1. Jahra hospital First case Talal Alanzi Yr 3 30-1-2014

2. 38 Yr. Female. Presented to OPD with 1 year history of dysuria and B/L loin pain.

3. Frequency Urgency Straining No constitutional symptoms. No urethral or vaginal discharge. No incontinence. Not stone passer nor former.

4. P.M.H: Nil. P.S.H: Nil. No drug allergy. Housemaid. P. OBS & GYN: delivered twice 2001- 2003 IUCD 2004 Delivered 2005

5. Vital Sign T 37 - P 80 - BP 110/70. On exam: Abd: soft,lax, non tender. Vaginal exam normal. Speculum: normal.

6. Inv Urine R/M: RBC 3 + CBC: HB 13 - WBC 4 - PLT 350. RFT: creat 70 - urea 5 LFT: normal. Urine c/s: normal.

9. Ultrasound Vesicle stones. TVU: device not in place.

17. Next plan

18. Consent form:…………..

19. Cystoscopy and proceed/hysteroscopy Open surgery

20. video

23. about 0.87 per 1,000 insertions. Insertion performed while women are lactating is associated with 10 times higher risk of uterine perforation. Balci O, Capar M, Mahmoud AS, Colakoglu MC. Removal of intra-abdominal mislocated intrauterine devices by laparoscopy. J Obstet Gynaecol 2011;31:650-2.

26. Post-insertion Before the first episode of sexual intercourse After her next menses Maruti Sinha1, Ridhima Gupta2, Minimally invasive surgical approach to retrieve migrated intrauterine contraceptive device.. Int J Reprod Contracept Obstet Gynecol. 2013 Jun;2(2):147-151

27. Mechanisms can explain the spontaneous migration of IUDs overlooked iatrogenic uterine perforation spontaneous uterine contraction Involuntary bladder contraction gut peristalsis peritoneal fluid movement

28. Risk factor inexperienced persons inappropriate positioning of the IUD susceptible uterine wall because of multiparity. endometrial atrophy chronic inflammation to copper containing recent abortion or pregnancy.

29. Thank you For listening