Misplaced (''Missing'') Intrauterine Contraceptive Device Among Clients at a Rural Tertiary Hospital in South Western Nigeria

Abstract

Background: Misplacement is one of the complications reported with intrauterine contraceptive devices (IUCDs) as a form of contraception. Objective: To study the methods of diagnosis and the mode of management of misplaced IUCDs at the Federal Teaching Hospital, Ido-Ekiti. Methods: This was a retrospective review of records of all clients who presented with complaints of missing IUCD over a 5 year period, from 1st January 2011 to 31 st December 2015. Results: A total of 527 clients were seen at the family planning unit within the period under review. Three hundred and one (301) clients used IUCD, giving a prevalence of 57.1% of total contraceptive use. Of these, 12 IUCDs were reported misplaced, giving the incidence of misplaced IUCDs as 4%. The peak age of the clients reporting misplaced IUCD was 31-40 years. IUCDs insertion during puerperium was seen in 33.4% while most (41.6%) had their IUCD insertion more than 12 months following last childbirth. When considering IUCD insertion in relation to abortion and menses, most (50%) had insertion during menstrual period, 25% had insertion just before the onset of the next menses, postabortal insertion was seen in 16.7% while one (8.3%) could not ascertained the event that preceded the insertion of IUCD. Inability to feel the thread was the commonest presenting complaint in 6 (50%). Most of the clients with misplaced IUCD had the device inserted at the primary health centre (41.6%) and private hospitals (33.4%). Pelvic examination with uterine sound and abdominal ultrasound were the diagnostic methods commonly used. Most clients (83.3%) missed their IUCDs within the first twelve months of use. Retrieval hook was used for removal in 91.7% of the cases. One (8.3%) had exploratory laparotomy to recover the missing IUCD. Conclusion: Intrauterine devices should be inserted after proper case selection by properly trained medical personnel in both primary and tertiary centres in order to reduce reported cases of missing IUCDs.