Role of 3D Ultrasound in Assessment of Correlation between Position of Intrauterine Contraceptive Device and Post-Insertion Uterine Bleeding

Objective: The objective of this study is to assess the role of 3D-US in correlating the position of IUD and bleeding complaints related to IUD use. Also to detect the cut-off values for normal position of the IUD beyond which bleeding complaints will significantly increase. Patients and Methods: 2D and 3D-US were done to assess IUD position in the uterine cavity of two groups of patients, a group having bleeding complaints after using IUD and another group of asymptomatic users. The IUD-Endometrial (IUD-E), IUD-Myometrial (IUD-M), IUD-Fundal (IUD-F) and lateral displacement were measured by 2D and 3D-US and compared and the most sensitive and specific distance to indicate the limit above which the removal of the IUD will be recommended as bleeding complaints will significantly increase was assessed. Results: The distance measurement between IUD and endometrium or myometrium or the fundus with 2D and 3D-US did not differ significantly. However, a significant difference was found in IUD-F, IUD-M and IUD-E distances and the amount of lateral displacement between normal IUD users and those with complaints. IUD-E distance and the amount of lateral displacement are the more sensitive and specific indicators for detecting the relation between IUD position in the uterus and bleeding complaints related to IUD use. The Cut-off distance for IUD malposition is: IUD-E ³11mm and lateral displacement !2.4mm. Conclusion: The study strongly correlates the occurrence of IUD induced abnormal uterine bleeding to IUD malposition which 3D has more advantage over 2D-US in detecting missed cases which could reach up to 10%. Therefore, 3D-US has a role in cases of unexplained bleeding after IUD use if 2D-US failed to explain why especially cases of lateral displacement, incarceration and incomplete opening of both horizontal arms as the 3D-US allows better visualization of the uterine cavity and the spatial position of all IUD parts inside the uterus.