Question: A 62 years old postmenopausal woman is referred to the gynae. clinic due to the incidental finding of a Lippes loop on a pelvic x-ray (taken for orthopaedic reasons). A pelvic ultrasound scan confirms extrauterine positioning of this device. What evidence-based guidance exists to guide clinicians on management?
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Answer: The Faculty of Sexual and Reproductive Healthcare guidance on intrauterine contraception (1) says that surgical retrieval of an extrauterine device is advised. (Evidence level IV) Cases of complications of extrauterine Lippes loops, and techniques for removal have been reported(2-12). (Evidence level III)
References:
- Faculty of Sexual and Reproductive Healthcare. Intrauterine contraception. FSRH: London, 2007.
- Demir SC. Cetin MT. Ucunsak IF. Atay Y. Toksoz L. Kadayifci O. Removal of intra-abdominal intrauterine device by laparoscopy. European Journal of Contraception & Reproductive Health Care. 7(1):20-3, 2002 Mar. Abstract
- Trivedi SS. Goel M. Jain S. Hysteroscopic management of intra-uterine devices with lost strings. British Journal of Family Planning. 26(4):229-30, 2000 Oct. Abstract
- el-Diasty TA. Shokeir AA. el-Gharib MS. Sherif LS. Shamaa MA. Bladder stone: a complication of intravesical migration of Lippes loop. Scandinavian Journal of Urology & Nephrology. 27(2):279-80, 1993. Abstract
- Dietrick DD. Issa MM. Kabalin JN. Bassett JB. Intravesical migration of intrauterine device. Journal of Urology. 147(1):132-4, 1992 Jan. Abstract
- Sasidharan K. Chally R. Intravesical migration of Lippes loop with stone formation. British Journal of Urology. 61(4):363-4, 1988 Apr. Abstract
- Iype E. Nair VR. Rajammal. Laparoscopic removal of displaced intra uterine devices. Asia-Oceania Journal of Obstetrics & Gynaecology. 10(2):181-3, 1984 Jun. Abstract
- Moulay A. Zahi M. [Abdominal migration of intrauterine devices. Apropos of 4 devices removed using celioscopy]. [French La migration abdominale des dispositifs intra-uterins. A propos de quatre cas extraits par coelioscopie]. Semaine des Hopitaux. 59(42):2905-9, 1983 Nov 17. Abstract
- McKenna PJ. Mylotte MJ. Laparoscopic removal of translocated intrauterine contraceptives devices. British Journal of Obstetrics & Gynaecology. 89(2):163-5, 1982 Feb. Abstract
- Kim DS. Hwang YY. Kang KC. Park MI. Migration of the Lippes loop into the fallopian tube. Obstetrics & Gynecology. 60(3):393-4, 1982 Sep. Abstract
- Chaoui A. Elbied A. Osstovar K. [Extra-uterine migration of Lippe's loop]. [French. La migration extra-uterine de la boucle de Lippes] Journal de Gynecologie, Obstetrique et Biologie de la Reproduction. 1(5 Suppl 2):350-2, 1972. Abstract
- Villablanca E. [Ectopic Lippes' intrauterine devices. Hysterography]. [Spanish - Dispositivos intrauterinos de Lippes ectopicos. Estudio histerografico]. Revista Chilena de Obstetricia y Ginecologia. 35(2):59-66, 1970. Abstract
Search date: June 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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