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  • Title: [Value of hysteroscopy in the removal of intrauterine devices lacking an examination string].
    Author: Khrouf M, Slim N, Zouari F, Chelli H, Chelli M.
    Journal: Tunis Med; 1985; 63(8-9):475-7. PubMed ID: 4089991.
    Abstract:
    A missing IUD string on examination is rare but poses problems of diagnosis and treatment. Sonography should be used to ascertain whether the IUD is in the uterus. If not, abdominal radiography should be used to determine whether the device has been expelled or has migrated. The diagnosis should be confirmed by hysteroscopy or laparoscopy. If the sonogram shows that the IUD is still in the uterus, hysteroscopy can be used to confirm the diagnosis and guide removal of the device. Blind removal may be traumatising and unsuccessful. General anesthesia was used during 7 removals of intrauterine IUDs with missing strings. 6 cases required more than 1 attempt. A Wolff type panoramic hysteroscope with CO2 was used. The IUD was removed with fine forceps. The patients were 30 years old on average and had 3 children. The average duration of IUD use was 5 years. 5 of the 7 were seen on the occasion of a voluntary or spontaneous abortion. The diagnosis of intrauterine IUD was made by sonography in 4 cases. In 5 cases, attempts at blind removal were made before hysteroscopy. 2 cases involved Lippes Loops and the rest were Copper Ts. The 2 devices are the only ones used in Tunisia. The predominance of Copper Ts may be explained by their reduced surface in comparison with Lippes Loops, which allow them to move more freely. Removal of an IUD under hysteroscopic control during induced abortion or curettage after spontaneous abortion allows repeated and possibly traumatizing attempts at removal to be avoided.
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