# Evaluation and Management of Intrauterine Device (IUD) Complications in Ethiopia

## TL;DR

This study examines the management of intrauterine device (IUD) complications in Ethiopia, finding that missing IUDs and uterine perforation are common and require specialized care.

## Contribution

The paper provides insights into the evaluation and surgical management of IUD complications in a low-resource setting.

## Key findings

- Missing IUDs were the most common complication, with uterine perforation diagnosed in 10 out of 12 cases.
- Laparoscopic removal was used in 9 out of 10 cases of extrauterine IUDs, suggesting it as the preferred method.
- Ultrasound is recommended as a routine diagnostic tool for evaluating missing IUDs.

## Abstract

Though safe in most circumstances, intrauterine device (IUD) has some rare serious complications such as missing IUD, uterine perforation, missing strings, and pregnancy with IUD in situ (failed IUD). This study reviewed IUD complications and management techniques utilized at a national complex family planning center in Ethiopia.

This was a retrospective study of women who had an IUD complication and were managed at St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia between May 2017 and April 2024. Data were collected retrospectively by reviewing the medical records of patients. Data were analyzed using SPSS version 23. Simple descriptive statistics were employed. Frequency and proportions were used to present the results.

Thirteen cases were excluded due to incomplete data. Out of the 27 women included in the final analysis, 12/27 (44.4%) had a missing IUD, followed by 7/27 (25.4%) who had missing strings. There were two cases of pregnancy with IUD in situ. Among those with a missing IUD, 10 were diagnosed with uterine perforation and were managed surgically (9 managed laparoscopically and one managed with an open laparotomy). Both women with a pregnancy and IUD in situ chose to continue the pregnancy after removing the IUD.

In this study, missing IUD (with uterine perforation diagnosed in 10 out of 12 patients) was the most common complication, occurring in close to half of the study participants. Ultrasound should be routine in evaluation of missing IUDs, and laparoscopy should be considered the gold standard for extrauterine removal, even in low‐resource settings (patients with such serious complication should be referred to centers that have this capacity).

Missing IUDs should be carefully evaluated with ultrasound, as uterine perforation is a common finding. We support laparoscopic removal of IUD as the standard for management for extrauterine IUDs.