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Re: Lost IUDFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Tue Mar 27 05:04:23 2007
At Mon, 26 Mar 2007, R. Daniel Braun wrote: > >Mirena's don't show up very well on flat plate especilly if she has a high >BMI >US is acutally the method of choice. If she is not obese and you don't see >it on U/S, it ain't in the uterus. >So she has alreaady had all the imaaging tht she needs, Since mirena does >not have any closed loops or copper, it really doesn't need to be removed >from abdominal cavity. So don't worry about it, except that she needs >contraception. >Vast majority will have been expelled undetected. >Those that perf ute happen at insertion and are almost always associated >with severe cramping during the insertion. > >Dan > Excellent points Dan, I am not so sure if it is sitting next to the uterus the amenorrehea will not persist the levonogesterol may be close enough to continue to have an effect. I have removed non merina's , from the culde suc probably perforated through the posterioir lower uterine segment, fundus perforated but not through the serosa and uterosacral ligaments. They were removed when doing laproscopy for pain/infertility, I usually found varring degrees of scarring. Have also found them by the diaphram and sitting in omentum. If They perforate at insertion but not nessarily completely they will often just tent the serosal peritenium. Severe cramping durring inserstion is non specific I usually order an ultrasound and have yet to see a perforation. I hate inserting then in nuligravids but they have become so popular I have had patients demand them.
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Take care, John
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