The application of hysteroscopy in diagnosis and treatment of missing intra-uterine devices

Objective To evaluate the efficacy of hysteroscopy for diagnosis and treatm ent of missing intra-uterine devices (IUDs). Design A retrospective study of 274 patients. Setting Shanghai Institute of Planned Parenthood Research, Shanghai Jiading District Gynaecological Endoscopy Centre and Shanghai First Maternity and Infant Health Hospital. Subjects 274 patients with missing IUDs, who had previously undergone up to four unsuccessful attempts at IUD removal, were included in our study. Amo ng them, 45 patients had been menopausal for more than 1 year. Interventions Hysteroscopy was used to detect and/or remove the missing IUD s or their broken pieces in all patients. Results In 237 out of 274 patients with missing devices, the IUDs or their broken pieces in the uterine cavity were detected by hysteroscopy. In 236 o ut of these 237 patients, the IUDs or their broken pieces were removed succ essfully under hysteroscopic view or after hysteroscopic location. In one c ase only a small piece of the IUD remained in the uterine wall because of b reakage during extraction. The IUDs of the remaining 37 patients were not f ound in the uterine cavity: in 13 patients there was expulsion of IUDs; in two there were broken pieces embedded in the uterine wall; 14 patients had IUDs removed by laparoscopy, and eight IUDs were removed by laparotomy. Conclusion Our study indicates that hysteroscopy sometimes with an ultrasou nd B-scan or laparoscopic guide, is of great value not only for precise loc ating of the IUD, but also for its removal under direct vision, particularl y in the management of patients with broken and/or embedded IUD pieces.