title: Ultrasound-guided retrieval of lost intrauterine devices using very fine grasping forceps: a case series.
abstract: OBJECTIVE
  To assess the efficacy of a novel ultrasound-guided procedure for the retrieval of intrauterine contraceptive devices (IUDs) when the threads are not visible at the external cervical os ('lost threads').
  
  
  METHODS
  This was a prospective cohort study of consecutive women referred for ultrasound examination because of lost IUD threads. The procedures were performed under local anaesthesia in the outpatient setting. After injection of local anaesthetic, the anterior cervical lip was grasped with a vulsellum forceps. A 5Fr hysteroscopy grasping forceps was introduced transcervically into the uterine cavity under continuous transabdominal ultrasound guidance. The IUD was then grasped and removed from the uterus. Patients' demographic data, gynaecological history, ultrasound findings, duration of procedure, success rate and pain score were recorded.
  
  
  RESULTS
  Twenty-three consecutive women were included in the study. Ultrasound examination showed an IUD correctly sited in the centre of the uterine cavity in 20/23 (87%), in 2/23 (9%) it was partially embedded in the myometrium and in 1/23 (4%) the IUD was partially sited in the cervical canal. In 8/23 (35%) women the IUD threads were not visible on ultrasound scan. Removal of the IUD was successful in 22/23 (96%) cases with a median operating time of 3 (interquartile range 1.25-4.75) minutes. 15/23 (65%) women experienced no or minimal pain (pain score ≤3), 4/23 (17%) reported moderate pain (pain score 4-6) and 4/23 (17%) described the pain as severe (pain score 7-10). No complications were recorded during or immediately after the procedure.
  
  
  CONCLUSIONS
  Ultrasound-guided retrieval of lost IUDs using fine hysteroscopy grasping forceps is a highly successful technique and is well tolerated by women.
authors: Clinical Research Fellow, Institute of Women's Health, University College London, London, UK.
authors: Francesca
authors: F
authors: Moro
authors: Clinical Research Fellow, Institute of Women's Health, University College London, London, UK.
authors: Jure
authors: J
authors: Knez
authors: Clinical Research Fellow, Institute of Women's Health, University College London, London, UK.
authors: Katie
authors: K
authors: Pateman
authors: Clinical Research Fellow, Institute of Women's Health, University College London, London, UK.
authors: Grigorios
authors: G
authors: Derdelis
authors: Clinical Research Fellow, Institute of Women's Health, University College London, London, UK.
authors: Xulin
authors: X
authors: Foo
authors: Consultant Gynaecologist, Institute of Women's Health, University College London, London, UK.
authors: Davor
authors: D
authors: Jurkovic
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005548:Foreign-Body Migration / Q000000981:diagnostic imaging*; D006801:Humans; D015907:Hysteroscopy; D007434:Intrauterine Devices / Q000009:adverse effects*; D008875:Middle Aged; D013525:Surgical Instruments; D014599:Uterus / Q000000981:diagnostic imaging*
keywords: intrauterine devices; lost strings; retrieval; ultrasound