Journal of SAFOMS

Register      Login

VOLUME 7 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Multiple Wandering Intrauterine Devices and Barriers to Optimal Obstetric Care in Indonesia

Angela Grace, Kevin D Tjandraprawira

Keywords : Contraception, Intrauterine device, Low-resource setting, Missing intrauterine device, Point-of-care ultrasound

Citation Information : Grace A, Tjandraprawira KD. Multiple Wandering Intrauterine Devices and Barriers to Optimal Obstetric Care in Indonesia. J South Asian Feder Menopause Soc 2019; 7 (2):90-93.

DOI: 10.5005/jp-journals-10032-1179

License: CC BY-NC 4.0

Published Online: 01-12-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Aim: To highlight the shortcomings of obstetric care in Indonesia. Background: Wandering intrauterine devices (IUDs) is often asymptomatic, but it may also generate significant complaints. While preventable, negligence and human errors could worsen patient outcomes. Management of such cases is usually straightforward but could be hampered in low-resource settings. Case description: A 44-year-old para 2 abortus 2 (P2A2) woman with multiple wandering IUDs presented with acute urinary retention and a radiating left lower abdominal pain. A Lippes loop was inserted 19 years ago, which mistakenly was assumed to have been expelled during a miscarriage. A copper IUD was inserted 8 years ago, but she underwent no follow-ups. Abdominal radiograph revealed a copper IUD and another radiopaque foreign body. The copper IUD was successfully removed. Ultrasound revealed no intrauterine Lippes loop. Lack of on-site obstetricians/gynecologists led to her referral. Exploratory laparotomy was performed. The loop was in the rectovaginal pouch embedded to the posterior uterine wall with significant adhesions. An uneventful recovery ensued. Conclusion: The lack of on-site specialists and low-resource setting presented unique challenges to this case and underlines the importance of emergency physicians being adept at point-of-care ultrasound (POCUS) in specialist poor low-resource settings. Clinical significance: Emergency physicians should receive additional training, e.g., ultrasound, to better provide obstetric care in low-resource and specialist poor settings.

