SEARCHING FOR THE SILVER LINING; THE EVOLVING ROLE OF HYSTEROSCOPY IN RETRIEVAL OF MISSING INTRA-UTERINE CONTRACEPTIVE DEVICES
Formerly Published in Vol. 13 No. 2 Jul. - Dec., 2025
Keywords:
IUCD, hysteroscopy, retrieval, IUCD removal, missing IUCDAbstract
Background: The use of intrauterine device (IUD) is a safe and effective method of achieving long-term reversible contraception, with minimal and tolerable side effects to the client. Occasionally, the strings of the device become no longer visible at the external cervical os, in which case it is said to be missing.
A missing IUCD is often a significant source of worry to the client as well as the care-giver owing to the profound dilemma commonly associated with attempts at location and retrieval. Moreso, unsuccessful retrieval of the device may ultimately place the client at a risk of plethoric complications, thus underscoring the expedience of effective retrieval measures where the diagnosis has been confirmed. More often times than not, attempts at blind retrieval are unsuccessful, thus necessitating a resort to hysteroscopy for location and retrieval of the device.
With increasing awareness and utilization of IUCD as a method of contraception, cases of missing IUCD are becoming relatively frequent with the global prevalence currently staked at 2-4 percent.
Case Presentation: Our index patient was referred from the family planning unit of FMC Umuahia following failed attempts at blind retrieval of a missing IUCD, which had been inserted about 10 years priorly. Following evaluation in the Gynaecology clinic of same hospital, the IUCD was located with the aid of an abdomino-pelvic ultrasound, which revealed the device tucked high up in the uterine cavity. Eventually, the missing IUCD was successfully retrieved with the aid of grasping forceps under hysteroscopic guidance, with no complications to the patient.
Conclusion: Our case report provides a concise over-view of the typical presentation of clients with missing IUCD, challenges with blind location and retrieval of the missing device, and the success at hysteroscopic retrieval following failed attempts at blind retrieval. It also furnishes invaluable insights into existing literature on the use of Hysteroscopy to aid in the retrieval of a missing intra-uterine contraceptive device, with a view to standardizing clinical interventions and practice, especially as attempts at blind retrieval can be traumatizing and frequently unsuccessful.
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