Incarcerated and Transmigrated Intrauterine Contraceptive Devices Managed at a Tertiary Care Teaching Hospital of East Delhi: A 5-Year Retrospective Analysis

Abstract

Purpose of the Study: Intrauterine contraceptive devices (IUCDs) are highly effective form of long-acting reversible contraception having least number of complications. We aimed to find the incidence, risk factors and the management done for incarcerated and transmigrated intrauterine contraceptive devices at a Tertiary Care Teaching Hospital during past 5 years. Methods: A cross-sectional retrospective analysis of 5 years (January 2013–December 2017) was done, and the case records from Medical Record Department and Family Planning Unit of our institution were analysed. Results: Total number of IUCD insertions done in last 5 years (from January 2013 to December 2017) in our institution was 4557. Misplaced IUCDs requiring surgical interventions were 71 (1.6%) out of which 63 (88.7%) were incomplete perforations or embedded and 8 (11.3%) were complete perforations or transmigrated IUCDs. Transmigration sites were omentum, uterovesical fold, mesentery and bladder. Laparotomy was needed in 4 (5.6%), and 2 (2.8%) needed each laparoscopy and cystoscopy. Main risk factors identified were postpartum previous on or two caesarean sections, low parity, grade of operator and IUCD and uterocervical length discrepancy. Conclusion: The risk of perforation should not be a reason to defer IUCD insertion and every effort should be made to bring down its failure and complication rates.