Introduction:

This case report describes one of the possible adverse effects of Intrauterine devices (IUD) and explores the correct procedure in the primary health care setting.

Case description:

In October 2019, the patient chose a Copper intrauterine device (Cu-IUD) and a pre-procedure ultrasound was performed (no changes detected). In February 2020, the Cu-IUD was introduced without complications and an ultrasound was required to confirm its correct positioning. Due to the COVID-19 pandemic, the patient didn’t do it and kept condom use. In March 2021, after a new request, the ultrasound performed did not identify the device. The patient denied having expelled the device or any other symptoms. At our observation, the wires were not visible. An abdominal X-ray was performed, showing the device “in the middle area of the pelvic excavation, in an oblique position”. A new ultrasound then revealed the “presence of IUD in the pelvic cup, in extrauterine topography, lateralized to the left side of the uterus”. The patient was sent to an urgent gynecology appointment and the Health Products Surveillance Unit of INFARMED was notified. In June 2021, she was enrolled for laparoscopy for Cu-IUD removal and bilateral salpingectomy for definitive contraception.

Comment:

This case highlights the importance of ultrasound evaluation after placement of intrauterine devices, confirming their location and guaranteeing the effectiveness of the method and the rapid detection of complications. It was intended to review the correct procedure: physical examination, complementary diagnostic tests, participation to the competent authorities, and early referral to gynecology for rapid resolution of the incident.

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