Document Detail

Ultrasound-guided hysteroscopy to remove a levonorgestrel intrauterine system in early pregnancy.
MedLine Citation:
PMID:  22497757     Owner:  NLM     Status:  Publisher    
BACKGROUND: Correctly placed levonorgestrel-releasing intrauterine systems (LNG-IUSs) are rarely associated with intrauterine pregnancy when pregnancy occurs. LNG-IUS retrieval, termination of pregnancy and conservative management if retracted strings prevent ready removal are the usual clinical options given to women. The conservative course raises concerns about teratogenesis related to high local progestin exposure for the developing fetus. STUDY DESIGN: This case report describes combined saline hysteroscopy and ultrasound to retrieve an LNG-IUS at less than 9 weeks of gestational age. A systematic review of the literature was performed to identify similar case reports by contacting the manufacturer and searching Pubmed from 1900 through November 2011 using the terms ((levonorgestrel AND intrauterine) OR mirena) AND (pregnan⁎ OR fetal OR fetus OR teratogen⁎) NOT (menorrhagia OR hyperplas⁎ OR ectopic OR malig⁎ OR cancer). RESULTS: We identified 37 cases of LNG-IUS pregnancy exposures in the absence of spontaneous expulsion or myometrial or intraperitoneal placement of LNG-IUS. Given the presence of two congenital anomalies reported in the group, the anomaly rate is 5.4%, 95% confidence interval 0% to 11.5%. CONCLUSIONS: Intrauterine LNG-IUS exposure is associated with a low frequency of congenital anomalies. Combining hysteroscopy with ultrasound facilitates surgically precise LNG-IUS removal despite retracted strings.
Elizabeth A McCarthy; Nisha Jagasia; Peter Maher; Miranda Robinson
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-10
Journal Detail:
Title:  Contraception     Volume:  -     ISSN:  1879-0518     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0234361     Medline TA:  Contraception     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Crown Copyright © 2012. Published by Elsevier Inc. All rights reserved.
Department of Perinatal Medicine, Mercy Hospital for Women, Heidelberg, VIC 3078, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Heidelberg, VIC 3078, Australia.
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