Malpositioned intrauterine contraceptive devices: risk factors, outcomes, and future pregnancies.

Braaten KP, et al. Obstet Gynecol. 2011;118:1014Y1020. The purpose of this retrospective casecontrol study was to evaluate risk factors, management, and outcomes for women with malpositioned intrauterine contraceptive devices (IUDs). One hundred eighty-two women with malpositioned IUDs as seen on pelvic ultrasound were compared with a control group of 182 women with IUDs positioned in the expected location within the uterine fundus. Insertion 6 to 9 weeks postpartum or insertion after abortion was not associated with a higher rate of IUD malpositioning. In the multivariate analysis, suspected adenomyosis (odds ratio [OR], 3.04) and symptoms suggesting IUD malpositioning (OR, 1.74) were statistically significant risk factors for malpositioning,whereas prior vaginal delivery (OR, 0.53) and private insurance status (OR, 0.38) were protective. Two thirds of the malpositioned IUDs were removed. In the subsequent 2 years, statistically significantly higher pregnancies occurred in the case cohort compared with the control group (19.2% vs 10.5%), although the proportion of unplanned pregnancies was not statistically different. In the case cohort, most of the pregnancies occurred in those known to have the malpositioned IUDs removed or expelled, and none occurred in women whose malpositioned IUDs remained in situ. The authors conclude that IUD insertion in the postpartum period does not result in a higher risk of malpositioning, contrary to some previous beliefs. Because of their finding of an increased pregnancy rate after removal, their study raises questions about whether all malpositioned IUDs need to be removed. Observations on Hydroceles Following Adolescent Varicocelectomy