BACKGROUND: The management of a malpositioned levonorgestrel (LNG)-releasing intrauterine system (IUS) can present a clinical challenge, complicated by the high cost of replacing it with a new device. We tried to challenge the guidelines and common practice that usually suggest prompt removal of any malpositioned IUS and replacement with a new one. STUDY DESIGN: We present our experience with 18 patients in whom the LNG-releasing IUS was found during a routine sonographic evaluation to be displaced towards the cervical canal 2 to 36 months postinsertion. Using an alligator forceps, the device was repositioned in the uterine cavity. RESULTS: The procedure was deemed successful in 17 (94.4%) of 18 cases. In 3 (17.6%) of the 17 successful procedures, the LNG-releasing IUS was found again to be malpositioned within 2 months. No complications were noted, and no postprocedural infection occurred. CONCLUSION: Repositioning of a malpositioned LNG-releasing IUS should be considered, as it is an easy and simple manipulation that can be done in the office with a high success rate and minimal risk of complications. Copyright Â
BACKGROUND: The management of a malpositioned levonorgestrel (LNG)-releasing intrauterine system (IUS) can present a clinical challenge, complicated by the high cost of replacing it with a new device. We tried to challenge the guidelines and common practice that usually suggest prompt removal of any malpositioned IUS and replacement with a new one. STUDY DESIGN: We present our experience with 18 patients in whom the LNG-releasing IUS was found during a routine sonographic evaluation to be displaced towards the cervical canal 2 to 36 months postinsertion. Using an alligator forceps, the device was repositioned in the uterine cavity. RESULTS: The procedure was deemed successful in 17 (94.4%) of 18 cases. In 3 (17.6%) of the 17 successful procedures, the LNG-releasing IUS was found again to be malpositioned within 2 months. No complications were noted, and no postprocedural infection occurred. CONCLUSION: Repositioning of a malpositioned LNG-releasing IUS should be considered, as it is an easy and simple manipulation that can be done in the office with a high success rate and minimal risk of complications. Copyright Â
Authors: Jason D Bell; Ingrid L Bergin; Melissa F Natavio; Fatima Jibrel; Melissa K Zochowski; William J Weadock; Scott D Swanson; David M Aronoff; Dorothy L Patton Journal: Contraception Date: 2012-10-29 Impact factor: 3.375