Challenging PPIUCD Removal: A Case of Hysteroscopic Extraction from the Uterine Fundus
Authors: Hema Divakar  , Rita Singh  , Poorni Narayanan  , Poornima Rajanna  , Sheetal Joshi  , Pallavi Suresh Pushpa  , Gubbi Venkatasubbaiah Divakar  , Bhavana Girish  
Published: December 2024

Intrauterine contraceptive devices offer reliable and reversible contraception. However, there are still challenges that persist in their management, particularly regarding deeply embedded PPIUCDs (Post-Partum Intrauterine Contraceptive Devices). We present a case study of a 30-year-old woman who had two caesarean deliveries and sought PPIUCD removal to plan a future pregnancy. On speculum evaluation, the threads of the device were undetectable with no abnormal health symptoms. Subsequent ultrasound analysis confirmed the presence of PPIUCD, positioned obliquely within the uterine cavity. The first removal attempt under aseptic precautions with an IUCD hook was unsuccessful. The second attempt was guided by ultrasound and hysteroscopy, which successfully eliminated the IUCD. The case highlights the intricate challenges in managing PPIUCDs and emphasizes the importance of proactive management strategies. By integrating advanced techniques like hysteroscopy, healthcare providers can navigate these challenges effectively, enhancing patient care and satisfaction.
Intrauterine contraceptive devices have become a reliable and convenient method of birth control due to their high effectiveness and reversibility. Long-acting contraceptives provide reliable and lasting protection against unintended pregnancy, making them a popular choice for individuals looking for a hassle-free contraception method. The PPIUCD technique involves implanting an IUCD within 48 hours following either vaginal delivery or caesarean surgery to block sperm survival and prevent endometrial foreign body reactions.[1] The acceptability rate for PPIUCD implantation is 36.25%.[2] The placement of the PPIUCD is preferable since it does not interfere with breastfeeding.[3]
The prevalence of modern contraceptives among married women who have reached reproductive age has gradually increased globally, rising from 55.0% in 2000 to 57.1% in 2019.[4] According to the recent India National Family Health Survey, the contraception prevalence rate among currently married women under 15 to 49 increased from 54% in 2015-16 to 67% in 2019-21. Intrauterine devices comprise only 2.1% of all contraceptive techniques used in family planning. However, all government facilities offer free IUCD services.[5] Complications like bleeding, pain, infection, perforation, and expulsion contribute to 20–40% discontinuation rates.[6] Younger women using IUDs are more likely to experience adverse effects than older women.[7] The limited progress was attributed to factors such as the low quality of services offered, restricted access, and misconceptions about techniques held by providers and users.
Despite their effectiveness, IUDs can lead to potential complications. One such issue is the occurrence of lost or embedded IUDs, which are rarely observed, with approximately 1-2 cases per 1000 insertions.[8] This case report illustrates the difficulties encountered in removing embedded IUDs and underscores the significance of exploring alternative techniques to manage challenging cases safely and effectively.