PDF Share
  1. Stoddard A, McNicholas C, Peipert JF. Efficacy and safety of long-acting reversible contraception. Drugs 2011;71(8):969–980. DOI: 10.2165/11591290-000000000-00000.
  2. Mitinunwong C, Huang K-G, Thepsuwan J, et al. Forgotten intrauterine device wandering in the abdomen of an endometrial cancer patient. Gynecol Minim Invasive Ther 2014;3:26–27. DOI: 10.1016/j.gmit.2014.01.003.
  3. Turok DK, Gurtcheff SE, Gibson K, et al. Operative management of intrauterine device complications: a case series report. Contraception 2010;82(4):354–357. DOI: 10.1016/j.contraception.2010.04.152.
  4. Peipert JF. Lippes loop and the first IUDs: lessons from a bygone era. Am J Obstet Gynecol 2018;219(2):127–128. DOI: 10.1016/j.ajog.2018.06.001.
  5. Lippes J. The making of the first loop. Am J Obstet Gynecol 2018;219(2):203–206. DOI: 10.1016/j.ajog.2018.06.022.
  6. Stanford JB, Mikolajczyk RT. Mechanisms of action of intrauterine devices: update and estimation of postfertilization effects. Am J Obstet Gynecol 2002;187(6):1699–1708. DOI: 10.1067/mob.2002.128091.
  7. Sağiroğlu N, Sağiroğlu E. Biologic mode of action of the Lippes loop in intrauterine contraception. Am J Obstet Gynecol 1970;106(4):506–515. DOI: 10.1016/0002-9378(70)90033-5.
  8. Group WS. Mechanism of action, safety and efficacy of intrauterine devices. Geneva: World Health Organization; 1987.
  9. Thomsen R, Rayl D. Dr Lippes and his loop. Four decades in perspective. J Reprod Med 1999;44(10):833–836.
  10. Sinha M, Rani R, Gupta R, et al. Lippes loop inserted 45 years back: the dilemma to remove it or leave it in situ. a case report with review of literature. J Clin Diagn Res 2015;9(4):QE01–QE05. DOI: 10.7860/JCDR/2015/12981.5832.
  11. Aniulienė R, Aniulis P. Lippes loop intrauterine device left in the uterus for 50 years: case report. BMC Womens Health 2014;14:97. DOI: 10.1186/1472-6874-14-97.
  12. Sun C-C, Chang C-C, Yu M-H. Far-migrated intra-abdominal intrauterine device with abdominal pain. Taiwan J Obstet Gynecol 2008;47(2):244–246. DOI: 10.1016/S1028-4559(08)60095-9.
  13. Gill RS, Mok D, Hudson M, et al. Laparoscopic removal of an intra-abdominal intrauterine device: case and systematic review. Contraception 2012;85(1):15–18. DOI: 10.1016/j.contraception.2011.04.015.
  14. Tsafrir A, Plotkin V. One intrauterine device lost, two found. Fertil Steril 2008;90(1):185. DOI: 10.1016/j.fertnstert.2007.09.065.
  15. Kandirali E, Topcuoglu A, Semerciöz A, et al. Double intrauterine device: presented with protruding urethral stone. Marmara Medical Journal 2008;21(1):61–63.
  16. Bharathi RS, Chakladar A, Kumari P. Mystery of the missing loop. Med J Armed Forces India 2011;67(2):177–178. DOI: 10.1016/S0377-1237(11)60029-4.
  17. Kart M, Gülecen T, Üstüner M, et al. Intravesical migration of missed intrauterine device associated with stone formation: a case report and review of the literature. Case Rep Urol 2015;2015:581697. DOI: 10.1155/2015/581697.
  18. Takahashi H, Puttler KM, Hong C, et al. Sigmoid Colon Penetration by an intrauterine device: a case report and literature review. Mil Med 2014;179(1):e127–e129. DOI: 10.7205/MILMED-D-13-00268.
  19. Subramanian V, Athanasias P, Datta S, et al. Surgical options for the retrieval of a migrated intrauterine contraceptive device. J Surg Case Rep 2013;2013(9):rjt072. DOI: 10.1093/jscr/rjt072.
  20. Aydogdu O, Pulat H. Asymptomatic far-migration of an intrauterine device into the abdominal cavity: a rare entity. Can Urol Assoc J 2012;6(3):E134–E136. DOI: 10.5489/cuaj.11100.
  21. Knudsen H, Rasmussen K. The “forgotten” intrauterine device: a cause of infertility. Arch Gynecol Obstet 1993;253(3):143–144. DOI: 10.1007/BF02767331.
  22. Haimov-Kochman R, Doviner V, Amsalem H, et al. Intraperitoneal levonorgestrel-releasing intrauterine device following uterine perforation: the role of progestins in adhesion formation. Hum Reprod 2003;18(5):990–993. DOI: 10.1093/humrep/deg203.
  23. Penney G, Brechin S, de Souza A, et al. FFPRHC guidance (January 2004). The copper intrauterine device as long-term contraception. J Fam Plann Reprod Health Care 2004;30(1):29. DOI: 10.1783/147118904322701956.
  24. Cheung M-L, Rezai S, Jackman JM, et al. Retained intrauterine device (iud): triple case report and review of the literature. Case Rep Obstet Gynecol 2018;2018:8. DOI: 10.1155/2018/9362962.
  25. Balci O, Mahmoud AS, Capar M, et al. Diagnosis and management of intra-abdominal, mislocated intrauterine devices. Arch Gynecol Obstet 2010;281(6):1019–1022. DOI: 10.1007/s00404-010- 1374-8.
  26. Balci O, Capar M, Mahmoud AS, et al. Removal of intra-abdominal mislocated intrauterine devices by laparoscopy. J Obstet Gynaecol 2011;31(7):650–652. DOI: 10.3109/01443615.2011.593646.
  27. Cetinkaya K, Kumtepe Y, Ingec M. Minimally invasive approach to cases of lost intra-uterine device: a 7-year experience. Eur J Obstet Gynecol Reprod Biol 2011;159(1):119–121. DOI: 10.1016/j.ejogrb.2011.07.003.
  28. Ertopcu K, Nayki C, Ulug P, et al. Surgical removal of intra-abdominal intrauterine devices at one center in a 20-year period. Int J Gynecol Obstet 2015;128(1):10–13. DOI: 10.1016/j.ijgo.2014.07.025.
  29. Markovitch O, Klein Z, Gidoni Y, et al. Extrauterine mislocated IUD: is surgical removal mandatory? Contraception 2002;66(2):105–108. DOI: 10.1016/S0010-7824(02)00327-X.
  30. Inal HA, Ozturk Inal Z, Alkan E. Successful conservative management of a dislocated IUD. Case Rep Obstet Gynecol 2015;2015:130528. DOI: 10.1155/2015/130528.
  31. Thornton GR. Intrauterine devices: malpractice and product liability. Law Med Health Care 1986;14(1):4–12. DOI: 10.1111/j.1748-720X.1986.tb01665.x.
  32. Micks T, Sue K, Rogers P. Barriers to point-of-care ultrasound use in rural emergency departments. CJEM 2016;18(6):475–479. DOI: 10.1017/cem.2016.337.
  33. Stolz LA, Muruganandan KM, Bisanzo MC, et al. Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department. Trop Med Int Health 2015;20(8):1067–1072. DOI: 10.1111/tmi.12511.
  34. Whitson MR, Mayo PH. Ultrasonography in the emergency department. Crit Care 2016;20(1):227. DOI: 10.1186/s13054-016- 1399-x.
  35. Stein JC, Wang R, Adler N, et al. Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med 2010;56(6):674–683. DOI: 10.1016/j.annemergmed.2010.06.563.
  36. Sohoni A, Bosley J, Miss JC. Bedside ultrasonography for obstetric and gynecologic emergencies. Crit Care Clin 2014;30(2):207–226. DOI: 10.1016/j.ccc.2013.10.002.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.