Re: Lost IUD
From: R. Daniel Braun (rd.braun@gmail.com)
Tue Mar 27 17:36:21 2007
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> 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] 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
