The Unbelievable Case of Primary Placement of IUCD in Urinary Bladder

Intrauterine contraceptive device (IUCD) is one of the most popular temporary methods of contraception used worldwide. The advantages of IUCD use are its high efficacy, easy reversibility, maintains privacy and its use is independent of sexual activity. Insertion of IUCD in health centers in India is done by skilled health workers or doctors. Uterine perforation and migration are rare but known complications of IUCD insertion. Here we present an unusual case of primary misplacement of IUCD into urinary bladder. Mrs X, a 31 year old multiparous lady and an IUCD user for last 10 years, visited primary health centre for getting the earlier device replaced. The removal followed by replacement was carried out by a trained nurse. At insertion, the client felt severe abdominal pain and dizziness which was followed by hematuria for about five days. This prompted her to seek advice at our centre. On examination, there was mild tenderness in lower abdomen and IUCD thread was missing. X-ray showed the presence of IUCD in pelvis and USG confirmed the location of device in bladder. The IUCD was subsequently removed through cystoscopy. Migration of IUCD following uterine perforation into the bladder, pelvis, abdominal cavity, and large gut has been commonly reported but primary placement into the bladder is very unusual. The aim of present case report is to highlight the importance of training the staff involved in such large scale health programmes since even a single complication could be a reason to demotivate many others.