Contraception failure with an intrauterine device in a grand multipara woman: an undiagnosed septate uteri

Objective

Congenital uterine anomalies are usually asymptomatic. Women having undiagnosed uterine anomaly may have contraception failure. In this case report, we aimed to present a woman having intrauterine device(IUD) and intrauterine pregnancy because of undiagnosed uterine septum.

Case(s)

A twenty-eight years old, G7P6Y6 woman was admitted to our outpatient clinic with a complaint of pregnancy and IUD. Her history revealed that she had pregnancy with IUD again before 3 years ago. Except that, her reproductive history was normal and she had term vaginal births without presentation anomaly. She didn`t remember her last menstrual period. String of IUD were not seen in gynecological examination. Her TV-USG revealed that dimensions of uterus were increased and a long uterine septation were observed. While IUD and fluid in mixed echoes were seen in left uterine cavity, there were an viable embryo with a crown rump length of 7.7 mm (6w 5d) in the right uterine cavity. There was no pathological findings in adnexial region and douglas pouch. She wished to continue her pregnancy and she were taken follow-up.

Results

The exact incidence of congenital uterine anomalies is difficult to determine since many women with such anomalies are not diagnosed. Uterine anomalies occur in 2 to 4 percent of fertile women with normal reproductive outcomes. The type and frequency of abnormalities were septate uteri (90 percent), bicornuate uterus (5 percent), and didelphic uterus (5 percent). They may cause intrauterine growth restriction and presentation anomalies. Pregnancy outcomes reported in such women revealed spontaneous abortion in 21-44 percent, preterm delivery in 12-33 percent, and live birth in 50-72 percent. This patient had normal reproductive history except a pregnancy with IUD. Intrauterine devices (IUDs) which are easily applied, inexpensive and one of the most reliable contraceptive methods have been used worldwide for contraception.They are frequently placed by midwives in the outpatient setting in developing countries due to easy placement, some complications due to its misplacement occasionally can occur. We conclude evaluation of the pelvis by ultrasound prior to placement of IUDs even in asymptomatic patients may be helpful in identifying uterine anomalies that make IUD placement unsuitable. History of contraception failure with IUD should bring to mind uterine anomaly.

Keywords

Uterine anomaly, contraception failure, intrauterine device