Re: Lost IUD
From: Harrison Sheld (hsheld@vwestm.net)
Tue Mar 27 17:54:18 2007
Mon ami, easy to put the Birnberg Bow in, but getting it out you needed
a piano tuner.
R. Daniel Braun wrote:
> You beat me by 2 years, I inserted my first one in 1964 as an intern.
> It was a Birnberg Bow.
>
> Dan
>
> On 3/27/07, *Atkinson, Samuel M* <ATKINSONS@ecu.edu
> <mailto:ATKINSONS@ecu.edu>> wrote:
>
> If you don't see it with ultrasound then it is likely in the sewer
> system. If it was still in the uterus she would in all likelihood be
> having scant or no menses. Using the withdrawal technique for
> insertion
> of Mirena makes it highly unlikely that a perforation has occurred and
> even less likely to be intraperitoneal. I would deplore anything
> except
> a flat plate. If it isn't there it ain't there. An intraperitoneal
> insertion of a Mirena is somewhat unprecedented. Spontaneous
> passage in
> a menstrual clot is common. As an aside, copper IUD's are highly
> inflammatory in the peritoneal cavity and adhere to most everything.
> Removal with a laparoscope is difficult and laparotomy is usually
> required. Copper IUD's should be removed. There is debate as to
> whether
> a Mirena even needs to be removed if in the peritoneal cavity as
> it has
> no copper. The minute amount of progesterone secretion in the abdomen
> would not prevent pregnancy nor affect it.
> PS: I inserted my first IUD's in 1962. My latest was two weeks ago (a
> Mirena). My only publications were about the Dalkon Shield and I
> testified in numerous class action claims about it.
> sAm
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net <mailto:ob-gyn-l@obgyn.net>
> [mailto:ob-gyn-l@obgyn.net <mailto:ob-gyn-l@obgyn.net>] On Behalf
> Of Garry
> E. Siegel, M.D.
> Sent: Monday, March 26, 2007 7:17 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Gyn: Lost IUD
>
> 25 YO P1001 with a Mirena of around one year's duration, came in for
> removal. No string seen, and on exploring the uterus with an IUD
> hook,
> well, no IUD found.
>
> Ultrasound did NOT find her IUD, so it is lost.
>
> I have recommended H-scope/lapscope to find it, but she has asked
> about
> having a CT first. Actually, I hadn't thought of that, and it seems
> that a plain X-ray may be even the better first choice.
>
> My real questions is: Is there any role for imaging? My instinct
> says we
> simply need to go to the OR, as she couldn't have expelled it and not
> known it, I wouldn't think. That said, if it is up under her
> diaphagm.
> . .
>
> Garry
>
> --
> Garry E. Siegel, M.D.
> Private Practice
> Roswell, GA
>
> --
> R. Daniel Braun, MD FACOG(L) CMT
> Professor Emeritus
> Dept. of Obstetrics and Gynecology
> Indiana U. School of Medicine
>
> R. Daniel Braun
>
> "The way to health is an aromatic bath and scented massage
> everyday".
> Hippocrates
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