Remove intrauterine spiral - Causes, symptoms and treatment. MF.
For visualization of intrauterine contraceptives in cases when they are in the uterus for a long time, there is a suspicion of tight attachment or ingrowth of the contraceptive to the uterine wall, and if there are no control strings on the contraceptive, hysteroscopy is used.
Hysteroscopy in these cases allows to localize the intrauterine contraceptive in the uterine cavity, to clarify the degree and place of ingrowth in the uterine wall, and, thus, to determine the tactics of its management depending on the clinical situation.
Hysteroscopically visible parts of intrauterine contraceptives have a normal appearance when they are briefly located in the uterine cavity; in cases of prolonged stay in the uterine cavity they are covered with fibrinous overlays, endometrium and even embedded in the myometrium.
Technique for removing the intrauterine contraceptive:
The operation is performed in a large operating room, where, if necessary, laparoscopy or laparotomy can be performed. It is better to perform this operation on the 5th-7th day of the menstrual cycle. The cervical canal is expanded as usual for hysteroscopy to No. 11.5 of Gegar's expander.
Enter the hysteroscope into the uterine cavity. When a free-lying IUD is detected, it is grasped and removed by forceps inserted into the operating channel of the hysteroscope.
In cases where a uterus of the IUD is ingrown into the wall, attempts to remove the contraceptive through the cervical canal should be performed under the supervision of laparoscopy.
When the IUS grows into the uterine wall, it is removed either with hysteroscopic forceps, or with a curette or with an abortion. If the greater part of the IUD has grown into the uterine wall and there are no conditions for its removal from the abdominal cavity, then, assessing the clinical situation, it is necessary to decide whether to continue the attempts of removal or the possibility of leaving the IUD.
When most of the IUS penetrates into the free abdominal cavity, it is removed by laparoscopic forceps from the side of the abdominal cavity.
If the IUD is located in close proximity to large vessels, ureters or the bladder, the question of removing the IUD when laparotomy should be addressed.
Bleeding from the uterine wall after removal of ingrown IUDs, as a rule, does not happen. Therefore, in the postoperative period, no special measures are required.