Malpositioned Intrauterine Contraceptive Devices

Braaten KP, Kari P. Braaten, Carol B. Benson, Benson CB, Maurer R, Rie Maurer, Goldberg AB, Alisa B. Goldberg
Obstetrics and gynecology · 2011 · vol. 118(5) , pp. 1014–1020 · doi:10.1097/aog.0b013e3182316308 · PMID:22015868 · W2010721653
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Suspected adenomyosis was associated with IUD malpositioning, while prior vaginal delivery and private insurance were protective; malpositioned IUDs were removed in most cases and were not associated with unintended pregnancy.

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Abstract

OBJECTIVE: To assess possible risk factors, management, and outcomes for women with malpositioned intrauterine contraception devices (IUDs). METHODS: This retrospective case-control study compared 182 women with malpositioned IUDs shown by ultrasonography at a single institution from 2003 to 2008 with 182 women with properly positioned IUDs. We evaluated whether insertion at 6-9 weeks postpartum, postabortion placement, breastfeeding, type of IUD, pregnancy history, leiomyomas, suspected adenomyosis, and indication for placement were associated with malpositioning. Our study had 70-99% power to detect whether postpartum placement was associated with an odds ratio (OR) of 2-3. RESULTS: Malpositioned devices were noted on 10.4% of ultrasonography scans among women with IUDs having pelvic ultrasonography for any indication. Most malpositioned devices (73.1%) were noted to be in the lower uterine segment or cervix. Insertion of IUDs at 6-9 weeks postpartum was not associated with malpositioning (OR 1.46, 95% confidence interval [CI] 0.81-2.63). Among other possible risk factors examined, suspected adenomyosis was associated with IUD malpositioning (OR 3.04, 95% CI 1.08-8.52), whereas prior vaginal delivery (OR 0.53 95% CI 0.32-0.87) and private insurance (OR 0.38, 95% CI 0.24-0.59) were protective. Approximately two-thirds (66.5%) of malpositioned devices were removed by health care providers. There were more pregnancies within 2 years among those in the case group than those in the control group (19.2% compared with 10.5%, P=.046). All pregnancies were the result of IUD expulsion or removal, and none occurred with a malpositioned IUD known to be in situ. CONCLUSION: Malpositioning of IUDs does not appear to be associated with insertion at 6-9 weeks postpartum. Women with malpositioned IUDs are more likely to become pregnant because of IUD removal without initiation of another highly effective contraceptive method.
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Objective

To assess possible risk factors, management, and outcomes for women with malpositioned intrauterine contraception devices (IUDs).

Methods

This retrospective case–control study compared 182 women with malpositioned IUDs shown by ultrasonography at a single institution from 2003 to 2008 with 182 women with properly positioned IUDs. We evaluated whether insertion at 6–9 weeks postpartum, postabortion placement, breastfeeding, type of IUD, pregnancy history, leiomyomas, suspected adenomyosis, and indication for placement were associated with malpositioning. Our study had 70–99% power to detect whether postpartum placement was associated with an odds ratio (OR) of 2–3.

Results

Malpositioned devices were noted on 10.4% of ultrasonography scans among women with IUDs having pelvic ultrasonography for any indication. Most malpositioned devices (73.1%) were noted to be in the lower uterine segment or cervix. Insertion of IUDs at 6–9 weeks postpartum was not associated with malpositioning (OR 1.46, 95% confidence interval [CI] 0.81–2.63). Among other possible risk factors examined, suspected adenomyosis was associated with IUD malpositioning (OR 3.04, 95% CI 1.08–8.52), whereas prior vaginal delivery (OR 0.53 95% CI 0.32–0.87) and private insurance (OR 0.38, 95% CI 0.24–0.59) were protective. Approximately two-thirds (66.5%) of malpositioned devices were removed by health care providers. There were more pregnancies within 2 years among those in the case group than those in the control group (19.2% compared with 10.5%, P=.046). All pregnancies were the result of IUD expulsion or removal, and none occurred with a malpositioned IUD known to be in situ.

Conclusion

Malpositioning of IUDs does not appear to be associated with insertion at 6–9 weeks postpartum. Women with malpositioned IUDs are more likely to become pregnant because of IUD removal without initiation of another highly effective contraceptive method. LEVEL OF EVIDENCE: II

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Condition tags

adenomyosis

MeSH descriptors

Intrauterine Devices Postpartum Period Adult Case-Control Studies Female Humans Intrauterine Devices Pregnancy Pregnancy Rate Risk Factors Ultrasonography

Citation neighborhood

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