Three-Dimensional Ultrasound in Risk Assessment of Levonorgestrel-Releasing Intrauterine System (Mirena) Expulsion
Abstract
Aim of the study was to find three-dimensional ultrasound criteria which could help to predict risk of levonorgestrel-releasing intrauterine system (Mirena) expulsion. Uterus cavity shape and size in coronal view were used as such criteria. 103 patients aged from 28 up to 52 years old who underwent treatment by Mirena due to menometrorrhagia, endometrial hyperplasia, and adenomyosis were included in to the study. First subgroup was formed by 86 patients who underwent mandatory three-dimensional transvaginal ultrasound with uterus coronal plane reconstruction before treatment by Mirena; second subgroup - by 17 patients with Mirena expulsion who did not undergo preliminary three-dimensional ultrasound. High frequency of expulsions was related to uterine cavity deformation (64.7% among second subgroup patients without preliminary three-dimensional ultrasound); increase of uterine cavity width on tubal orifices level in coronal view more than 4.5 cm (sensitivity of expulsion prediction 58%, specificity - 98%); increase of uterine cavity area more than 9.0 cm2 (sensitivity of expulsion prediction 58%, specificity - 98%).
About the Authors
K. A. Tokhunts
Yerevan State Medical University after Mkhitar Heratsi
Russian Federation
Russian Federation
A. D. Khudaverdyan
Yerevan State Medical University after Mkhitar Heratsi
Russian Federation
Russian Federation
K. S. Julhakyan
Central Clinical Military Hospital, Yerevan
Russian Federation
Russian Federation
N. B. Abgaryan
Yerevan State Medical University after Mkhitar Heratsi
Russian Federation
Russian Federation
References
1. Beatty M.N., Blumenthal P.D. The levonorgestrel-releasing intrauterine system: safety, efficacy, and patient acceptability // Ther. Clin. Risk Manag. 2009. V. 5. No. 3. P. 561-574.
2. Grimes D.A. Intrauterine devices (IUDs) // Contraceptive Technology. 19th ed. / Ed. by R.A. Hatcher. NY: Ardent Media, 2007. P. 117-143.
3. Trussell J. Choosing a contraceptive: efficacy, safety, and personal considerations // Contraceptive Technology. 19th ed. / Ed. by R.A. Hatcher. NY: Ardent Media, 2007. P. 19-47.
4. Fritz M.A., Speroff L. Endometriosis // Clinical Gynecologic Endocrinology and Infertility. 8th ed. Philadelphia: Lippincott Williams & Wilkins, 2011. P. 1221-1248.
5. Exacoustos C., Brienza L., Di Giovanni A. et al. Adenomyosis: three-dimensional sonographic findings of the junctional zone and correlation with histology // Ultrasound Obstet. Gynecol. 2011. V. 37. No. 4. P. 471-479.
6. Buttini M.J., Lordan S.J., Webb P.M. The effect of the levonorgestrel releasing intrauterine system on endometrial hyperplasia: an Australian study and systematic review // Aust. N. Z. J. Obstet. Gynecol. 2009. V. 49. No. 3. P. 316-322.
7. Speroff L., Darney P.D. Intrauterine contraception // A Clinical Guide for Contraception. 5th ed. Philadelphia: Lippincott Williams & Wilkins, 2011. P. 239-279.
8. Merki-Feld G.S., Schwarz D., Imthurn B., Keller P.J. Partial and complete expulsion of the Multiload 375 IUD and the levonorgestrel-releasing IUD after correct insertion // Eur. J. Obstet. Gynecol. Reprod. Biol. 2008. V. 137. No. 1. P. 92-96.
9. Benacerraf B.R., Shipp T.D., Bromley B. Threedimensional ultrasound detection of abnormally located intrauterine contraceptive devices which are a source of pelvic pain and abnormal bleeding // Ultrasound Obstet. Gynecol. 2009. V. 34. No. 1. P.110-115.
10. Gemzell-Danielsson K., Inki P., Heikinheimo O. Recent developments in the clinical use of the levonorgestrel-releasing intrauterine system // Acta Obstet. Gynecol. Scand. 2011. V. 90. No. 11. P.1177-1188.
11. Kurjak A., Kupesic S. Color Doppler, 3D & 4D Ultrasound in Gynecology, Infertility and Obstetrics. 2nd ed. New Delhi: Japee Brothers, 2011. P.87-92.
12. Andreotti R.F., Fleischer A.C. The sonographic diagnosis of adenomyosis // Ultrasound Q. 2005. V. 21. No. 3. P.167-170.
13. Гажонова В.Е. Ультразвуковая диагностика в гинекологии. М.: МЕДпресс информ, 2005. С. 102-113.
14. Kung F. Risk factors for Levonorgestrel-releasing intrauterine system (LNG-IUS) expulsion among Chinese women treated for menstrual disorders: retrospective cohort study in a regional hospital // Hong Kong J. Gynaecol. Obstet. Midwifery. 2011. V. 11. No. 1. P. 49-53.
15. Bahamondes M.V., Monteiro I., Canteiro R. et al. Length of the endometrial cavity and intrauterine contraceptive device expulsion // Int. J. Gynaecol. Obstet. 2011. V. 113. No. 1. P. 50-53.
Review
For citations:
Tokhunts K.A., Khudaverdyan A.D., Julhakyan K.S., Abgaryan N.B. Three-Dimensional Ultrasound in Risk Assessment of Levonorgestrel-Releasing Intrauterine System (Mirena) Expulsion. Ultrasound & Functional Diagnostics. 2015;(2):56-67. (In Russ.)
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