Case report Vaginal misoprostol aids in difficult intrauterine contraceptive removal: a report of three cases

Background: Intrauterine devices are the most used long-acting reversible contraceptive method worldwide. Under normal circumstances, removal of an intrauterine contraceptive (IUC) is an uncomplicated procedure requiring gentle traction on the string. Study Design: We report three cases of nonvisible IUC strings where, following use of vaginal misoprostol, the IUC strings were visualized and the IUCs were removed intact with gentle traction. Conclusions: The uterotonic and uterocontractile effects following vaginal misoprostol facilitated removal in three cases of nonvisible IUC strings. We suggest that clinicians consider including vaginal misoprostol alone or prior to planned repeat office or procedure-clinic interventions for nonvisible IUC strings. © 2012 Elsevier Inc. All rights reserved.

[1]  M. Ingec,et al.  Minimally invasive approach to cases of lost intra-uterine device: a 7-year experience. , 2011, European journal of obstetrics, gynecology, and reproductive biology.

[2]  N. Abou-Salem,et al.  A double-blind randomized controlled trial of vaginal misoprostol for cervical priming before outpatient hysteroscopy. , 2011, Fertility and sterility.

[3]  T. Vrekoussis,et al.  A systematic review and meta-analysis of randomized studies comparing misoprostol versus placebo for cervical ripening prior to hysteroscopy. , 2011, European journal of obstetrics, gynecology, and reproductive biology.

[4]  J. Jensen,et al.  Effects of prophylactic misoprostol administration prior to intrauterine device insertion in nulliparous women. , 2011, Contraception.

[5]  O. Dekkers,et al.  Vaginal misoprostol prior to insertion of an intrauterine device: an RCT. , 2011, Human reproduction.

[6]  Alice W. Chuang,et al.  In-office retrieval of intrauterine contraceptive devices with missing strings. , 2011, Contraception.

[7]  C. Choksuchat.  Clinical use of misoprostol in nonpregnant women: review article. , 2010, Journal of minimally invasive gynecology.

[8]  L. Takser,et al.  Cervical ripening using vaginal misoprostol before hysteroscopy: a double-blind randomized trial. , 2008, Journal of minimally invasive gynecology.

[9]  O. Istre,et al.  Comparison of self-administered vaginal misoprostol versus placebo for cervical ripening prior to operative hysteroscopy using a sequential trial design* , 2007, BJOG : an international journal of obstetrics and gynaecology.

[10]  P. Ho,et al.  Misoprostol: Pharmacokinetic profiles, effects on the uterus and side‐effects , 2007, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[11]  A. Weeks,et al.  Misoprostol in obstetrics and gynecology , 2007, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[12]  O. Stephansson,et al.  Cervical priming with sublingual misoprostol prior to insertion of an intrauterine device in nulliparous women: a randomized controlled trial. , 2007, Human reproduction.

[13]  S. Healey,et al.  Use of misoprostol before hysteroscopy: a systematic review. , 2006, Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC.

[14]  T. Kuo,et al.  Cervical softening with vaginal misoprostol before intrauterine device insertion , 2005, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[15]  B. Yavuzer,et al.  The duration of use, causes of discontinuation, and problems during removal in women admitted for removal of IUD. , 2005, Contraception.

[16]  M. Bygdeman,et al.  Effects of misoprostol on uterine contractility following different routes of administration. , 2004, Human reproduction.

[17]  R. Windrim,et al.  The use of oral misoprostol as a cervical ripening agent in operative hysteroscopy: a double-blind, placebo-controlled trial. , 2002, American journal of obstetrics and gynecology.

[18]  P. Darney,et al.  Misoprostol and pregnancy. , 2001, The New England journal of medicine.

[19]  S. Preutthipan,et al.  Vaginal Misoprostol for Cervical Priming Before Operative Hysteroscopy: A Randomized Controlled Trial , 2000, Obstetrics and gynecology.

[20]  F. Arias,et al.  Pharmacology of oxytocin and prostaglandins. , 2000, Clinical obstetrics and gynecology.

[21]  B. Spur,et al.  Comparison between oral and vaginal administration of misoprostol on uterine contractility. , 1999, Obstetrics and gynecology.

[22]  P. Ho,et al.  Oral misoprostol for cervical priming in non-pregnant women. , 1997, Human reproduction.

[23]  N. Benowitz,et al.  Absorption Kinetics of Misoprostol With Oral or Vaginal Administration , 1997, Obstetrics and gynecology.

[24]  P. Ho,et al.  Oral misoprostol versus placebo for cervical dilatation before vacuum aspiration in first trimester pregnancy. , 1995, Human reproduction.

[25]  D. Wheatley,et al.  Cervical priming with prostaglandin E1 analogues, misoprostol and gemeprost , 1994, The Lancet.

[26]  M. Hosseiny,et al.  The value of X-ray with uterine sound in the diagnosis of IUDs with missing tails , 1986, Advances in contraception : the official journal of the Society for the Advancement of Contraception.

[27]  J. Guillebaud.  Scheme for management of lost IUD threads. , 1980, IPPF medical bulletin.

[28]  Rao Rp.  Lost intrauterine devices and their localization. , 1978 .