, Boston, MA, USA

  3. 3

    Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

  4. 4

    Department of OB GYN, Massachusetts General Hospital, Boston, MA, USA

  5. 5

    Department of Harvard Medical School, Boston, MA, USA

*Diagnostic Ultrasound Associates, 333 Longwood Avenue, Boston MA 02115, USA

Publication History

  1. Issue published online: 29 JUN 2009
  2. Article first published online: 29 JUN 2009
  3. Manuscript Accepted: 17 DEC 2008

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Keywords:

  • 3D ultrasound;
  • IUD;
  • pelvic pain

Abstract

Objective

To determine whether intrauterine contraceptive devices (IUDs) that are located abnormally within the myometrium or cervix cause a higher incidence of pelvic pain and abnormal bleeding compared with normally positioned devices.

Methods

Over a period of 9 months, all patients with an IUD presenting at our unit for two-dimensional pelvic ultrasound underwent a three-dimensional (3D) volume reconstruction of the coronal view, to visualize the entire IUD within the cavity. The IUD was deemed malpositioned if any part extended past the cavity, into the myometrium or cervix. The indications for ultrasound were recorded at presentation for the exam. The presenting symptoms of patients with an abnormally located IUD were compared with those with normally positioned ones.

Results

Among 167 consecutive patients with an IUD evaluated using the 3D reconstructed coronal view, 28 (16.8%) had an IUD with side arms abnormally located within the myometrium. The abnormal positioning of the IUD arms was only detected using the 3D coronal view. A higher proportion of patients with an abnormally located IUD presented with bleeding (35.7%) or pain (39.3%) compared with those with normally positioned IUDs (15.1% with bleeding and 19.4% with pain) (P = 0.02 and 0.03, respectively). Seventy-five percent of patients with an abnormally located IUD presented with bleeding or pain compared with 34.5% of those whose IUD was normally placed (P = 0.0001). Twenty of 21 patients with an abnormally located IUD presenting with pelvic pain or bleeding reported improvement in their symptoms after IUD removal.

Conclusion

A 3D coronal view of the uterus is useful in the visualization of IUDs. The coronal view showing the entire device and its position within the uterus may help in identifying the cause of pelvic pain and bleeding in patients with an embedded IUD. Copyright © 2009 ISUOG. Published by John Wiley & Sons, Ltd.

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