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E1846. Ultrasound of Female Contraceptive and Sterilization Devices
Authors
  1. Samuel Johnson; Wayne State University
  2. Ibraheen Malkawi; Wayne State University
Background
In 2011 45% of U.S. pregnancies United States were unintended, with the rate rising to 64% in black women and 75% in teenagers aged 15 to 19. Unintended pregnancies may produce medical, psychological and economic adverse effects. In addition to oral and injectable contraceptive methods, a variety of implantable and inserted devices have been employed. These implantable and inserted devices have an overall failure rate of < 1%, ranging from 0.05 to 0.80. These devices are placed into the uterine cavity, fallopian tubes, vaginal canal or upper extremities. Proper positioning of these devices in essential for a desired contraceptive effect and malposition may result in unintended pregnancy. Complications secondary to these devices may result in infection, hemorrhage, visceral perforation and intrauterine and ectopic pregnancy. Transvaginal and three-dimensional ultrasound are the imaging method of choice in evaluating device location and complications. We present a pictorial essay of the sonographic appearance of implantable and inserted contraceptive devices and methods for distinguishing models and veryifying appropriate location. Sonographic examples of malpositioned devices and complications are presented. The essential contribution of three-dimensional ultrasound in the assessment of these devices is emphasized.

Educational Goals / Teaching Points
To demonstrate the sonographic appearances of reversible and irreversible inserted contraceptive devices. To depict both common and unusual locations for malpositioned devices. To illustrate the role of three-dimensional ultrasound in characterizing contraceptive device type and location. To describe device complications, e.g. fracture, infection, perforation and pregnancy.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Characterization of Intrauterine Contraceptive Devices (IUD's) is discussed, including type, position and complications. Hysteroscopically inserted devices for permanent tubal blockage are no longer in production. Over 750,000 of these devices were sold worldwide, and encounters with these devices remain common, either as an incidental finding on ultrasound performed for other indications or on an exam to assess potential complications from a prior insertion of the device. Examples of the expected sonographic appearance of these devices, abnormal positioning, uterine and extra-uterine perforation and localized peritonitis are provided. Vaginal rings as a contraceptive method are assessed on self exam or clinical exam. Sonographic features of their appearance as an incidental imaging finding are presented. Progestin containing single rods are implanted subcutaneously in the proximal upper extremity, providing a contraceptive effect for 3-5 years. The location of these devices is assessed clinically by palpation. High frequency ultrasound can identify devices that are not palpable due to deep insertion or weight gain subsequent to insertion, and can assist in device extraction.

Conclusion
Ultrasound performs an essential role in the demonstration and classification of inserted contraceptive devices and identifying complications that may result in device failure or patient morbidity.