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Human Reproduction, Vol. 18, No. 11, 2323-2327, November 2003
© 2003 European Society of Human Reproduction and Embryology

The value of transvaginal ultrasound to monitor the position of an intrauterine device after insertion. A technology assessment study

C.D.de Kroon, J.C.van Houwelingen, J.B. Trimbos and F.W. Jansen1

Departments of Gynaecology and Medical Statistics, Leiden University Medical Center, P.O.Box 9600, 2300 RC Leiden, The Netherlands

1 To whom correspondence should be addressed. e-mail: f.w.jansen{at}lumc.nl

BACKGROUND: The intrauterine device (IUD) is an effective contraceptive method. The contraceptive power as well as the side-effects of IUD are thought to relate to the position of the IUD in the uterine cavity. We assessed the accuracy of clinical evaluation of IUD position. METHODS: A prospective comparative study was performed. The clinical evaluation was compared with the TVU measurement of IUD position both immediately after insertion and 6 weeks after insertion. The primary outcome measures were the positive and negative predictive values (PPV and NPV) of the clinical evaluation of IUD position. RESULTS: 195 women were included consecutively, 181 women (92.8%) were available for follow-up. The PPV and NPV of clinical evaluation of IUD position immediately after insertion were respectively 0.60 (95% CI: 0.39–0.81) and 0.98 (95% CI: 0.96–1.0). The prevalence of an abnormally positioned IUD was 7.7% (95% CI: 3.9–11.4). The PPV and NPV of the clinical evaluation at follow-up were respectively 0.54 (95% CI: 0.26–0.81) and 1.0 (95% CI: 0.98–1.0). The prevalence of abnormal position was 4.0% (95% CI: 1.7–7.1). CONCLUSION: Clinical evaluation is an excellent test for the evaluation of the position of an IUD and routine TVU is not indicated for this purpose.

Key words: contraception/follow-up/gynaecological examination/intrauterine device/transvaginal ultrasound


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