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Re: Gyn: Lost IUDFrom: Dr. John Provatopoulos B.Sc. M.D.C.M. F.R.S.C. (johnprov@sympatico.ca)Mon Mar 26 17:56:02 2007
At Mon, 26 Mar 2007, Garry E. Siegel, M.D. wrote: > >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 > I have had a few of these over the years, but only just recently saw one with mirena IUD, I have sent her for U.S. and she will get a flat plate after her BHCG is negative. Most of the copper T's I usually found in the cul-de sac or pelvic side wall. The problem with the mirena is that if it is sitting in the cul-de sac or side wall the amenorrehea and contraceptive effect will persist. Indeed the one I just saw wants to get pregnant and this is unlikely to happen if it is sitting in the cul-de sac so unless the flat plate shows nothing I will have to remove it. In the past I would not necessarily remove it unless I was doing a laparscopy for tubal factor infertility, I would just advise them they could get pregnant and to use other contraception.
--
Take care, John
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