Intrauterine device translocation: Case series and management algorithm

Intrauterine devices (IUDs) are the most commonly used long-term contraception due to their 98–99% effectiveness in preventing pregnancy. There are two types of IUD available in Indonesia, a copper-containing IUD and levonorgestrel-releasing IUD. IUD causes chronic inflammatory changes in the endometrium and fallopian tubes that inhibit fertilization and make a hostile environment for implantation. The increased number of endometrial leukocytes is fatal for sperm. In addition, levonorgestrel will inhibit ovulation. The use of an IUD is associated with side effects and complications. The most commonly met complications are IUD expulsion, displacement, translocation, and pregnancy. The average IUD translocation prevalence is 1.3/1000 which mainly occurs during insertion. Translocated IUD may further cause perforation of the bladder or intestines, intestinal obstruction, fistula formation, abscess, adhesion, undesired pregnancy, and chronic pelvic pain. Regardless of the type and location, the WHO recommends removal of the translocated IUD due to its potentially severe complications. Here, we present four cases of IUD translocation at Cipto Mangunkusumo National Hospital from 2020 to 2021, focusing on how to diagnose and the management to remove it.