Case Presentation

IUD DISLOCATION

Presented by :
dr. Selly Rizany

Moderator :
Dr. H. Firmansyah Basir, SpOG(K)-Obginsos, MARS
DEPARTMENT OF OBSTETRIC AND GYNECOLOGY
FACULTY OF MEDICINE SRIWIJAYA UNIVERSITY
Dr. MOH. HOESIN GENERAL HOSPITAL PALEMBANG
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MEDICAL RECORD

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 ANAMNESIS

Identification
Name : Ny. REN
Med.Rec : 1199933
Age : 38 years old
Ethnicity : Palembang
Education : Bachelor
Religion : Islam
Occupasion : Police officer
Adress : Seberang Ulu I, Palembang
Admission : March 17th 2021

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 Marital Status
1x, 12 year

ANAMNESIS Obstetric History

P2A0

Other History
History of IUD insertion 5 years ago

History of nutrition and welfare

moderate

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 ANAMNESIS
Chief complaint:
Abdominal pain
History of disease :

The patient came to clinic with complaints of abdominal pain since 3

months ago.
History of vaginal discharge was denied, history of fever was
denied, vaginal bleeding was denied. The patient presented to
OBGYN and was diagnosed with IUD dislocation. Then patient was
referred to Mohammad Hoesin hospital for further examination.

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General Status

Height : 165 cm Weight : 87 kg

Blood pressure : 120/80 mmHg Conciousness : compos mentis
Pulse rate : 82 x/ minute Respiratory rate : 18 x / minute
Temperature : 36,5oC

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Specific Examination

Head : normocephali, scleral icterus (-/-)

Neck : JVP (5-2) cmH2O, lymph nodes enlargement (-)
Thorax: Heart : I-II HR N, regular, murmur (-), gallop (-)
Lungs : vesicular (+/+) N, ronkhi (-/-), wheezing (-/-)
Extremity : edema (-)

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Gynecological Examination
Abdomen :
Flat abdomen, cesarean scar (+), supple, tenderness (+) in right
iliac region, free fluid sign (-)

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Supporting Examination: US Gynecology

Conclusion :
There was IUD dislocation (located in right
posterior corpus of uterine) 9
Working Diagnosis
IUD Dislocation

Prognosis
Dubia ad bonam

Management

Histeroscopy Diagnostic
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 Histeroscopy Result

Conclusion :
There was IUD dislocation (located in right
posterior corpus of uterine) 11
2
PROBLEMS

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How is the diagnosis made in this patient?

What is the cause of IUD dislocation in this patient?

Is the management of this patient correct?

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PROBLEM ANALYSIS

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How is the diagnosis made in this patient?
IUD : the most common
method of reversible
contraception in women
because it is safe,
inexpensive, and not difficult
to provide
Possible sites for IUD
migration are the bladder
(intravesika), peritoneum,
omentum, rectosigmoid,
appendix, small intestine,
colon, adnexa and iliac
veins.
Perforation and migration of
IUD insertions with an
incidence of 1.9-3.6 / 1000
insertions
Possible complications
include sepsis, septic
abortion, ectopic pregnancy,
pelvic abscess, peritonitis, to
death.
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Diagnosis

Anamnesis :
history of previous
IUD insertion and USG
persisten abdominal
pain

Histeroscopy : as
diagnostic and X-Ray, CT-Scan
therapeutic tools

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Causes

1. IUD Types 2. Uterine Positions

IUD types reported which had
higher IUD malpositioned
- ParaGard IUDs (Cooper
Surgical, Trumbull, CT, were the
most common malpositioned
IUD (24.2%)
- Mirena IUDs (Bayer, Whippany,
NJ)
Uterine positions which
commonly caused the IUD
malpositioned :
- Retroflexed uterine positions
- All uterine anomalies, such
as septate uteri, bicornuate
uteri, and fibroids.
.

In this case, patient used th Cooper T IUD which was

the most common caused of the IUD malpositioned 17
USG

The most common malposition presentation :

- being low but not extending to the cervix (38%)
- followed by cervical (26%)
- low and extending into the cervix (22%)
- extrauterine (1%).

In this case, the IUD was located in right posterior corpus

of uterine
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How is the diagnosis made in this patient?

In this case, the patient had a persistent abdominal pain + US

examination (IUD dislocation)  Histeroscopy is performed to
confirm the presence of the IUD and performs its removal at
once. 6

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What is the cause of IUD dislocation in this patient?

In this case the IUD type most likely

one of the causes of the IUD
dislocation. The other possible causes
hadn’t been examined, such as the
uterine position or uterine anomalies.

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Is the management of this patient correct?

The WHO IUD report as well as some studies recommends that a

dislocated IUD should be removed because of potential problems
with bowel injury, chronic pelvic pain, and infertility. The preferred
method for the removal of a dislocated IUD is laparoscopy but
laparotomy may have to be performed in some cases.

Based on WHO recommendation, the managamenet of this case

was appropriate because the patient came with a chronic pelvic
pain so the removal of the IUD should be performed.
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4
CONCLUSION

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To avoid complications of IUD use, it is recommended to
control to healthcare professionals if there are any
complaints soon after post insertion. Type of IUD and
uterine position in this patient must be accessed to find the
causes of this case. The dislocated IUD must be removed
when it comes with a symptom.

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THANKYOU!

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