When Mrs X was brought into hospital after a road traffic accident, the emergency unit did a full body workup. Scans of her pelvis were to look for possible fractures, but found something else. The gynaecologists were called in.
The findings were three intrauterine contraceptive devices (IUCD) embedded in the lining of her endometrium—the tissue that lines the womb. IUCDs are one of the most effective contraceptive devices used for short- and long-term child spacing.
It was a first for the doctors who treated her at National Hospital. Literature search didn’t turn up known cases of women with multiple IUDs. They entered a case report in the Tropical Journal of Obstetrics and Gynaecology, calling for adequate history taking and physical examination of patients before provision of family planning services.
Mrs X was 54, and six years past menopause, when the IUDs were discovered. She told her doctors she didn’t know about still having any IUDs inside her.
With five children, she had previously had IUDs inserted and removed three times. Each time the health workers told her they removed the previous IUD before inserting a new one, she told her doctors.
“Many questions come to mind as to why there were three IUDs in one woman? Was this intentional or by mistake? There is no evidence as at now that there is need for multiple IUDs for effectiveness. Why didn’t the health care provider notice the tails of the previous IUDs in the vagina at the time of insertion? Was it possible that the patient was not aware that the old IUDs were in place before going for another?”, authors of the case report wrote in the journal.
They still have no answers to any of the questions, said Dr Idris Liman, one of three authors who reported the case.
The crux is “for the fact that it is forgotten and in multiples. Even if it wasn’t forgotten, why would one woman put it in three? And even if she wants three, the health care provider that inserted it will tell her she doesn’t it. There’s no medical basis for that,” he told Daily Trust.
“As shocking as it is to the patient who didn’t know she had IUD, so also it is shocking to us, and we felt we should let the scientific world know,” said Liman.
The move is so anyone with “this kind of shocking discovery” can help establish “case series of multiple IUDs”, he said. Then research can begin to sift through backgrounds to establish the reason for multiple IUDs—intentional or not
