OB-GYN-L Messages for December, 2007: Re: Prforation of the uterus with a Mirena IUD in a waoman with a

Re: Prforation of the uterus with a Mirena IUD in a waoman with a

From: art fougner, md

evsono@pipeline.com

Sun Dec 16 10:31:57 2007

You may wish to contact these guys.

Hum Reprod. 2003 Jun;18(6):1231-3. Management of a perforated levonorgestrel-medicated intrauterine device--a pharmacokinetic study: case report. Haimov-Kochman R, Amsalem H, Adoni A, Lavy Y, Spitz IM.

Department of Obstetrics and Gynecology, Hadassah University Hospital, Jerusalem, Israel. rkochman@hotmail.com

Intrauterine contraception is a widely used, highly effective method of birth control. Uterine perforation is a serious albeit rare complication with the use of an intrauterine device (IUD). Although uterine perforation by the levonorgestrel-releasing intrauterine system (LNG-IUS) has already been described, no plasma LNG concentrations in this setting were reported. Neither has the management of LNG-IUS been commented on to date. Two months after insertion of an LNG-IUS into a 33-year-old woman, it was noted to be in the peritoneal cavity. Laparoscopy for IUD removal was conducted 5 months after insertion. LNG and sex hormone-binding globulin plasma concentrations were measured prior to and following the laparoscopic removal of the IUD. Intra-peritoneal dislocated LNG-IUS resulted in plasma LNG levels 10 times higher (4.7 nmol/l) than the plasma level of LNG observed with LNG-IUS placed in utero. This high plasma LNG level suppresses ovulation. Therefore a misplaced LNG-IUS should be removed when pregnancy is desired.

Art

At Sun, 16 Dec 2007, jacob urbach wrote: >
>Dr Bulley
> Sorry for my ignorance. It is indeed my first time in this web site. I
>practice medicine, and I am an OBGyn in Israel.
> Jacob
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Joanne
>Bulley, MD
>Sent: Sunday, December 16, 2007 6:16 PM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: Prforation of the uterus with a Mirena IUD in a waoman with a
>previous laparatomy.
>
>Jacob
>
>The courtesy on this list is to list how you are and where you practice
>medicine and what type of medicine yo practice.
>
>ARe you an MD practicing medicine or someone phishing here on this list?
>
>I don't recall "seeing" you here before. Sorry if I missed your
>credentials
>
>At Sun, 16 Dec 2007, Jacob wrote:
>>
>>I would like to ask the forum for their opinion regarding a perforation
>>of the uterus with a Mirena IUD. The woman, a 36 yaer old para 3, with
>>a previous laparotomy, myomectomy. Apart from that a healthy woman. The
>>"lost" IUD was diagnosed a year after insertion, after an hysteroscopy,
>>which revealed an empty uterus, and an X ray of the pelvis, showing the
>>IUD in the lower left hand side of the pelvis.
>>What's the forum opinion, should the IUD be left in place, or an
>>attempet be made to withdraw it with a laparoscope.
>
>--
>Joanne Bulley, MD, FACOG
>Solo gyn
>Keene, NH USA
>
>More Great Snow!!!!
>24 inches so far in 2 weeks and it isn't even officially winter! YEAH!
>

-- art fougner, md "May The Wings of Liberty Never Lose a Feather." - Jack Burton

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