ULTRASONOGRAPHICALLY GUIDED INTRAUTERINE CONTRACEPTIVE DEVICE REMOVALBEFORE CHORIONIC VILLUS SAMPLING

OBJECTIVE: Management of a retained intrauterine contraceptive device with no visible string during early pregnancy presents a dilemma. Beca use these devices are frequently used by multiparous women, it is not unusual that many women with retained devices are also of advanced mat ernal age. We describe our experience with ultrasonographically guided first-trimester retrieval of an intrauterine contraceptive device in conjunction with chorionic villus sampling. STUDY DESIGN: Patients wit h a first-trimester pregnancy and a retained intrauterine contraceptiv e device where no string was visible were offered ultrasonographically guided retrieval of the device. If the patient had genetic risks and desired prenatal diagnosis, chorionic villus sampling was offered at t he same office visit. RESULTS: Six patients underwent intrauterine con traceptive device retrieval, under continuous ultrasonographic guidanc e, by use of an intrauterine contraceptive device hook. All patients h ad a posterior or fundal device. One patient had two in situ: a Lippes Loop (Ortho Pharmaceutical Corp., Raritan, N.J.) removed by its strin g and a Cu-7 (G.D. Searle and Co., Chicago) removed under ultrasonogra phic guidance. The remaining five patients had a Cu-7. Four of six pat ients had chorionic villus sampling performed immediately after the in trauterine contraceptive device removal and one patient had chorionic villus sampling 3 weeks later. There were two losses in our series: on e after a lengthy procedure and one before documented viability. All i nfants were structurally normal and born at term. CONCLUSION: First-tr imester ultrasonographically guided retrieval of a retained intrauteri ne contraceptive device may be safely performed in conjunction with ch orionic villus sampling.