Jahra hospital

First case

Talal AlanziYr 330-1-2014

• 38 Yr.• Female.• Presented to OPD with 1 year history of dysuria and B/L loin

pain.

• Frequency• Urgency• Straining • No constitutional symptoms.• No urethral or vaginal discharge.• No incontinence.• Not stone passer nor former.

• P.M.H: Nil.• P.S.H: Nil.• No drug allergy.• Housemaid. • P. OBS & GYN: delivered twice 2001- 2003

• IUCD 2004• Delivered 2005

Vital Sign• T 37 - P 80 - BP 110/70.• On exam:• Abd: soft,lax, non tender.• Vaginal exam normal.• Speculum: normal.

Inv • Urine R/M: RBC 3 + • CBC: HB 13 - WBC 4 - PLT 350.• RFT: creat 70 - urea 5 • LFT: normal.• Urine c/s: normal.

Ultrasound• Vesicle stones.

• TVU: device not in place.

•Next plan

•Consent form:…………..

• Cystoscopy and proceed/hysteroscopy• Open surgery

video

• about 0.87 per 1,000 insertions.

• Insertion performed while women are lactating is associated with 10 times higher risk of uterine perforation.

Balci O, Capar M, Mahmoud AS, Colakoglu MC. Removal of intra-abdominal mislocated intrauterine devices by laparoscopy. J Obstet Gynaecol 2011;31:650-2.

• Post-insertion• Before the first episode of sexual intercourse• After her next menses

Maruti Sinha1, Ridhima Gupta2, Minimally invasive surgical approach to retrieve migrated intrauterine contraceptive device.. Int J Reprod Contracept Obstet Gynecol. 2013 Jun;2(2):147-151

Mechanisms can explain the spontaneous migrationof IUDs

• overlooked iatrogenic uterine perforation• spontaneous uterine contraction• Involuntary bladder contraction• gut peristalsis• peritoneal fluid movement

Risk factor• inexperienced persons• inappropriate positioning of the IUD• susceptible uterine wall because of multiparity. • endometrial atrophy • chronic inflammation to copper containing

• recent abortion or pregnancy.

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listening