The Role of Three Dimensional Transvaginal Ultrasound in Detection of Intrauterine Device Displacement in Post Caesarean Section: A Case Report

Intrauterine Devices (IUDs) are used as an efficient and inexpensive method of contracep¬tion. Contraceptive efficacy depends on the intrauterine location of IUD and intrauterine displacement of the IUD leads to decreased contraceptive efficacy. Expulsion of IUD and its penetration into myometrium is one of the complications of IUD. In cases where IUDs are not detected by ultrasound method, in addition to expulsion of IUD, risk of displacement or improper placement of the IUD arises. In the present case, following cesarean section IUD was inserted. However, due to ambiguous observation of the IUD in the cervical canal and in the uterus cavity on two-dimensional ultrasound, three-dimensional ultrasound was performed.  By using this method, expulsion of IUD from the previous cesarean section scar was visible. This finding was confirmed by laparoscopy. Three-dimensional ultrasound is recommended for precise assessment and tracking the placement of the IUD into the uterine cavity, particularly in cases where there is a history of cesarean delivery, especially if IUD is not visible in the uterine cavity or when it is displaced. Three-dimensional ultrasound has more accuracy as compared to two-dimensional ultrasound in determination of the location of IUD and it is not an invasive method such as laparoscopy. Also as three-dimensional ultrasound provides images in coronal plane; it is more efficient in detecting IUDs expelled through cesarean section scars.