When to remove the IUCD:
After expiry of the effective life span of the device we have to remove it.
If pelvic pain and cramping or abnormal or excessive bleeding troubling the patient the device should be removed.
In patient having acute pelvic inflammation the device should be removed.
In case of Displacement of the IUD, it should be removed.
When the woman is pregnant the device should be removed.
In case of uterine or cervical malignancy the device should be removed.
When the woman attains menopause – after one year the device should be removed.
In case of non-physical reasons – like patient is having desire of pregnancy, husband's death, or at request the device can be removed.
Technique of removal of IUCD, eg.Cu T:
Threads are held by artery forceps and steady traction applied to bring it out.
Missed IUCD eg.Cu T:
To diagnose the missed IUCD, pregnancy should be excluded first. Then sounding of the uterine cavity should be done to feel the missed device in the cavity.
Straight X-ray with radio-opaque sound can detect missed device and its position.
Hysteroscopy can be done for direct visualization.
If tail is not seen, cervix is cleaned, cavity probed with sound, cervix steadied with vulsellum, dilated and vaccum curette applied.
If it fails, general anaesthesia given and IUD is curetted, with long Spencer Wells forceps.
If probing can not detect the device there are two possibilities:
1. IUCD is expelled.
2. Has perforated the uterus.
IUCD can be removed by culdoscopy, colpotomy, laproscopy or laprotomy depending on the position.
Hysteroscopic guided removal is the best procedure.
After expiry of the effective life span of the device we have to remove it.
If pelvic pain and cramping or abnormal or excessive bleeding troubling the patient the device should be removed.
In patient having acute pelvic inflammation the device should be removed.
In case of Displacement of the IUD, it should be removed.
When the woman is pregnant the device should be removed.
In case of uterine or cervical malignancy the device should be removed.
When the woman attains menopause – after one year the device should be removed.
In case of non-physical reasons – like patient is having desire of pregnancy, husband's death, or at request the device can be removed.
Technique of removal of IUCD, eg.Cu T:
Threads are held by artery forceps and steady traction applied to bring it out.
Missed IUCD eg.Cu T:
To diagnose the missed IUCD, pregnancy should be excluded first. Then sounding of the uterine cavity should be done to feel the missed device in the cavity.
Straight X-ray with radio-opaque sound can detect missed device and its position.
Hysteroscopy can be done for direct visualization.
If tail is not seen, cervix is cleaned, cavity probed with sound, cervix steadied with vulsellum, dilated and vaccum curette applied.
If it fails, general anaesthesia given and IUD is curetted, with long Spencer Wells forceps.
If probing can not detect the device there are two possibilities:
1. IUCD is expelled.
2. Has perforated the uterus.
IUCD can be removed by culdoscopy, colpotomy, laproscopy or laprotomy depending on the position.
Hysteroscopic guided removal is the best procedure.
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