Intrauterine contraceptive device
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At the time the article was created Mohamed Refaey had no recorded disclosures.View Mohamed Refaey's current disclosures
At the time the article was last revised Craig Hacking had the following disclosures:
- Philips Australia, Paid speaker at Philips Spectral CT events (ongoing)
These were assessed during peer review and were determined to not be relevant to the changes that were made.View Craig Hacking's current disclosures
Intrauterine contraceptive devices (IUCD) (also known as intrauterine devices (IUD) and colloquially commonly as the coil) are one of the most frequently used methods of contraception throughout the world. It prevents pregnancy by:
thinning the endometrial lining
preventing sperm motility
There are two main types of intrauterine contraceptive devices:
hormonal, e.g. Mirena, Kyleena, Liletta, Skyla
The preferred abbreviation for an intrauterine contraceptive device is IUCD. Occasionally IUD is employed instead, however, this shortening is disliked by some specialists as it is also used as an abbreviation for intrauterine death.
IUCD migration can take many forms 13
spontaneous IUCD expulsion: passage in or through the external cervical os
abnormal rotation or inferior position in the lower uterine segment or cervix
IUCD position >3-4 mm has been associated with an increased likelihood of IUCD related symptoms, such as pain and bleeding 2,9 as well as expulsion 10 - although further studies have shown that most low IUCDs migrate to the fundus after a few months 6
asymptomatic displacement of a hormone-releasing IUCD (e.g. Mirena®) may not affect its efficacy in prevention of pregnancy, according to some studies 6-8; in contrast, for copper IUCDs, displacement from the fundal position is associated with higher rates of inadvertent pregnancy 7
IUCD embedment: penetration into the myometrium, but not through the serosa
IUCD perforation: penetration through myometrium and serosa
three-fold increased risk of generalized pelvic inflammatory disease (PID)
associated pregnancy with spontaneous miscarriage
all intrauterine contraceptive devices are radiopaque (by design) 6
preferred modality for assessing an intrauterine contraceptive device
properly-placed IUCD may be visualized as a straight hyperechoic structure in the endometrial canal of the uterus and the arms of the IUCD extending laterally at the uterine fundus
often causes posterior acoustic shadowing
distance from the uterine fundus >4 mm is more often associated with symptoms such as bleeding and pain, as well as with a higher risk of expulsion or displacement 2 although most low IUCDs migrate to the fundus in a few months 6
in cases where it becomes embedded, a part of it may be visualized within the myometrium
3D ultrasound may be useful to help visualize the IUCD location (especially with serpiginous IUCDs) 2.
hyperattenuating structures with metallic density
The MRI compatibility of intrauterine contraceptive devices may be of concern to women undergoing MRI examinations. Generally speaking, stainless steel devices are unsafe and non-metallic devices are considered safe. Copper devices have been found to be "conditionally safe" at 1.5 and 3.0 T 11.
History and etymology
The forerunner to the intrauterine contraceptive device was first introduced by the German physician, Richard Richter of Waldenburg, in 1909 4,5. His device comprised a loop of silkworm gut placed into the endometrial cavity 5.
The contraceptive efficacy of non-fundal placement of an IUCD cannot be guaranteed. Measuring the distance between the fundal end of the cavity and the superior end of the IUCD is important when assessing placement. Low-lying IUCDs (those that are over 2 cm from the fundal end of the cavity) should be reported and the measurement included in the report 12.
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- 13. Boortz H, Margolis D, Ragavendra N, Patel M, Kadell B. Migration of Intrauterine Devices: Radiologic Findings and Implications for Patient Care. Radiographics. 2012;32(2):335-52. doi:10.1148/rg.322115068 - Pubmed
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