title: Complication rates associated with levonorgestrel intrauterine system use in adolescents with developmental disabilities.
abstract: OBJECTIVE
  To assess the complication rates with the use of the levonorgestrel intrauterine system (LNG IUS) in adolescents with developmental disabilities.
  
  
  METHODS
  Retrospective chart review of all adolescents with developmental disabilities taken to the operating room for LNG IUS insertion between January 2000 and July 2009 at the Royal Children's Hospital, Melbourne, Australia. Cases identified from the surgical database, and medical records reviewed.
  
  
  METHODS
  Complication rates with LNG IUS use in adolescents with development disabilities: non-insertion, uterine perforation, infection, and expulsion.
  
  
  RESULTS
  Fifty-six adolescents with developmental disabilities had an attempted LNG IUS insertion. The average age at insertion was 15.6 years (range 10.5-21.5 y). The LNG IUS was used as first line therapy in 14 cases (25%). Pre-insertion ultrasonography was ordered in 48% of cases, out of which 5 cases had uterine lengths <6 cm. Despite this, 4 of these cases had successful insertions. Two insertion attempts were abandoned intra-operatively (3.6%); one due to inadequate uterine length of 4 cm, and the other due to anatomic distortion. One spontaneous expulsion occurred at approximately 5 months (1.9%). Four IUDs were removed prematurely (7.4% withdrawal rate); 1 for persistent abdominal pain, 1 for irregular bleeding, and 2 for suspected malpositions. There were no documented cases of infection, perforation, or pregnancy.
  
  
  CONCLUSIONS
  Our experience in this population has been very positive and confirms that complication rates are comparable to that in adults.
authors: Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors: Ingrid
authors: I
authors: Savasi
authors: Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors: Kokum
authors: K
authors: Jayasinghe
authors: Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors: Patricia
authors: P
authors: Moore
authors: Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
authors: Yasmin
authors: Y
authors: Jayasinghe
authors: Department of Paediatric and Adolescent Gynaecology, The Royal Children's Hospital, Melbourne, Victoria, Australia. Electronic address: s.grover@bigpond.net.au.
authors: Sonia R
authors: SR
authors: Grover
mesh_terms: D000293:Adolescent; D001315:Australia; D002648:Child; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D002658:Developmental Disabilities / Q000150:complications*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects; D006801:Humans; D007433:Intrauterine Device Expulsion; D007436:Intrauterine Devices, Medicated / Q000009:adverse effects*; D016912:Levonorgestrel / Q000008:administration & dosage; D009929:Organ Size; D012189:Retrospective Studies; D014463:Ultrasonography; D014595:Uterine Perforation / Q000209:etiology*; D014599:Uterus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016912:Levonorgestrel
keywords: Adolescents; Disability; Expulsion; Intrauterine device (IUD); Levonorgestrel intrauterine system (LNG IUS); Menstrual management; Mirena; Ultrasonography; Uterine length