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Uterine dimensions and intrauterine device malposition: can ultrasound predict displacement or expulsion before it happens?

  • General Gynecology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

Intrauterine devices (IUDs) are the most commonly used method of long-acting reversible contraception. IUD malpositions are described as expulsion, embedding, displacement, and perforation, which may cause contraception failure, organ injury, hemorrhage, and infection. The aim of the study was to evaluate the relationship between displacement and IUD positioning in the uterus, and uterine dimensions as measured using transvaginal ultrasonography.

Materials and methods

Three-hundred and eighty-four patients who had TCu380A devices inserted at a tertiary hospital were evaluated at insertion and at 1 month, 3 months, and 6 months after insertion. At the insertion visit, demographic characteristics, history of menorrhagia, dysmenorrhea, previous IUD displacement, and obstetric history were recorded. Transvaginal ultrasonographic measurement of the uterine cavity, uterine length, uterine width, cervix length, cervix width, transverse diameter of the uterine cavity, the distance between the tip of the IUD and the fundus, and endometrium were measured to evaluate IUD displacement.

Results

Sixteen of 384 patients had displacement. There were significant differences in times between last pregnancy outcomes and IUD insertion and dysmenorrhea history (p = 0.004 and p = 0.028, respectively). Among TCu380A users, women with 7.5 mm IUD endometrium distances had a higher risk for displacement with a sensitivity of 81% and specificity of 37.5% (AUC: 0.607, 95% CI 0.51-0.70). Women with uterus width less than 41.5 mm were more likely to have displacement with a sensitivity of 53.8% and a specificity of 75% (AUC: 0.673, 95% CI 0.60–0.75).

Conclusion

IUD endometrium distance and uterus width are important parameters for displacement for TCu380A.

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Acknowledgements

Our thanks to Sevda Sagdıc (SS), our hospital’s family planning certificated trained midwife, for working devotedly and helping us with inserting IUDs properly.

Funding

This study was not funded by any company.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, University of Health Sciences Konya Training and Research Hospital, Konya, Turkey

    Feyza Nur İncesu Çintesun, Ümmügülsüm Esenkaya & Oğuzhan Günenc

  2. Department of Obstetrics and Gynecology, Selçuk University, Konya, Turkey

    Ersin Çintesun

Authors
  1. Feyza Nur İncesu Çintesun
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  2. Ersin Çintesun
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  3. Ümmügülsüm Esenkaya
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Contributions

All authors have contributed to the study conception and design. FNİÇ: Corresponding author, Data collection and management, and Manuscript writing. EÇ: Project/protocol development, Data analysis, and Manuscript editing. ÜE: Data collection and management, and supporting supervisor. OG: Lead supervisor. The first draft of the manuscript was written by Feyza Nur İncesu Çintesun and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Feyza Nur İncesu Çintesun.

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Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Ethical approval

Study was approved by the local institutional review board (Selcuk University Medical Faculty Review Board).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Çintesun, F.N.İ., Çintesun, E., Esenkaya, Ü. et al. Uterine dimensions and intrauterine device malposition: can ultrasound predict displacement or expulsion before it happens?. Arch Gynecol Obstet 302, 1181–1187 (2020). https://doi.org/10.1007/s00404-020-05713-0

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  • DOI: https://doi.org/10.1007/s00404-020-05713-0

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